SCCAP/APA Convention/2017/Beyond Empirically Supported Treatments–Advances in the Evidence-Based Practice of Psychology

Beyond Empirically Supported Treatments - Advances in the Evidence-Based Practice of Psychology

Session Chair: Anna Van Meter, PhD, Yeshiva University

Too often, the evidence-based practice of psychology is conflated with the use of empirically supported treatments. This symposium will focus on efforts -- across research, education, and community mental health -- to disseminate the evidence-based practice of psychology to better support clinicians and the clients with whom they work. The innovative ways to close the gap between research and practice highlighted in this presentation will inform the work of psychologists across multiple disciplines.

Dr. Eric Youngstrom will discuss the gap between research and practice in psychological assessment; although research has lead to advancements in the efficiency and accuracy of clinical decision making, many clinicians do not follow the recommended process. Learning new techniques can be intimidating; making evidence-based tools, including a clear, 12-step assessment process, available broadly (e.g., through Wikipedia) can reduce barriers to the adoption of evidence-based assessment.

Dr. Bethany Teachman will present a new clearinghouse to facilitate the dissemination of evidence-based principles of change. This represents an acknowledgment of the limitations inherent to some empirically supported treatments -- interventions that work well, but are intended to treat a distinct population through a prescribed set of steps. Evidence-based principles of change, in contrast, inform client work across demographic and diagnostic groups, and --importantly -- resources to educate people on these principles of change can be provided through an open-access, free platform.

Dr. Michael Southam-Gerow will discuss the outcomes from an ambitious study designed to implement Managing and Adapting Practice (MAP), a system designed to support evidence-based treatment for youth with mental health problems. Over 1700 therapists were trained over a 30-month period, and more than 11,000 clients participated in the program, demonstrating the feasibility of dissemination and implementation of evidence-based practice in the community. This study also provides evidence of effectiveness; client outcomes were strong, with effect sizes in medium to large range.

The Evidence-Based Assessment Makeover: Using Science and Technology to Transform Our Practice

Presenter: Eric Youngstrom, PhD, University of North Carolina at Chapel Hill

Abstract content

Typical assessment training and practice have not kept pace with research advances, nor with changes in technology that create new automation and innovation for assessment. Contributing factors include the huge volume of published research, the low rate of clinically relevant and valid studies (<2% according to both IBM and Cochrane), a lack of knowledge about shortcomings of clinical judgment, misperceptions about burden, and gaps in the literature on how to match tools with assessment goals. Despite these hurdles, it is possible to update our practices to produce more accurate evaluations, better engagement and retention of clients, and better outcomes. The goal is not to conduct the perfect assessment every time, but rather to use principles to select high utility methods for key clinical functions: are you aiming for prediction (i.e., identifying risk factors, quantifying symptoms), prescription (i.e., matching treatment with diagnosis and patient values), or process (i.e., monitoring progress, defining goals)? Each function needs different strengths from an assessment approach. Assessing youths adds issues of development, multiple informants, and confidentiality. Knowing the vital few presenting problems and matching these with well curated tools creates an efficient assessment process that yields more accurate diagnoses, better patient engagement, and improved outcomes. These steps add less than five minutes and less than five dollars to the typical assessment, yet yield large gains in accuracy, more agreement about next clinical action, and better outcomes. Technology is also making it possible to disseminate these tools in new ways, including open-source pages with background information and free administration, scoring, and decision support.

Accessing Tools That Work: Resources to Guide Treatments Based on Principles of Change

Presenter: Bethany Teachman, PhD, University of Virginia
Co-Authors: Douglas S. Mennin, PhD, City University of New York Hunter College; Erin Reilly, MA, University at Albany, State University of New York; Allison Meyer, MA, Duke University; Jonathan Abramowitz, PhD, University of North Carolina at Chapel Hill; David Smith, PhD, University of Notre Dame; David Sbarra, PhD, University of Arizona; Mitchell J. Prinstein, PhD, University of North Carolina at Chapel Hill

Abstract content

The research used to determine clinical practice guidelines and direct training of our students is mostly based on treatment packages (e.g., a 16-week, one-on-one therapy protocol to treat a single disorder). These packages are valuable, but few people expect that relying on those alone will optimally train providers to actually reduce the burden of mental illness. One concern is that it is not practical or efficient to train people on an impossibly long list of treatment packages for each disorder separately (there are many hundreds). Another concern is that co-occurring disorders are the norm and the various disorders often have overlapping features (e.g., avoidance is present across the various anxiety disorders and depression), so using many separate treatment packages is slow and will introduce a lot of redundancy. Thus, instead of planning a treatment sequence for a single client that includes five separate treatment packages, there is increasing recognition that we need to instead focus on the smaller set of underlying principles of change that can help many problems simultaneously. This simple idea has far-reaching implications because students and providers cannot realistically learn hundreds of different disorder-based treatment packages, but can learn a basic set of tools that focus on research-supported principles of change. However, to date, there is no central place where providers, educators, and students can access free resources to become trained in implementing strategies designed to shift these core principles of change in the treatment of adults. We describe efforts to develop a clearinghouse to achieve this goal, and our proposal to crowd source building this resource for the field.

Scale-Up of an Evidence-Based Approach to Service Provision for Children in Los Angeles County, California

Presenter: Michael A. Southam-Gerow, PhD, Virginia Commonwealth University
Co-Authors: Eric Daleiden, PhD, PracticeWise, LLC, Satellite Beach, FL; Bruce F. Chorpita, PhD, University of California Los Angeles

Abstract content

Many behavioral health care systems have seen major transformations related to cost-management and efforts to provide evidence-based treatments (EBTs). Los Angeles County, CA engaged in a particularly ambitious effort along these lines, working with private agencies to implement more than a dozen EBTs starting in 2010. In this study, we provide some data on the scaling up of Managing and Adapting Practice (MAP), one of the programs in the array of evidence-based treatments selected by the county to be eligible for reimbursement via a key funding stream. MAP was used to treat youth with problems related to anxiety, depression, conduct, or trauma. We report data on the success of two different training pathways for MAP therapists: (a) National Training model and (b) MAP Agency Supervisor model (i.e., train the trainer). We also examined utilization of MAP and the outcomes of clients served by MAP. Over 1700 therapists were trained in a 30-month period via the National Training and MAP Agency Supervisor models. Therapists performance was evaluated by a standardized portfolio system. Data suggested that therapists trained via either path were successful in completing this credentialing process in a timely fashion and with acceptable competency scores, with a slight advantage of the National Training model (86% vs. 81% success on first submission). Utilization of MAP was robust, with more than 11,000 clients participating in MAP services in a 1-year period (28% of clients) Finally, outcomes with MAP were strong, with effect sizes in medium to large range. Overall, data are promising for this rapid scaling up of a mental health services approach for children and adolescents with mental health problems.

Other 2017 Resources

• SCCAP_APA_Convention/2017/Advancements_in_Research_and_Practice_with_Childhood_Externalizing_Problems
• SCCAP_APA_Convention/2017/Children's_Mental_Health_in_the_Aftermath_of_Disaster
• SCCAP_APA_Convention/2017/How_to_Succeed_in_Your_First_Faculty_Job
• SCCAP_APA_Convention/2017/Novel_Approaches_to_Improve_the_Identification_and_Treatment_of_Suicide_Risk
• SCCAP_APA_Convention/2017/The_Adolescent_Brain_Cognitive_Development_Study_(ABCD)
• SCCAP_APA_Convention/2017/Beyond_Empirically_Supported_Treatments–Advances_in_the_Evidence-Based_Practice_of_Psychology