[AVAPL Members] Re: Some Thoughts on Evidence Based Practice

  • From: "Mirch-Kretschmann, Susan" <Susan.Mirch-Kretschmann@xxxxxx>
  • To: <members1@xxxxxxxxx>
  • Date: Mon, 24 May 2010 13:23:56 -0700

I would be interested in a workgroup on outcome measures.

Sue

 

Susan Mirch-Kretschmann, PhD, CPRP

VA Palo Alto HCS

 

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of
Brownlee-Duffeck, Martha CMOVAMC
Sent: Thursday, May 20, 2010 11:12 AM
To: members1@xxxxxxxxx
Cc: Weingardt, Ken
Subject: [AVAPL Members] Re: Some Thoughts on Evidence Based Practice

 

What was so impressive about Dr Goodheart's model was that it seemed to
take into account the complexity of variables on both patient/client and
therapist/provider sides of the equation.  

 

I would like to get more information about Dr Goodheart's model and try
to implement either her model or another EBP model across treatment
teams at our facility.    My thought  is that, as psychologists,  it is
important to be proactive and identify which variables  to track and
which  measures of outcome  are meaningful before other outcome measures
are imposed by external sources which we may not view as relevant/valid.

 

I will try to contact Dr Goodheart and share information with other
folks who are interested.  At the AVPAL meeting, Ken Weingardt kindly
offered to establish a "clinical research website" to facilitate
communication and discussion.  This might be a good vehicle for posting,
discussing and problem solving how to implement this kind of database.
In the mean time, perhaps we can just create an e-mail group.

 

Your thoughts Toni and Ken?

 

Martha

 

Martha Brownlee-Duffeck

Martha Brownlee-Duffeck, Ph.D., ABPP

Psychology Leader & Director of Training, 

Post-doctoral Program

Behavioral Health Service Line, 

Harry S Truman Veteran's Hospital

800 Hospital Drive, BHSL

Columbia, Missouri 65201

 

Adjunct  Professor, 

Department of Physical Medicine & Rehabilitation

University of Missouri School of Medicine

 

Adjunct Professor, Department of Health Psychology

University of Missouri School of Health Professions

 

E-mail: Martha.Brownlee-Duffeck@xxxxxx
<mailto:Martha.Brownlee-Duffeck@xxxxxxxxxx> 

 

Tel.  573-814-6486

FAX: 573-814-6493

 

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Menefee, Deleene
S.
Sent: Thursday, May 20, 2010 10:30 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Some Thoughts on Evidence Based Practice

 

It was impressive that Dr. Goodheart's data demonstrated that "specific
techniques" accounted for only 15% of change in the clinical outcomes
she was referring to, similarly to the effects of placebo at 15%.
Relationship factors accounted for 30% and patient qualities 40%. [I am
referring to my notes and am hopeful that these numbers are accurate]. I
agreed that patient preferences, culture and the context of the
treatment are variables that psychologists are trained to anticipate and
accommodate; variables that are not necessarily prescribed in the EBPPs
and that separate clinicians from technicians.  In agreement with other
voices on this listserv, I believe that we have unique contributions to
make to the evidence-base by incorporating effectiveness studies of the
interventions that we are employing daily in our practices. Dr.
Goodheart's suggestion was for us to think about "what is not known?" in
the clinical arena of our work. This may be a great place to start.   

 

Deleene S. Menefee, PhD

Psychologist - Women's Inpatient Specialty Environment 

of Recovery Program (WISER)

Michael E. DeBakey VA Medical Center

Assistant Professor

Menninger Dept. of Psychiatry & Behavioral Sciences

Baylor College of Medicine

2002 Holcombe Blvd, MHCL 116

Houston, Texas 77030

Office: 713-791-1414 ext 6754

 

 

 

 

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Goldberg, Robert
W. (VHACLE)
Sent: Thursday, May 20, 2010 10:12 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Some Thoughts on Evidence Based Practice

 

Apart from the way the VA is approaching evidence-based practices, with
which I am generally supportive, there are more traditional
evidence-based practices that are not being rolled out systematically.
There are many relationship, therapeutic alliance, and technique
variables which have been empirically supported in dozens of studies:
Rogers, Kiesler, Strupp, et al.  There are protocols for training people
in these techniques.  However, they've been shunted aside as mere
preconditions or 'nonspecific' factors when, indeed, they are the
vehicles for powerful change.   

 

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Besyner, James K
Sent: Thursday, May 20, 2010 10:45 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Some Thoughts on Evidence Based Practice

 

I agree with Martha and Chad.  All that we do should have 1) evidence to
decide to offer it, and 2) evidence that it did/did not do some good.  

 

I also like the idea of standardization of training and practice but do
not believe that given all the important variables impacting outcomes,
such as the quality of the therapeutic alliance,  that training in a set
of techniques itself guarantees positive outcomes.  Perhaps the
forthcoming templated progress notes will go a long way for VA
Psychology/MH to tease out a whole host of issues/problems/factors
associated with our therapies - including the clinical reasons for going
"off manual."

 

Jim

 

James K Besyner, Ph.D., ABPP

Board Certified in Clinical Psychology

Chief of Psychology

Mental Health Service

VA North Texas Health Care System

Dallas, TX

 

Clinical Professor of Psychiatry

University of Texas Southwestern Medical Center

 

Voice:  214-857-0534

Fax:  214-857-0531

 

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of
Brownlee-Duffeck, Martha CMOVAMC
Sent: Thursday, May 20, 2010 9:31 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Some Thoughts on Evidence Based Practice

 

Dear All,

 

I too was very inspired by Dr Goodheart's talk and discussed with our
psychologists the idea of "piloting" her model at our VA to the extent
practicable.  I am looking forward to the workshops she will be doing at
APA this year. 

 

In the end, treatment efficacy (with or without a manual) becomes an
empirical question.  It is only by making clinical outcomes research
part of clinical care that we move the science and practice of
psychology forward. 

 

Perhaps, if there is a group of us that want to try this we could
approach her via e-mail  and form an "electronic workgroup" to problem
solve implementation issues as the arise.

 

Let's talk more "back channel" to avoid overloading mailboxes.

 

Martha

 

 

Martha Brownlee-Duffeck

Martha Brownlee-Duffeck, Ph.D., ABPP

Psychology Leader & Director of Training, 

Post-doctoral Program

Behavioral Health Service Line, 

Harry S Truman Veteran's Hospital

800 Hospital Drive, BHSL

Columbia, Missouri 65201

 

Adjunct  Professor, 

Department of Physical Medicine & Rehabilitation

University of Missouri School of Medicine

 

Adjunct Professor, Department of Health Psychology

University of Missouri School of Health Professions

 

E-mail: Martha.Brownlee-Duffeck@xxxxxx
<mailto:Martha.Brownlee-Duffeck@xxxxxxxxxx> 

 

Tel.  573-814-6486

FAX: 573-814-6493

 

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Feld, Daniel
Sent: Thursday, May 20, 2010 9:11 AM
To: AVAPL Membership
Subject: [AVAPL Members] Some Thoughts on Evidence Based Practice

 

Dear Friends and Colleagues,

It was great to see and talk with many of you at the AVAPL conference.
I was left with some thoughts about evidence based practice after
hearing Dr. Goodheart's address that I wanted to put out there. 

It occurred to me that the way VA is responding to the call to offer
evidence-based treatments to all veterans who want them is to train
clinicians in specific therapies that have been supported by the
research literature--and that have been shown to be effective for many.
I think this approach is admirable and we've seen first-hand at our
facility how these treatments have helped several veterans reclaim their
lives. 

But what I found particularly inspiring about Dr. Goodheart's talk was
the idea that we can develop an evidence base for the treatments we
already do by incorporating outcome measures into our clinical work with
veterans. I'm sure that many of us who haven't been trained in any of
the evidence-based therapies being rolled out do feel that we are
effective with many of the veterans we work with, and that the folks we
see make significant changes in their lives.

So...what I'm wondering is if we can consider including the use of
outcome measures to look at how effective we are in working with our
veterans. This could only add to the constructive efforts that we're
already making in VA to provide our veterans with treatments that work.
It also has the potential of expanding how we define evidence based
practice. 

What do you all think?

Best,

Danny

Daniel Feld, Psy.D.

Assistant Chief of Psychology

VA New York Harbor Healthcare System

Brooklyn and St Albans Campuses

(718) 836-6600 x6806

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