Research Objectives and Scope
The paper looks deeper into matters revolving around this practice that is used in the area of psychology. Evidence based practice, being simply the use of integration of available research with clinical expertise, means that its scope is applied in the context of the characteristics of the patients, their cultures and preferences. With this view in mind, the paper seeks to go deeper to find the achievements that have been reached at, a number of practices that are carried on today and critique the practices with the view of making the practice grow to be better. To have a better understanding of all these, a summary of the foundation of this practice is captured briefly. This practice grew up from a policy statement on Evidence Based Practice in psychology. A policy statement on this was adopted by the American Psychologists Association (APA) council back in 2005.
The scope of the paper will encompass explanation of concepts, analysis and critique where it is called for. To define this term ‘Evidence –based practice’, which at times is referred to as Empirically-supported treatment, relates to the use of behavioral and mental health interventions that are directed purposefully for systematic empirical research. This has provided enough statistical evidence that is used to improve the effectiveness on treatment of particular problems.
In the recent years, the Evidence Based Practice has been publicly emphasized by the professional bodies, such as, the American Psychological Association, American nurses association among others. They have proposed that their supporters need to carry out investigations that provide adequate evidence for, or against application of certain interventions. Pressure for use of this practice also emanates from the private and public health care insurance providers, who at times have been adamant to offer coverage’s of practices that are short of evidence of usefulness.
The key areas that practice professions such as psychiatry, medical, psychology and rehabilitation, had a past background of practicing using loose body of knowledge. Some knowledge was even farfetched from the experiences of the practitioners who were in the field earlier on. This points it clear that much of it had no valid scientific evidence that would be used if justification of the practice was required. In the realm past, the entry to quackery practice was easier where individual who had no training at all in particular fields were able to practice, and this created the impression of their selfish motives and profit gains that they wanted to achieve with time.
Interestingly as time moved, the scientific method became much recognized as to be of sound validation to the practice in these fields. Therefore, it became clear that there was need to get rid of these quack practitioners, so as to keep the standards and integrity of their professions and to a bigger extend protection to the public, from the risks that may come along with their ‘treatment.’ In addition to this, was that even in areas where quackery was not evident, there was need to know what was not working so that it could be improved for the better.
Evidence based practice had also an influence in other fields such as education. A number of commentators have written that lack of conspicuous growth, is much attributed to the inexperienced thousands of teachers. Who teach but fall to learn from the exposed scientific evidence, about what works and what works not. On the other side, there are opponents of this view who argue that the teaching profession is different from the medical or psychological one (Grant, 2010).
They argue that knowing what kind of drugs work is very different from knowing, which teaching methodology would work to help the learner grasp a concept. For the understanding of the learners, may depend on many other external factors; other than the teaching approach that is used by the teachers in giving of instructions. Therefore, the opponents of Evidence Based Practice in Education are of a suggestion that a teacher needs to develop a personal practice that is based on personalized knowledge through the experience they have gone through.
In a simpler manner, evidence based Practice or treatment is an approach that makes effort to give specificity to the way in which different professionals work. This specificity is directed to help the professionals make formidable decisions, and rating the made decisions in line with how scientific it is supported. The main goal here is to minimize and if possible eliminate the excess risky practices that were practiced in the days of ignorance. Evidence based practice uses different kinds of methodologies in its practice.
These may include; to summarize research carefully, to put up research summaries that can analyze and educate masses of professional on how to apply research findings by first understanding the research. On the extreme, it may involve forcing the professionals to pay keener attention to evidence that they use to base their decisions. For where Evidence Based Practice is used, the professionals are motivated to make use of the best evidence available.
It is also vital to note that Evidence Based Practice plays a bigger role in interpretation, collection and more so integrating the valid, essential and patient reported and research derived evidence. This implies that even after settling on the best alternative based on available evidence, it still can be moderated by the preferences’ and the state of the patients. All this is done in a bid to improve the quality of psychological and/or clinical judgments together with settling for a cost effective care. This may be more applicable to the areas of health care, in which the practitioner is required to systematically appraise, find and use the most valid and current research as a basis for clinical decisions.
After getting acquainted with what Evidence based practice is, then a look at the overview of this research may come in handy to even shade more light to the subject matter. In this overview, a comparison can be done with respect to top application of Evidenced Based Practice in the field of psychology and in the field of medicine. In psychology as put forth by the American Psychologist Association (APA), Evidence Based Practice involves the integration of the best research that can be availed with the expertise (clinical based) that relates to the circumstances of patients characteristic, cultural backgrounds and the preferences of the patient.
This definition from the Association of American Psychologists (APA) is slightly similar to that of Institute of Medicine, which defines Evidence Based Practice as the relation of the best research evidence with the clinical expertise that patients have together with the values of the patients. The purpose of Evidence Based Practice in psychology is to promote effective practice of psychology and to boost public health through application of empirical principles that govern psychology, formulation of different case studies, promotion of therapeutic relationships and application of necessary interventions.
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This bring a deductive definition that Best Research Practice refers to a number of scientific outcomes, as they relate to the applied intervention strategies, assessments, patient populations, clinical problems and challenges. It involves a body of evidence that is conclusively drawn from a variety of methodologies and research designs that increases efficiency in psychological practices. In a general sense, the evidence that is based on clinical research activity on psychological practice, then it should be further based on reviews that are systematic (Steele, 2007).
How valid such conclusions are from research should be based on a general progression, after a systematic clinical observation of randomized trials. There is also a need to recognize the limitations and gaps that exist during the study. Health policies and practice are also formed through research by use of variety methods in the different fields. These fields may include the public health sector, human development sector, epidemiology sector, social and social relations sectors, and neural science areas. Different researchers should come together to make possible the research on psychological practice, that is both valid internally and clinically. It is essential not to have interventions that have not been analyzed in a controlled setting as assumptions.
In the same view, one needs to look at the clinical implication of the decision arrived at after looking at the evidence. Clinical decisions should be formulated with the acceptance of the patient, based on clinical relevant evidence that scores best. This consideration should also extend to look at other factors such as probability of the cost involvement, the available resources and the options that are open for the use of these resources.
In essence, it is the psychologist who is involved in the treatment of the patient who makes the ultimate decision regarding to a special or particular intervention, and/or treatment plan. It is true that the involvement of an active and informed patient is very crucial to the psychological services success. Emphasis here is that treatment decisions should not be left by untrained persons, who are not familiar to the specifics that the case may require. Finally it is important to note that the monitoring of the patients progress and adjustment with time, is a crucial process that should be left (Morris, 2008).
From this overview, a deductive opinion can be reached at on how important Evidence Based Practice is. It is evident that the evidence based practice movement today has risen up to be an important feature of the health care systems as well as the health care policies. In fact within this context, the American Psychologist Association (APA), presidential task force discussed and defined the Evidence Based Practice as an integration of both the science and the practice. Actually the task force report on Evidence Based Practice described the fundamental psychology commitment, to the sophisticated Evidence Based Practice Psychology (EBPP). In addition to this, they take into consideration the absolute range of evidence that psychologists and policy makers do consider. Patient’s characteristics, clinical expertise and research are greatly supported as relevant to ensure there is good outcome. This and other concepts form part of this paper.
Two Evidence Based Practices, Definitions and Rationale for their Inclusion into EBP
There are a number of practices that are carried out in line with the ‘Evidence Based Practice’. The paper narrows down into two such practices. They include:
A).Practice One: Clinical Expertise Practice
The psychologist’s practice of clinical expertise involves, implementation of a number of actions that are aimed at promoting positive outcomes from the psychological therapy that is given. These clinical expertise practices include:
a). Conducting systematic assessments, developing judgments that are diagnostic, and being involved in formulation of systematic case studies and treatment plans. These actions are necessary in the clinical expertise practice, as they related directly to the outcome that is expected. It is crucial to conduct systematic assessments, for through the outcomes of the assessments one can tell the strength of the evidence that was used in that context. These assessments are able shade more light on what may need to be added or reduced. The findings of the assessments should not be treated as discreet, but should be viewed with the attitude of making a better outcome from the finding. This requires honest to look through the assessed results from the patient. Too much optimism or extreme pessimism should also not be applied in assessing the situation of the patient.
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Under this practice, one practitioner should also develop judgments that are diagnostic, analytic or investigative. This means that judgments reached at with haste are not valid. How the judgments are put should also portray they are deductive rather than inductive. The judgment should not be an end to it, but should give a clear way for further investigation to be carried. They should relate to evidence used, in a manner that the said evidence can be used to defend the judgment position that is taken. The judgment should be descriptive and should giver room for more analysis to be carried. There needs to be room for more diagnosis of the judgment that is arrived at.
The final part that should be looked at in the clinical expertise action is the formulation of systematic case studies and treatment plans. In other words is that there is need for precise, well structured treatment plan. Nothing is supposed to be done off the schedule that was reached at during making of the decision. The schedule was reached at after keen, consideration of the available evidences at the initial stages of treatment.
(b). Coming up with clinical decisions, timely implementation of treatments and monitoring of the patients progress. Clinical decisions imply they are decisions that have been arrived at after careful analysis of the alternatives. The decision maker should have first given keener attention to the evidence that was provided for each alternative. These clinical decisions should too have a bearing in terms of it, so that it can defend its position and why it had to be considered over the others. Evidence based practice narrows on evidence as that supports the decision or a judgment that has been taken over. Therefore the decisions should be analytical, objective and not subjective.
Just to add weight on this matter is the need for timely implementation. When alternatives have been put on the table and each has been read and analyzed. There is great need for timely implementation so that the patient is not left hanging or rather the matter is not left pending. The iron should be struck when hot. The best time to implement such moves is immediately the deal is reached at. This will also give the patient the peace of mind. This is opposed to giving a lot of time before the real implementation. This may spark fear and panic even to the patient, whether psychology patient.
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The issue of monitoring of patients progress is also of importance. When treatment is offered to a patient either in form of psychological treatment or even medical treatment, a number of outcomes are expected. It is vital that these outcomes get monitored by psychologists to ensure that patients are responding well to the given prescription. Patients would also need to be monitored so that they can abide by the given guidelines, to get better outcomes at the end of the therapy.
c) Possessing and the use of interpersonal expertise, which includes the formation of therapeutic alliances. This may be in the form of used the expertise that is between the patient and that that is between the patient and the psychologist or medical professional. Interpersonal expertise is also important as it may also involve benchmarking meaning it will help to keep pace to the desired outcome. It may be helpful to give confidence to the patient as the expertise that is used here is not farfetched but is found in the parties concerned.
d) A continuation of self-reflect and acquisition of professional skills may also be captured in the practice of clinical expertise. This means that as the experience of offering treatment to the patients, brings fourth professionalism to the psychologists as he/she gains more experience in the subject matter. The patient is also privileged to go through self reflection which is a very important part of therapy in an individual (Steele, 2007).
e) The practice may also encompass evaluation and use of research evidence in both basic and applied psychological science. This means that practice is held within the constraints in the fields of psychological science. This should be captured in order to have positive outcomes of the whole process of treatment.
f) The practice also involves the understanding of the influence of individual, cultural, and contextual differences on treatment. This is very essential. The human race isn’t homogeneous in its cultural orientation, and background upbringing. This means that each patient should be treated with the specialty that is required. No assumptions should be made as regards to any matter that may arise during the process of treatment. Psychologist or medical professional needs to find further on the association of patient’s cultural background and the response to treatment, so as to increase efficiency or direct the response of patient to the desired outcome.
(g) Seeking available resources (e.g., consultation, adjunctive or alternative services) as needed. The process of treatment of patient would certainly involve resources that psychologist should seek to make available. This is to increase the bid to improve the treatment process in a manner that is directed towards patients well being.
h) There is shear need to have a cogent rationale for clinical strategies. This is because expertise develops from consistent clinical and scientific training offered to patient, theoretical understanding of the treatment process, experience in therapy, self-reflection abilities of both patient and psychologist, knowledge of current research and findings. This should be done together with a continuation of education and training (Morris, 2008).
Clinical expertise practice is used to integrate the best research evidence with clinical data. For instance the information about the patient obtained over the course of treatment that is related to the patient’s characteristics and preferences to deliver services that have a high probability of
being achieved. This practice is important to clinical expertise; which creates awareness of the limits of one’s knowledge and skills. The approach is both cognitive and affective and can affect clinical judgment. In addition to this psychologists have a wide understanding of their very own values, characteristics and the contextual interaction that he/she has with patient.
B). Practice Two: Working with Patients Characteristics, Values, and Contexts.
This second practice involves practicing Evidence Based Practice. This practice increases the effectiveness of the treatment process. This is because it responds to the specific problems, strengths, social and cultural factors, personality and general preferences of the patient. This is important because, a number of patient. Characteristics, that may include, readiness to change, functional status, and social level support have been proved to have direct relations to therapeutic outcomes.
The other important characteristics of patient is that psychologist needs to consider in the formation and maintenance of treatment relationship may include; variations in problem presentation, observance of concurrent symptoms or syndromes, and behavior as well as the study of chronological age and developmental patterns, developmental background history, and life stage. The portrayed social, cultural and familial factors such as gender identity, gender, race, ethnicity, ones social class, religious background, current disability status, the family structures and to a bigger extent the sexual orientation of the patient. Other factors to consider may include the environmental context of the patient, for instance cases of institutional racism, disparities in health care and personal stressors that may include but is not limited to unemployment or major life events. A good touch on values, personal preferences, and preferences related to treatment may too be of asset in this practice (Grant, 2010).
It has been observed that a number of effective treatments have got the involvement of interventions that were directed towards others found within the patient’s environment. These ‘others’ may include but is not limited to parents, teachers, and caregivers. Therefore the central goal of this practice is to maximize patient choice among the many effective alternative interventions.