Treadwell J.R.,Evidence-Based Practice Institute, Llc |
Singh S.,Johns Hopkins University |
Talati R.,University of Connecticut |
McPheeters M.L.,Vanderbilt University |
Reston J.T.,Evidence-Based Practice Institute, Llc
Journal of Clinical Epidemiology | Year: 2012
Objective: Systematic reviewers often use a "best evidence" approach to address the key questions, but what is meant by "best" is often unclear. The goal of this project was to create a decision framework for "best evidence" approaches to increase transparency in systematic reviews. Study Design and Setting: The project was separated into three areas: 1) inclusion criteria, 2) evidence prioritization strategies, and 3) evaluative approaches. This commentary focuses only on the second task. The full report is available on the Effective Healthcare Web site of the Agency for Healthcare Research and Quality. Results: The four identified strategies were as follows: 1) Use only the single best study; 2) Use the best set of studies; 3) Same as 2, but also consider whether the evidence permits a conclusion; and 4) Same as 3, but also consider the overall strength of the evidence. Simpler strategies (such as #1) are less likely to produce false conclusions, but are also more likely to yield insufficient evidence (possibly because of imprecise data). Conclusion: Systematic reviewers routinely prioritize evidence in numerous ways. This document provides a conceptual construct to enhance the transparency of systematic reviewers' decisions. © 2012 Elsevier Inc. All rights reserved.
Kanter J.W.,University of Wisconsin - Milwaukee |
Tsai M.,University of Washington |
Holman G.,Evidence-Based Practice Institute, Llc |
Koerner K.,Evidence-Based Practice Institute, Llc
Psychotherapy | Year: 2013
Therapists of many persuasions emphasize the therapy relationship in their work, a priority backed by strong empirical evidence. Training in how to maximize the power and potential of the therapy relationship, however, has lagged behind. A novel approach to using the therapy relationship and to training therapists in its use is provided by Functional Analytic Psychotherapy (FAP). FAP training involves eight 2-hr weekly training sessions conducted online using web-conferencing technology. The training integrates behavioral principles with a focus on trainee-trainer and trainee-trainee relationships in a highly structured course that evokes the desirable FAP therapist-trainee behaviors and collectively shapes the behaviors through reinforcement by the trainer and other trainees. In a preliminary study, 16 therapist-trainees were randomly assigned to receive either immediate FAP training or training after a waitlist period. Significant and large effects of training were found on both self-reported and observerassessed measures for the first training group, and the waitlist training group replicated the first training group with significant within-subject change over the course of training. Finally, qualitative feedback from therapists indicated high satisfaction with the primary elements of the training protocol. Several important limitations to this preliminary study are discussed © 2012 American Psychological Association.
Koerner K.,Evidence-Based Practice Institute, Llc |
Castonguay L.G.,Pennsylvania State University
Psychotherapy Research | Year: 2015
Abstract: The goal of this paper is to describe the authors’ experience conducting research in and for private practice. Based on two distinct research programs (one guided by a scientist practitioner leading various groups of clinicians and another from a network of practitioners and researchers), a number of practice-oriented studies are presented. Lessons learned from these collaborative projects are discussed in terms of challenges and strategies to deal with them, as well as benefits that can be earned from conducting empirical studies within clinical routine. General recommendations are then offered to foster the engagement of clinicians in their own working environment and to facilitate partnerships between researchers and practitioners in developing and implementing valid, feasible, and informative clinical studies. © 2014, © 2014 Society for Psychotherapy Research.
Beidas R.S.,Temple University |
Beidas R.S.,University of Illinois at Chicago |
Koerner K.,Evidence-Based Practice Institute, Llc |
Weingardt K.R.,Stanford University |
Kendall P.C.,Temple University
Administration and Policy in Mental Health and Mental Health Services Research | Year: 2011
This review offers practical recommendations regarding research on training in evidence-based practices for mental health and substance abuse treatment. When designing training research, we recommend: (a) aligning with the larger dissemination and implementation literature to consider contextual variables and clearly defining terminology, (b) critically examining the implicit assumptions underlying the stage model of psychotherapy development, (c) incorporating research methods from other disciplines that embrace the principles of formative evaluation and iterative review, and (d) thinking about how technology can be used to take training to scale throughout all stages of a training research project. An example demonstrates the implementation of these recommendations. © 2011 Springer Science+Business Media, LLC.
Morgan S.,Evidence-Based Practice Institute, Llc
Nursing management (Harrow, London, England : 1994) | Year: 2010
Personalisation of social care services encourages service users to assess their own needs and decide which services they think will assist them most. Its development involves a transformation of services and how they are delivered and funded. Personalisation has been introduced into health care and healthcare professionals must ensure that patients are involved in decisions about their management. This approach requires that the healthcare workforce and funding methods are changed, and service leaders must manage these changes creatively.
Sullivan N.,Evidence-Based Practice Institute, Llc |
Schoelles K.M.,Evidence-Based Practice Institute, Llc
Annals of Internal Medicine | Year: 2013
Complications from hospital-acquired pressure ulcers cause 60 000 deaths and significant morbidity annually in the United States. The objective of this systematic review is to review evidence regarding multicomponent strategies for preventing pressure ulcers and to examine the importance of contextual aspects of programs that aim to reduce facility-acquired pressure ulcers. CINAHL, the Cochrane Library, EMBASE, MEDLINE, and PreMEDLINE were searched for articles published from 2000 to 2012. Studies (any design) that implemented multicomponent initiatives to prevent pressure ulcers in adults in U.S. acute and long-term care settings and that reported pressure ulcer rates at least 6 months after implementation were selected. Two reviewers extracted study data and rated quality of evidence. Findings from 26 implementation studies (moderate strength of evidence) suggested that the integration of several core components improved processes of care and reduced pressure ulcer rates. Key components included the simplification and standardization of pressure ulcer-specific interventions and documentation, involvement of multidisciplinary teams and leadership, use of designated skin champions, ongoing staff education, and sustained audit and feedback.
Holman G.,Evidence-Based Practice Institute, Llc |
Koerner K.,Evidence-Based Practice Institute, Llc
Journal of Contextual Behavioral Science | Year: 2014
There remains great potential for collaborative, participatory advancement of research through the generation of Single-case designs (SCD) by contextual behavioral practitioners working in applied settings. Development of such communities of applied scientists is core to the vision of contextual behavioral science (CBS). Beyond their contributions to science, SCD may also serve a useful role in clinical practice as means of validating clinical decisions, trouble-shooting treatment failures, and overall building competency in the kind of clinical decision-making that is a hallmark of the CBS clinician. This article is not a thorough review of SCD methodology; instead it provides an overview of issues related to implementation of SCD in outpatient psychotherapy practice, supplementing the many excellent methodological reviews already available and updating previous arguments about the value of this approach for our contemporary context. © 2014 Association for Contextual Behavioral Science.
Agency: Department of Health and Human Services | Branch: | Program: SBIR | Phase: Phase I | Award Amount: 184.20K | Year: 2011
DESCRIPTION (provided by applicant): Our ultimate goal is to build PracticeGround, a commercially successful online platform that has the potential to improve outcomes for patients receiving mental health treatment by increasing practitioners' implementation of evidence-based practices (EBPs) and speeding the study of dissemination and implementation of EBPs. When completed, PracticeGround will provide the technical infrastructure to deliver online training and consultation in any EBP while measuring patients' response to it and practitioners' implementation of it. Practice Ground already has two components: a beta continuing education site offering online education to practitioners and an active international EBP Learning Community with over 170 paying members. In Phase I we plan to build and test a third component, Online Progress Tracking (OPT). OPT will seamlessly link an online assessment engine that gathers and displays progress monitoring (PM) data from patients and practitioners with online EBP training, expert consultation, and peer community to work like a GPS, locating the progress of the therapy or training process relative to benchmarks, and providing context-specific assistance when practitioners need help implementing or learning EBPs and serveas a platform for implementation research. Specific aims of this project are to design the OPT prototype, conduct user testing to identify the key feasibility and acceptability barriers to professionals' and patients' use of OPT, improve OPT's design to address stakeholder's implementation barriers, and then carry out further user testing and a pilot study to test whether the OPT prototype is acceptable to practitioners in diverse practice and training settings and increases their implementation of the EBPof PM. By the end of Phase I, we will have a saleable product. In Phases II and III we will expand our platform to other EBPs, expand our marketing of the platform, and carry out studies to test the hypothesis that OPT leads to improved patient outcomes.PUBLIC HEALTH RELEVANCE: Our ultimate goal is to build PracticeGround, a commercially successful online platform that aims to improve outcomes for mental health patients by increasing practitioners' implementation of evidence-based practices (EBPs) and speeding the study of dissemination and implementation of EBPs. In this project we build and test the prototype of Online Progress Tracking (OPT), a central component of the PracticeGround platform. OPT will seamlessly link an online assessment engine that gathers and displays progress monitoring data with online EBP training, expert consultation, and peer community to work like a GPS, locating the progress of the therapy relative to benchmarks, and providing assistance when practitioners need help implementing or learning EBPs.
Agency: Department of Health and Human Services | Branch: National Institutes of Health | Program: SBIR | Phase: Phase I | Award Amount: 274.26K | Year: 2016
DESCRIPTION provided by applicant Every minutes someone in the United States U S chooses to end his or her life resulting in over suicides in the US each year The economic cost of suicide in the U S was $ billion annually in when adjusted for present day inflation the economic toll rises to $ billion The combined cost of medical and work loss is estimated at $ billion annually In people were treated in EDs for self inflicted injuries Beginning in with the Surgeon Generalandapos s Call to Action to Prevent Suicide millions have been devoted annually both publicly approximately $ million from NIH and privately approximately $ million from American Foundation for Suicide Prevention to prevent suicide Yet despite this significant and sustained effort there is no evidence of a decrease in suicides or suicide attempts in the U S Our overarching goal is to create a tool that could reduce suicide rates increase delivery of efficacious suicide interventions and decrease overall costs associated with suicidal behaviors With this in mind we intend to develop and scientifically validate a relational agent for suicidal patients that delivers Collaborative Assessment and Management of Suicidality CAMS an efficacious and cost effective intervention developed by David Jobes PhD and to create an integrated software system CAMS Relational Agent System CAMS RAS that assists medical personnel by synthesizing the CAMS intervention findings into an easy to interpret report and providing empirically derived clinical decision support integrates into the health care systemandapos s electronic health record EHR enhances the patientandapos s coping capability by including psychoeducational skills training modules for use during and after hospitalization and automates the delivery of caring contacts an efficacious and brief suicide prevention intervention provided after discharge Our initial target will be EDs as they are often the initial point of contact and where personnel must make the decision whether to hospitalize or discharge the suicidal patient We will also conduct testing in other medical and outpatient mental health settings to ensure public health impact and commercial success Phase I project aims include creating an advisory board to guide the development of CAMS RAS iteratively design and develop relational agent andquot Dr Daveandquot modeled after the gestures expressions and mannerisms of CAMS treatment developer David Jobes PhD and conduct feasibility tests to determine whether CAMS RAS is acceptable easy to use and liked by target end users acutely suicidal patients admitted to hospital EDs psychiatric inpatient units and medical floors for treatment of injuries sustained during a suicid attempt hospital medical personnel administrators and other stakeholders including peer advocates and outpatient suicidal patients clinicians and administrators PUBLIC HEALTH RELEVANCE Suicide is the tenth leading cause of death among Americans of all ages Over suicides occurred in the U S in one suicide every minutes In the same year over a million U S adults reported attempting suicide were treated in emergency departments EDs for self inflicted injuries and were hospitalized The cost of suicidal behaviors in the U S was $ billion in The Collaborative Assessment and Management of Suicidality CAMS is an evidence based cost effective suicide specific intervention that facilitates engagement assessment and treatment of suicidal risk Unfortunately most ED and outpatient mental health clinicians do not know CAMS and lack knowledge in how to effectively assess and intervene with suicidal individuals The CAMS Relational Agent System seeks to facilitate the delivery of CAMS and other evidence based procedures to reduce suicide
Agency: Department of Health and Human Services | Branch: National Institutes of Health | Program: SBIR | Phase: Phase II | Award Amount: 1.27M | Year: 2015
DESCRIPTION provided by applicant Mental disorders affect million Americans and result in an annual loss of $ billion and total costs of at least $ billion While numerous psychosocial empirically supported therapies ESTs exist few clinicians are adequately trained to deliver them The overarching goal of this project is to develop a comprehensive software solution that effectively and efficiently facilitates the delivery of psychosocial ESTs for mental health problems To ensure significant reach and public health impact Practice Ground will be designed using industry standards for commercial success Specifically Practice Ground will be built as a third party module that seamlessly integrates into electronic health records EHRs and optimizes usersandapos workflow Practice Ground aids delivery of ESTs by integrating the following components dynamic progress monitoring clinical decision support rich visual displays of client outcomes online training modules in ESTs just in time training for guided real time assistance in delivering ESTs educational videos and a client portal In Phase I we developed and tested the usability acceptability and feasibility of an online progress tracker OPT prototype OPT was specifically selected because of its design and workflow complexities We also adapted an existing training course on progress monitoring PM to an online training format Proof of concept was determined in two phases extensive feedback from target end users clinicians clients and other stakeholders clinic directors program managers throughout software development formative evaluation and a within subjects pilot study N of the final prototype summative evaluation Consistent with initial hypotheses OPT significantly increased progress monitoring over time and significantly reduced barriers to use In addition we self funded continued work on OPT for a second year andquot Phase I Aandquot in order to complete a commercial ready HIPAA compliant product for launch in July We met and exceeded original aims In Phase II we intend to complete the development of PracticeGround using an agile development process to ensure usability and optimize workflow We will populate it with ESTs for depression insomnia bipolar disorder PTSD and suicide risk intervention and management loosely integrate PracticeGround into PracticeFusion and NetSmart using HL and develop a systems architecture design for tight integration of PracticeGround into EPIC PracticeFusion and NetSmart in Phase III We will conduct feasibility field tests at three sites that focus on usability and satisfaction frequencyof use across clients in their caseload and barriers to use We will then conduct an week randomized controlled trial N comparing PracticeGround n to care as usual n in depressed outpatient clients Primary outcomes include depression psychological distress treatment satisfaction clients and clinicians and treatment drop out Secondary clinician outcomes include extent of PracticeGround use with clients across cliniciansandapos caseload PUBLIC HEALTH RELEVANCE Our ultimate goal is to facilitate the delivery of empirically supported treatments ESTs for mental disorders and to improve client mental health outcomes Toward this end this Phase II SBIR proposal seeks to complete the development and testing of PracticeGround a comprehensive software system designed to integrate with electronic health records and that contains multiple methods of training clinicians in ESTs and delivering ESTs to clients continuous progress monitoring of client outcomes and clinical support tools to guide clinicians and clients through delivery of the necessary EST