Escolar Documentos
Profissional Documentos
Cultura Documentos
BasedPractice
Charles Wilson, MSSW, Executive Director of Chadwick Center
TheSamandRoseSteinChaironChildProtection
Rady Childrens Hospital-San Diego
www.cachildwelfareclearinghouse.org
HowThingsChange
AProblemis
Recognized
ActionAnyAction
ActionCreationofOrphanTrains
Between1854and1929100,000200,000
childrenwereplacedinnewfamiliesviathe
OrphanTrains.
http://www.orphantraindepot.com
HowThingsChange
AProblemis
Recognized
ActionAnyAction
InformedAction
SeriesofTrail
andErrors
Adjustments
SomeBetter
SomeWorse
Family
Foster
Care
TrialandError
Orphanagesand
Boardingschools
TennesseePreparatorySchoolforDependentChildren
HowThingsChange
AProblemis
Recognized
InformedAction
InformedActionBasedonScience
Sohowdoweknowwhatworks
vs.
meremarketingmarketing
hyperbole?
LettheBuyer
Beware
ThoughtFieldTherapy
MoreClaimsforTFT
Q. How Can TFT Benefit You? What Kind of Problems Can Be Helped?
NPRAllThingsConsidered,
March29,2006
AccordingtopsychologistRogerCallahan,the
creatorofthoughtfieldtherapy,majorproblemslike
depressioncanbecuredquicklywiththismethod.He
saysposttraumaticstressdisorderiseasilydispatched
in15minutes,andeventhemostseriouscasesof
anxiety,addictionandphobiasarelikewisesubjectto
quarterhourcures.
ResearchonTFT?
Has any research been carried out on TFT?
There have been no control (sic) studies on the
success of TFT
From the Thought Field Therapy Training Center of La Jolla
Distinguishinggroundless
marketingclaimsfromreality
The Problem:
All sorts of
intervention
s are
available out
there.
WaitingRoomSign
BenSaunders
MUSC
EvidenceBasedSocialWork
Professionaljudgmentsandbehaviorsshouldbeguided
bytwointerdependentprincipals:
1. Wheneverpossible,practiceshouldbegroundedon
priorfindingsthatdemonstrateempiricallythatthey
arelikelytoproducepredictable,beneficial,and
effectiveresults.
2. Everyclientssystem,overtimeshouldbeevaluated
Evidence Based Practice Manual
Oxford University Press
2004
Albert Roberts, PhD
Kenneth Yeager, PhD, LISW
GlobalDefinitionofEBP
Theconscientious,explicitandjudicioususeofcurrentbest
evidenceinmakingdecisionsaboutthecareofindividualpatients.
IncludingBoth
Thebestavailableclinical
evidencefromsystematic
research
DavidSackett
HugePolicyImplications
ShouldpolicymakerssupportadoptionofEBP?
Ifso,whichonesWhenaretheyReadyforPrimetime
Whatisthestandardofevidence?
Ifso,howbestcantheysupportadoption?
Whatarethepitfallsofastateornationalpolicy
leveladoptionofEBP?
ImpactonInnovation
Misapplicationofgoodmodels?Onesizedoesnotfitall
Wateringdownofempiricallybasedpracticedangerof
implementinginnameonly
Ideologyvs.Sciencewhoisthejudgeofthescience?
ShouldwelimitwhatwedotoEBP?
Parachuteusetopreventdeathand
majortraumarelatedtogravitational
challenge:systematicreviewof
randomizedcontrolledtrials
(GordonCSmith,JillPPell,2005)
Theperceptionthatparachutesareasuccessfulinterventionisbased.
largelyonanecdotalevidence
Observationaldatahaveshownthattheiruseisassociatedwith,morbidityand
mortalityduetobothfailureoftheinterventionandmechanicalcomplications.In
addition,naturalhistory"studiesoffreefallindicatethatfailuretotakeor
deployaparachutedoesnotinevitablyresultinanadverseoutcome...
Theeffectivenessofaninterventionhastobejudgedrelativetonon
intervention.
Understandingthenaturalhistoryoffreefallisthereforeimperative.
Iffailuretouseaparachutewereassociatedwith100%mortalitythenany
survivalassociatedwithitsusemightbeconsideredevidenceofeffectiveness.
Therefore,studiesarerequiredtocalculatethebalanceofrisksand
benefitsofparachuteuse.
ProblemsintheChildAbuse
FieldintheU.S.
Empiricalevidenceofefficacyhasnotbeenacommoncriteriafortreatment
selectioninthechildmaltreatmentfield.
Lackofoutcomeresearchformanycommonlyusedinterventions.
Readywillingnessamongsometouse,embrace,promote,andstaunchly
defendpracticesthathavenoevidencefortheirefficacyandquestionable
theoreticalbases.
Poordisseminationofthesignificantclinicaloutcomeresearchthathasbeen
done.
Ineffectiveapproachestocontinuingeducation.
Pooradoptionofempiricallysupportedtreatmentsinrealworldclinical
settings.
Disconnectionbetweencurrentscientificknowledgeandpracticeinthefield.
ScaredStraight
TFCBT
ReactiveAttachmentDisorderand
AttachmentTherapy
InstituteofMedicine:
ApplythePrinciplesandMethodsof
EvidenceBasedPractice
Integration of:
Traditionalists
CommonErrorsWhenDeciding
aboutInterventionEffectiveness
Reliancesolelyonindividualanecdotesandrememberedcases.
Thatchildmadesuchamazingchangesduringtreatment.
Confusingclientsatisfactionwithclinicalimprovement.
Thefamilyjustlovedcomingtotherapy.Nevermissedasession
duringtheir3yearsoftherapy.Amazing.Toobadtheyhadtomove
away.
Misattributionofthecauseofchange.
Failuretoappreciateresilienceandnaturalrecovery.
Thefamilygotmultipleservicesandwraparoundcare.
WithtreatmentherPTSDresolvedinabout3monthsaftertherape.
Gurueffectintrainingandtreatmentadoption.
IheardDr.McDreamyisdoingalevelIItraining.And,itsinSan
DiegoinJanuary!
Thosevideoswerejustsoamazing!Ihavegottotrythat.
BenSaunders
MUSC
WhattolookforinaPractice?
Treatmentorinterventionprotocolthathasatleastsomescientific,empirical
researchevidenceforitsefficacywithitsintendedtargetproblemsand
populations.
Evidencemaybebasedonavarietyofresearchdesigns.
RandomizedClinicalTrial(RCT)
Controlledstudieswithoutrandomization
Opentrials,prepost,oruncontrolledstudies
Multiplebaseline,singlecasedesigns
Thedegreetowhichwearepersuadedthatthetreatmentiseffectivewillvaryby
thequalityofempiricalsupport.
NumberofRCTs
Replicationbyresearchersotherthanthetreatmentdevelopers
Sampling,samplesizeused,comparisontreatment,effectsize
Variousmethodshavebeendevelopedforclassifyingthelevelofempirical
supportenjoyedbytreatmentapproaches.
Shouldbeusefulforfrontlinepractitioners
CEBCWebsite:www.cachildwelfareclearinghouse.org
CurrentDataonVisitorstotheWebsite
TotalNumberofVisitstotheWebsite
46,635
14%
86%
Percentage of Total Visitors
from California
33%
Advisory Committee
TheAdvisoryCommitteeiscomposedof15membersdrawnfromabroadcross
representationofcommunitiesandorganizations.
Therearerepresentativesfrom:
CaliforniaDepartmentofSocialServices
ChildWelfareDepartmentsfromCaliforniaCounties
ChildWelfareDirectorsAssociation(CWDA)
CaliforniaChildWelfareTrainingLeaders
PublicandPrivateCommunityPartnersWithintheState
TheroleoftheAdvisoryCommitteeisto:
DeterminethetopicalareasfortheCEBC
EnsuretheCEBCremainsuptodatewithemergingevidence.
AssistindisseminatingtheproductsoftheCEBC.
ProvidefeedbackontheutilityoftheCEBCproducts.
National
Scientific Panel
The National Scientific Panel is composed of five core
members and up to 10 selected Topical Experts.
The Panel is nationally recognized as leaders in child
welfare research and practice, and who are
knowledgeable about what constitutes best
practice/evidence-based practice.
The Panel assists in identifying relevant practices and
research and provide guidance on the scientific
integrity of the CEBC products.
Peer-Reviewed Research
PeerreviewAprocessusedtocheckthe
qualityandimportanceofresearchstudies.It
aimstoprovideawidercheckonthequality
andinterpretationofastudybyhavingother
expertsinthefieldreviewtheresearchand
conclusions.
ScientificRatingScale
6.ConcerningPractice
and/or
5.EvidenceFailstoDemonstrateEffect
4.Acceptable/EmergingPractice
EffectivenessisUnknown
3.PromisingPractice
Same basic requirements as Level 4 plus:
2.WellSupportedEfficaciousPractice
Same basic requirements as Level 3 plus:
1.WellsupportedEffectivePractice
1.
High:
The program was designed or is commonly used to meet the needs of
children, youth, young adults, and/or families receiving child welfare
services.
2.
Medium:
The program was designed or is commonly used to serve children,
youth, young adults, and/or families who are similar to child welfare
populations (i.e. in history, demographics, or presenting problems) and
likely included current and former child welfare services recipients.
Low:
The program was designed to serve children, youth, young adults,
and/or families with little apparent similarity to the child welfare
services population.
3.
Safety
Permanency
Well-being
CommonContinuingEducation
DisseminationModel
One day
workshop
Book
Therapist
Use Tx with
appropriate
clients
XLayingtheGroundworkfor
Implementing
EvidenceBasedPractice
LevelsofImplementation
Fixenetal
PaperImplementation
ProcessImplementation
PerformanceImplementation
Fixsen,D.,Naoosm,S.,Blas,
K.,Friedman,R.,Wallace,F.(2005)
InstituteforHealthcare
ImprovementModel
Environmental Context
Organizational Context
Microsystem
Community, Government,
Funders
Organizations
Departments
and Programs
Within
Organizations
Patient and
Community
Social Workers, Therapists,
Medical Professionals and
Families
Contemplation
Changes in orientation
Preparation
Planning for change
Organizational and environmental
readiness
Action
Training
Maintenance
Monitoring/Institutionalization
ComponentsofImplementation
Select a Solution that Fits a Problem
Prepare the internal and external environment
Supervision and Leadership Buy-in
Acquire knowledge and skills
Use practice with support, supervision and
consultation
Adapt practice to environment
Monitor fidelity
Teach others
Institutionalize Practice
PracticeSelection
Attributesthatcanfacilitateadoption
RelativeAdvantageclear,unambiguousadvantageineither
effectivenessorcosteffectiveness
Coststraining/materials/ongoingconsultationlossproductivity
duringstartupcostsofdelivery
CompatibilityHowcompatibleisthepracticewiththeorganizational
andworkforcesvalues,norms,andclinicaltraditionsandorientation
Complexityperceivedasmoresimpletouseandtoimplement
Trialabilityabletoexperimentwithinalimitedbasis
ObservabilityofBenefitsoutcomesorinterimresults/measures
Reinventionifcanadapt,refineorotherwisemodifyittomeetown
needs
Riskifthereishighercertaintyofoutcomes
TaskIssuesIfrelevanttoperformanceofintendedusersworkand
improvedtaskperformance
Knowledgeifknowledgecanbecodifiedandtransferredfromone
contexttoanother
Augmentation/Supportifprovidedwithtraining/consultation
FromGreenhalghetal
OrganizationalReadiness
OrganizationalCulture/Traditions/History
Leadership
Supervision
CapacitytoevaluatechangeKnowifitisworking
SupportofOpinionLeaders
Connectionswithothersupportiveorganizations/individuals
Doesorganizationhavethetechnologytosupportthechange
Staffreadiness
StaffReadiness
StaffDirectlyandIndirectlyinvolved
UnderstandWhatBenefitsWilltheAdoptionoftheEBPBring
MeaningWhatdoesthechangemeantothestaff?
Whatconcernswillstaffhaveaboutadoption
Howcongruentarethetrainersinorientationandvalueswiththe
staff
PresenceofChampions
ReadinessofExternalEnvironment
CongruencewithCommunity/Cultural/FamilyValues
ReferralSourceUnderstandingandSupport
FundingSourceSupport
PoliticalSupport
RoleofSocialInfluence/DemandforServices
RoleSocialMovementTheory
SupportiveImplementationModel
Administrative Leadership and Support for EBT
Obtain
client
feedback
Technical Assistance
Supervision
Expert
Consultation
Therapist
Training
Materials
Community/Consumer Support for EBT
FindingEvidenceSupported
TreatmentsontheWeb
www.nctsn.org
www.cachildwelfareclearinghouse.org/
http://modelprograms.samhsa.gov/template.cfm?
CFID=119292&CFTOKEN=55491051
www.strengtheningfamilies.org/
www.ncptsd.va.gov/topics/treatment.html
www.childtrends.org
www.wsipp.wa.gov
http://ebmh.bmjjournals.com/
www.cochrane.org
www.campbellcollaboration.org
www.colorado.edu/cspv/blueprints/model/overview.html
ContactInformation
Download reports from:
www.chadwickcenter.org
E-mail:
cwilson@rchsd.org
www.cachildwelfareclearinghouse.org