04_Hierarchy of Evidence and EBPs

Question 1

Hierarchy of Evidence and EBPs

Answer 1

Ethically, psychologists must use evidence-based practices (EBPs) in their work with clients. In other words, therapeutic treatments and interventions must be supported by findings of efficacy and effectiveness across a number of studies. Studies with designs higher up on the Hierarchy of Evidence, if constructed and carried out well, produce the most convincing evidence.

Question 2

What is a Hierarchy of Evidence?

Answer 2

Research studies vary in quality and the strength of evidence they produce. When the study is of high quality and produces strong evidence, we can call it “trustworthy.”

• The hierarchy of evidence is a framework for examining the trustworthiness of research.
• If the evidence is not trustworthy, then we are unable to use it to make decisions (especially “big” decisions).

Question 3

Hierarchy of Evidence in a pyramid?
Internal Validity (UP)
Risk of Bias (down)
High Bias Risk, Weak Internal Validity

Answer 3

1. Meta- analyses, Systematic Reviews
2. Randomized Controlled Trials (RCTs, True Experiments)
3. Non-Randomized Controlled Studies (Quasi- Experiments)
4. Non-Randomized, Uncontrolled Studies (Correlational or Natural Manipulation)
5. Descriptive and Diagnostic Studies
6. Traditional Literature Review, Single Case Reports, Expert Opinions, Anecdotal Reports, Unstructured Interviews, etc.

Question 4

Evidence-Based Practice

Answer 4

Evidence-based Practices (EBPs) are now an expectation for psychological interventions (clinical practice guidelines).

Clinical Expertise + Research Evidence +Client Preferences/ Values

Question 5

Why do we care about EBPs?

Answer 5

Example: Facilitated Communication (Message passing)

• Began in the 1970s (Mulick, Jacobson, & Kobe, 1993).
• Method for helping individuals who are non- verbal (e.g., children with Autism) to communicate and, thus, reveal hidden intellectual capacity (e.g., Biklen, 1990).
• Became a widely-popular, “fad” treatment, though scientific evidence was of very low quality (Mulick, Jacobson, & Kobe, 1993).

Question 6

Before psychology professionals began considering the quality of research, many therapeutic practices were based on intuition.

Answer 6

• Causes of Spurious Therapeutic Effectiveness
• Placebo effect
• Spontaneous remission - (improvements occurs because of time)
• Regression to the mean - (fact of life = less extreme vic versa)
• Effort Justification
• Multiple Treatment Interference - (like to seek out a treatment but than change their lifestyles)

Question 7

Accountability is now ___

Answer 7

an expectation.

Question 8

What is the difference between Efficacy vs. Effectiveness Research?

Answer 8

Efficacy Research—Highly controlled research conditions.
- Does the intervention work?

Effectiveness Research—Follows the efficacy research; less control of conditions.
- Does the intervention work for the intended clinical population?

Question 9

SAMHSA

Answer 9

substance abuse mental health administration

Question 10

NIJ

Answer 10

National institute of justice (crimesolutions.com)

Question 11

Closing Thoughts

Answer 11

Remove the words ”prove” and “proof” from your discussion of research evidence.

• A single study does not “prove” anything.
• What the scientific evidence says today may change as the field advances, so we can never be sure we have 100% proof.

Maintain an open stance.
• No science, even the science for EBPs, is infallible.