Module 6 Flashcards
What is the scientist-practitioner model?
A pragmatic multi-method approach to translational research.
ie. evidence informs delivery
What is another name for the scientist-practitioner model?
When was it ‘conceived’?
Boulder Model
1947
What does the scientist-practitioner model do?
Initially as a training model for graduates which integrated science and practice, privileging science which should inform practice.
Relies on the premise that individuals should both utilise and produce scientific research, and that this research should in turn inform their practice.
How did universities adopt the scientist-practitioner model of training?
Through teaching both core research-related skills (i.e. critical thinking, higher-order skills) and pre-clinical and clinical skills through undergraduate and postgraduate training courses.
How is APAC linked to the scientist-practitioner model?
Adopting a scientist-practitioner model of training is mandated under current Australian Psychology Accreditation Council (APAC) course accreditation requirements for all accredited Psychology post-graduate courses.
What are some of the criticisms of the SP model?
Tends to be aspirational in its approach and not always clearly applicable to different work contexts (Stricker, 2002).
Eg. not all individuals will engage in a combination of clinical practice and research throughout their career
Also, unclear how the SP model may ‘look’ beyond the completion of postgraduate training
What is the LCS model?
Local Clinical Science Model
Begins with assumption that science is not defined by activities or generalisations, but by attitudes.
The LCS carries these attitudes into the practice setting, raising hypotheses in the consulting room and seeking confirmatory or disconfirmatory evidence in the immediate response of the patient (hence the local component of the LCS model).
According to Stricker (2002), what are 4 ways in which S-Ps can integrate science into practice?
- In the process of doing clinical work, they display a questioning attitude and search for confirmatory evidence - Apply research findings directly to practice
- Evaluate their individual practices
- Produce research themselves
What is EBP?
Evidence-based practice
Relatively new (since 1990s) - prior to this, psychologists used evidence-based treatment (EBT) to inform the type of intervention offered.
What is EBT?
How does it differ from EBP?
Evidence-based treatment.
Starts with a treatment and examines whether it works for a certain disorder/presenting problem under specified circumstances.
EBP starts with the client and examines what research evidence will assist the practitioner in achieving the best outcome for this client.
What are the 3 elements of EBP?
- Research evidence
- Clinical expertise
- Client values
All set within an organisational/environmental context of the practice
According to EBP, what 4 processes should you go through with a client?
- Psychological assessment
- Case formulation
- Therapeutic relationship
- Interventions
What are the 6 steps of EBP?
- Assess
- Ask the right question
- Access the evidence
- Appraise the evidence
- Apply the evidence
- Audit the clinical practice
What does equipoise mean?
In an Randomised Controlled Trials (RCT), treatment in any group should be consistent with competent care and there should be genuine uncertainty among experts as to which treatment (or control) is preferred
What is ‘best’ research evidence?
Defn: Methodologically sound, clinically relevant research about effectiveness / safety of assessment and intervention strategies, and various clinical problems studied both experimentally and in situ
Measurement / Method: RCTs that show:
- Statistical & clinical significance
- Reasonable effect sizes (Cohen’s d at least medium)
According to the NHMRC, what are the 6 levels of research evidence?
(National Health and Medical Research Council)
I Systematic review of RCTs
II RCT
III-1 Pseudo-RCT (eg: alternate allocation)
III-2 Cohort studies
III-3 Comparative studies with hsitorical control
IV Case series
What are the 4 main review bodies?
- Cochrane
- NICE (UK)
- APS
- WHO
Outline the ‘Evidence Pyramid’ from top to bottom
Systematic Reviews and Meta-Analyses Randomised Controlled Double-Blind Studies Cohort Studies Case studies Case reports Idea, Editorials, Opinions Animal Research In vitro 'test tube' research
Moriana et al. (2017): What disorders had excellent agreement among the four organisations?
- Generalised anxiety
- Specific phobias
- Bulimia nervosa
- OCD
Moriana et al. (2017); What disorders had good agreement among the four organisations?
- Anorexia
- Schizophrenia
- ADHD
What reasons did Moriana et al. (2017) propose for the discrepencies between organisations?
- Procedures or committees are biased
- Different RCTs and meta-analyses are reviewed
- Different criteria
- Reviews are made at different time periods
What are 2 recommendations Moriana et al. (2017) made?
- Unify the criteria for assesing evidence
- Improve the coordination between orgnaisations
What are some of Healy’s (and others) critiques of systematic reviews and clinical trials?
- Ghost writing of BigPharma
- Lack of access to data
- Only publishing positive results
- Greater funding for different research
- Negative outcomes attributed to first arm of study
- RCTs are based on specific experimental groups and may lack ecological validity
In PBE, who determines the efficacy of the treatment?
Practice-Based Evidence
Practitioner
What are 3 alternatives to EBP?
- Practice-based evidence (PBE)
- Practice-oriented research (POR)
- Research practice networks (PRN)
What kind of measures do PBE practitioners use?
Use common ‘universal’ outcome measures, like Health of the Nation Outcome Scales (HoNOS), to monitor and evaluate client progress.
Enables a more systematic comparison between practitioners for a given client issue and therapy type.
What is Practice-Based Evidence?
Evidence of efficacy is generated by the practitioner rather than the treatment framework (bottom up vs top down approach)
eg. efficacy of a treatment begins with the practitioners and client and is adopted ‘upwards’
How is Practice-Based Evidence evaluated?
- Clinically effective practice (outcome) determines evidence
- Common outcome measures (eg. CORE-OM in the UK and OQ-45 in the US
What are the clinical implications of Practice-Based Evidence?
Therapy should be:
- Collaborative
- Based on clinically relevent evidence
- Weighs costs vs benefits
Psych makes ultimate judgement on treatment or treatment plan, however client needs to be informed, involved and consulted throughout treatment
How does ratings work for the HoNOS scale?
Health of the Nation Outcome Scales
Psych rates client (at the end of each session) on 12 outcomes, on a modified 5-point Likert scale (0 = no problem to 4 = severe to very severe problem).
The sum of scale range 0-48 and a decreasing trend reflects a reduction of symptoms
Holmqvist: What are some key arguments for practice-based studies?
Patients - patients are more hetrogenous psychopathy than RCT accounts for
Therapists - therapists may have more hetrogenous competencies
Treatment Length - treatment duration may differ considerably from the manuals’recommendations
Under represented treatments - Some treatments are rarely or never studied in systematic trials although they represent a large part of actual thera- peutic work in routine psychiatry
Therapist effects and training - What is the level of training and experience that contributes to outcome?
Patient-treatment matching - in natural clinical setting, efforts made to match patient to suitable treatment, unlike the randomisation procedure used in clinical trials.
Dropouts
Service Effects - services differ in quality and extent of delivery of treatment
Holmqvist: What are some methodoligical issues associated with Practice-Based Evidence?
Devise a measure that is informed and/or endorsed by practitioners and service users, whilst also delivering to a national agenda in an increasingly outcome-oriented and politicized health delivery system
What is Practice-Oriented Research (POR)?
Practice-oriented research (POR) or practice-based research (another form of PBE) = conducting research in routine practice setting (naturalistic and ecologically valid) but also attempts to remove the power differential between researcher and the researched.
Instead of conducting research on a group, POR involves conducting research WITH a group/community.
Provides unique opportunities for two-way learning (between the researcher and the practitioner) and employs the complementary expertise, knowledge, and experiences of each stakeholder to conduct studies that are both clinically relevant and scientifically rigorous
In POR, who derives the research questions?
Practice-Orientated Research
The community
Researchers work with community members rather than simply acting from outside and ‘helicoptering’ into a community to research on a community and ‘mine’ data.