Ch 12 Flashcards
Step 1:
Identify the Clinical Role of the Decision Maker With Respect to the Therapist
Three types of decision makers with whom therapists are likely to communicate:
1) Clients or Family Members
◦Receive therapy services to improve their lives
◦Communication often occurs face-to-face in periodic and repeated appointments
2) Managers
◦Develop therapy programs; allocate resources; and guide the therapist’s provision of services
◦Communication may occur frequently and informally, or Infrequently and formally, and is often face-to-face
3) Funders
◦Decide whether to fund the development of future clinical programs and the provision of current clinical services
◦Communication with funders is often formal and in written form
Step 2: Identify the Decisions That the Decision Maker Will be Involved in Making With the Therapist
The therapist and decision maker engage in three decision making tasks with respect to client participation outcomes.
three decision making tasks with respect to client participation outcomes
- Description Task - Determine and describe participation issues that are relevant to a particular client population.
2.Assessment Task - Select assessment procedures to measure client attributes related to participation.
3.Intervention Task - Plan and implement intervention to maintain or improve client participation
Clients and their family members
•Need descriptive information from the therapist about the importance of participation in their lives.
•Need assessment and intervention information to make informed decisions related to choosing assessment and intervention procedures.
Managers
Need descriptive information about participation from the therapist in order to develop and support clinical programs that are likely to be responsive to client rehabilitation needs.
◦Need assessment and intervention information to decide which assessment and intervention procedures should be supported and provided by the organization.
Funders
Need descriptive information about participation from the therapist in order to determine whether or not a clinical program addresses or will address, if in the planning phase, important client rehabilitation needs.
◦Need assessment information to determine whether or not assessment procedures currently or will effectively document important attributes of clients and their responses to rehabilitation intervention.
◦Need intervention information to decide whether or not the current or predicted level of effectiveness and feasibility of a clinical intervention program is worth funding.
Step 3: Gather and Interpret Research Evidence that Is Guided by the Needs of the Decision Maker and the Clinical Population of Interest
◦As the therapist gathers and interprets information, the therapist formulates possible answers to the question.
◦The questions that guide the search for evidence for communicating with clients and their family members are written with the specific attributes of the client in mind
◦The questions that guide the search for evidence for communicating with managers and funders are written with a more general clinical population in mind.
◦The most effective and efficient use of the therapist’s time is to first search for research syntheses and meta-analyses.
Each question is composed of at least three elements:
1) Type of evidence that being sought
2) An attribute related to participation
3) A description of a clinical population
Step 4. Translate the Evidence into a Comprehensible Communication to Facilitate an Informed Discussion With the Decision Maker
For communication with clients, use:
◦Non-technical, simple, and concrete language with simple grammatical structure, and words with few syllables, presented orally if possible
◦Terms that cross cultures and perspectives
◦Brevity, with just enough detail for decision making
◦Checks for confusion or lack of comprehension
◦Suggestions for concrete actions or choice options related to the information
The most important attribute of the communication to keep in mind is that the therapist is providing possible answers, not the one correct answer, to a clinical question.
Interpreting Evidence
The therapist should determine the following:
◦If the research participants are relevant to client.
◦What possible answers the study gives to the clinical questions that guided the search for the evidence.
◦The strength of the evidence in answering the questions by evaluating the quality of the study design, procedures, and measures.
Evidence That Guides the Choice and Use of Assessment Tools
◦What is most crucial to the selection of an assessment tool is whether or not that tool has been tested for the particular forms of reliability and validity most pertinent to the purpose of the assessment.
◦Studies that provide access to qualitative and quantitative details about each participant are useful because they help the therapist directly examine similarities and differences in responses across different clients.
Evidence-Based Communication
in the Face of Uncertainty
◦If no meta-analysis is available, therapist can make an accurate integration, but it takes a great deal of skill.
◦Give heavier emphasis to studies that provide more accurate (stronger) evidence than to those studies with potentially less accurate (weaker) evidence.
◦Do not rely solely on significance tests and their P values unless the study involved roughly about 60 or more participants. Studies that have large sample sizes have more power to detect a statistically significant effect than studies with small sample sizes.
◦Conflicts in evidence call upon therapists to not only tap into their clinical reasoning skills, but also to start to develop research questions for an on-site research study.
Evidence-Based Communication
Opportunities in Everyday Practice
◦Incorporate time for literature searching and reading into clinical practice.
•Take advantage of opportunities for communicating evidence to clients and for utilizing group meetings as a forum for disseminating research evidence.
•Maintain balance of communicating just enough evidence for informed decision making while being prepared to communicate about evidence in a more detailed manner.
