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Evidence-Based Practice

The evidence-based practice movement has become an important feature of health care systems and health care policy. Evidence-based practice in psychology (EBPP) has been defined as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” (American Psychological Association (APA), 2005).

Best available research evidence:
Good practice and science call for the timely testing of psychological practices, in a way that adequately operationalises them, using appropriate scientific methodology. Best research evidence refers to scientific results related to intervention strategies, assessment, clinical problems and client populations in laboratory and field settings, as well as to clinically relevant results of basic research in psychology and related fields. Two dimensions have been identified as crucial in evaluating research on specific interventions, being:

1. Treatment efficacy - the systematic and scientific evaluation of whether a treatment works. (APA, 2006)
2. Clinical utility - the applicability, feasibility, and usefulness of the intervention in the local or specific setting where it is to be offered. This dimension also includes determination of the generalisability of an intervention whose efficacy has been established. (APA, 2006)

Clinical expertise:
Clinical expertise refers to the competence attained by psychologists, through education, training and experience, which results in effective practice. Clinical expertise encompasses a number of competencies that promote positive therapeutic outcomes (APA, 2006). These include:

• Assessment, diagnostic judgement, systematic case formulation, and treatment planning
• Clinical decision making, treatment implementation and monitoring of client progress
• Interpersonal expertise
• Continual self-reflection and acquisition of skills
• Appropriate evaluation and use of research evidence, in both basic and applied psychological science
• Understanding the influence of individual and cultural difference on treatment
• Seeking available resources (e.g. consultation, adjunctive or alternative services), as needed
• Having a cogent rationale for clinical strategies

Patient characteristics, culture, and preferences:
Psychological services are most likely to be effective when they are responsive to the client’s specific problems, strengths, personality, socio-cultural context, and preferences (APA, 2006). EBPP involves consideration of the client’s values, religious beliefs, world views, goals, and preferences for treatment with the psychologist’s experience and understanding of the available research.

EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship and intervention. EBPP starts with the client and asks what research evidence will assist the psychologist in achieving the best outcome.

 

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