S-P model/EBP Flashcards
What is the Science Practitioner model?
An integrative approach to science and practice wherein each must continually inform the other
What are the origins of the Science practitioner model?
Clinical psychology practice 20th century in the US by Wittmer, 1907. During WW1 to test for mental illness and intelligence
Freud & Jung believed psychotherapy should be conducted by?
Medical doctors only
Before WW1 why were there no mental health treatments available?
Psychology was purely academic and related to philosophy
Why did psychologists begin to study mental health treatments?
To manage shell shock (PTSD) in returning WW2 soldiers
When did clinical psychology become part of the APA?
In 1919
Why was the APA originally founded?
In 1892 as a society to promote the Science of psychology . Academically centred
When was clinical psychology accepted by the APA?
- Took responsibility for credentialing and training
What was the Boulder Committee?
Founded the Boulder model and created the curriculum which Integrated the Science practitioners model into applied training
List 4 recommendations the Boulder model gave for training
- Improve the accuracy and reliability of diagnostic procedures (assessment)
- Develop better understanding of human behaviour
- Develop more efficient methods of treatment
- Inclusion of research training in the preparation of all clinical psychologists
List 4 recommendations for practice from the Boulder Model
- Use scientific methodology in their practice
- Work with clients using scientifically valid methods, tools and techniques
- Inform clients of scientifically based findings and approaches to their problems
- Conduct science based research
What was Eysenck a major critic of?
Psychoanalysis for mental health problems
What did Eysenck identity a need for?
Control groups in psychological testing
What evidence did Eysenck for psychotherapy?
There is an inverse correlation between recovery and psychotherapy. The more psychotherapy, the smaller the recovery rate.
List 3 things that can be ensured in practitioners are trained in the scientist practitioners model
- Critical thinking skills (understand research and implement best practices)
- Can justify treatments and interventions on empirical grounds
- Avoids harm, reduces unnecessary treatment and increases the likelihood of better efficiency in treatment
Why do some clinicians argue against training in pure science?
Applied work is often incompatible with scientific work and some research doesn’t apply to practice.
Why do some people believe research skills are unnecessary for clinicians?
Only a few clinical psychologists publish after completing their training
What do all clinicians agree on concerning the study of research science?
The value of a solid background in undergraduate research methods and statistics. But question whether it’s necessary to be both research and practice orientated
What is the Practitioner - scholar model?
Focuses on clinical practice with a greater emphasis on service delivery
Taught to be producers of small scale clinical science rather than traditional research science
Under the Practitioner-Scholar model, what is the model of a clinician working scientifically? (List 4 things)
- Applied scientist who uses theory and validated principles of assessment and validated treatments (where they exist)
- If they don’t exist, apply scientific methods and principles of observation, hypothesis generation with testing applied in individual cases and client groups
- Duty to pursue ideas derived from psychological science to improve upon existing assessment/treatments, develop new procedures and investigation the nature of clinical problems that bring people to the clinic
- This ensures that public money is spent on procedures justified by the current state of knowledge
What does the scientist practitioners model provide a framework for?
Lifelong learning
What is Evidence Based practice?
The integration of best research evidence with clinical expertise and patient values
What does EBP make use of?
Science, research and evidence to guide decision making in applied and clinical settings
5 reasons why you should use EBP
- Health care and applied knowledge grows rapidly
- Knowledge base is vast
- Provides the skills to integrate the best available information with clinical expertise,patient values and your health care environment
- Avoids uncritical acceptance of usual practice
- Skills for lifelong learning and up to date practice
What are the barriers between research and practice?
There is a huge amount of research being produced (to much to get through and 95% of studies cannot reliably guide clinical decisions
What are the 5 A’s in EBP?
- Ask the right questions (PICO)
- Access relevant evidence
- Appraise evidence
- Apply evidence
- Assess its effectiveness
Why do you need to formulate a focused, well built, answerable question? (3 reasons)
- Gives you a head start in finding information that is relevant
- Provides you with a checklist for the main concepts to be included in your search strategy
- Allows you to find information quickly.
What does PICO stand for?
P-Population/patient
I -Intervention
C-Comparison
O-Outcome
What are 3 considerations when identifying the population/patient problem? (P in PICO)
- Who/what is the client/problem
- What are the most important characteristics of the client/problem
- What is the primary problem, disease or co-existing condition
An example of P in PICO
In patients with binge eating disorders…
What 2 considerations for interventions? (I in PICO)
- What is the main intervention you are considering?
2. What do you want to do for the client? Offer therapeutic intervention or teach a skill?
What are the interventions you might consider?
Medication
Placebo
Counselling
Diagnostic tests
Provision of differing environmental factors
Methods of education (best way to share information with the client)
What is an example of intervention (I in PICO)?
Interpersonal skills
What are 2 condor Comparison (C in PICO)
- What is the main alternative to compare with the intervention?
- Are you trying to decide between two therapies, therapy and placebo or two diagnostic tests?
Example of comparison in PICO
Or cognitive behavioural therapy
List 2 considerations for outcome (O in PICO)
- What are you hoping to accomplish, measure, improve or change?
- What are you trying to do for the client? Relieve or eliminate the symptoms? Improve function or test scores? Improve a work environment?
Example of outcome in PICO
…more effective in reducing frequency of episodes.
Example of PICO question
In patients with binge eating disorder, is interpersonal therapy or cognitive behavioural therapy more effective in reducing the frequency of binge eating episodes?
Population- people with binge eating disorder
Intervention- interpersonal therapy
Comparison- cognitive behavioural therapy
Outcome- reducing frequency of binge eating episodes
What is the Cochrane Library databases?
The Cochrane Library is a collection of evidence based medicine databases including:
The Cochrane Database of Systematic reviews
The Cochrane Database of abstracts of reviews of effects
The Cochrane Central register of controlled trials
The Cochrane methodology register
Health technology assessment database
NHS economic evaluation database
What is a review?
A collection of systematically generated articles which investigates particular areas of psychology. An executive summary of articles
What do Cochrane reviews adhere to?
A strict process, minimising bias and ensuing reliability
What is Hierarchy of evidence?
A core principle of EBP with hierarchy based on the rigours (strength and precision) of research methods. Study design is an indication of quality
It’s a top down approach to looking at the best evidence
Higher in the hierarchy, the less bias there is in interpretation of study results
What is the highest form of research in the hierarchy of evidence?
Systemic reviews/meta-analysis
What are systemic reviews and meta-analysis?
Thorough analysis of results, strength and weaknesses of studies collated to address a particular PICO question
What does meta-analysis involve?
A statistical evaluation of all relevant studies
DV is effect Size (outcome or results of each study)
IV relates to study characteristics (participants interventions and outcome measures)
But takes a long time to put together and information can change
What are some limitations of systematic reviews and meta-analysis?
Takes a long time to complete and information changes fast
A large well controlled RTC may provide more convincing evidence than a systematic review of smaller studies
What is a Randomised Control Trial?
Experimental study where participants are randomly assigned to receive one of several (at least 2) interventions with a control/placebo/waitlist condition
What is the purpose of an RCT?
- Eliminates bias in treatment assignment
2. Facilitates blinding of treatment to investigators
What are the 5 disadvantages of an RCT?
- Requires rigorous control of the allocation process
- Can be long and expensive
- May not be ideal for rare conditions or problems with a long latency
- Generalisability (often screens out vulnerable groups)
- Ethics (withholding treatment in control)
What are case control studies?
Allows you to determine whether exposure to something is linked to an outcome. Using existing records to identify people with a problem.
Eg comparing people with lung cancer to people without to see if they differ on a risk factor such as smoking
Starts with outcome and traces back to exposure
What are case control studies useful for?
Investigating outbreaks of a disease and rare diseases
What are the advantages of case control studies?
Quick simple inexpensive
What are the disadvantages of case control studies?
Proves an association not causality and weaker because retrospective
What are cohort studies?
A group of people who are linked in some way and followed over time. Researchers observe what’s happened to the group exposed to the same variable
What are cohort studies used for?
Determining if there is a relationship between a certain factor and disease/outcome
Are cohort studies retrospective or prospective?
Can be both
What question is addressed if the aim of the study was to simply describe a study population?
PO questions (population/outcome
What question was used if the aim of the study was to quantify relationship between factors?
PICO
What kind of studies are randomly allocated?
Experimental/RCT
What kind of studies are not randomly allocated?
Observational studies
If the outcome is determined after exposure, what kind of study is it?
Cohort (prospective) study
If outcome was determined at the same time as the intervention or exposure, what kind of study was it?
Cross sectional study
If the outcome was determined before exposure was, what kind of study was it?
Case control study (retrospective)
