US VERSUS THEM:EVIDENCE-BASED PRACTICE AND THEROAD LESS TRAVELLEDSusan M. Wilczynski, PhD, BCBA-DBall State University
We all want to belong so we form groups of people with whom wehave some value or characteristic in common
Sometimes we view ourselves as being part of a large group and sometimes we view ourselves as being part of a small group
But when we form our groups,we often put ourselves into agroup of “good people” (US)And we place people outside ofourselves into a group of “badpeople.” (THEM)
We want “US” (the good people) to bethe winners and “THEM” (the badpeople) to be the losersIn fact – we growto feel itabsolutely must bethis way.We take action toensure we “come outon top” at all costs
And so we go to battle With people who are actuallyextraordinarily similar toourselves
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Teacher Confession:Parent-Teach erConferences exp1ainalot.THAT DOESN’T LOOK LIKE YOU? does this look like you some of the time?THAT’S NOT “US,” THAT’S ”THEM” or is it more like this? THOSE CRAZY EXTREMISTS!
Like you, I’m not exempt fromseeing the world primarilyfrom my own perspective which is why I have this .and this and this and finally, this
In reality, we all have a lot incommon.Our similarities are morestriking than our differences.When we focus onsimilarities We see the other person ispart of “US.” We become better at takingsomeone else’s perspectiveConsidering someone else’sperspective almost alwaysimproves whatever task youare trying to accomplish.
When the task is finding theright treatment to improve thequality of life for a child oradolescent we have to do the hard workof considering every angle Evidence-Based Practicehelps us do exactly that!
ClientFactorsContextualFactorsBest AvailableEvidence Evidence-based practiceinvolves using professionaljudgment to select the righttreatment by integrating thebest available evidence withrelevant client and contextualfactors. When we are “us” and judgingthat they are “them,” we areunlikely to select the righttreatment. Why? We do not give seriousconsideration to the client andcontextual factors.
What is the right treatment? The one the decreases a problem behavior or increases a skill.The one that yields a happier child or adolescent.The one that is feasible.The one that does not leave other children or adolescents in the lurch.The one that can be sustained long enough to have real impact.The one the leads to socially meaningful improvements.The one that enhances quality of life.The one that addresses everyone’s concerns to the maximum extent possible.
Sounds too good to be true Here is how we accomplish this:
What does this person do thatmost of use don’t?
BEST AVAILABLE EVIDENCE a e '- ,s'-o-01oa'-a-oase
ABOUT TREATMENT EFFECTIVENESSSystematic Reviews are the best source ofinformation because:They produce the most credible andcomprehensive analysis possible.(Slocum, Spencer, & Detrich, 2012)
WHY THE LEAST BIASED SOURCE OFEVIDENCE?With Systematic Reviews (a) research is identified in a thorough, analytic, andstandardized manner(b) clear procedures are developed forselecting/weighing evidence(c) the process is transparent and can be replicated(d) the objectivity of the process minimizes personaldecisions will influence the process.(Slocum, Spencer, & Detrich, 2012).
WHAT IS REQUIRED?Careful analysis of Quality Quantity Consistency of research findings(Moher, Liberati, Tetzlaff, & Altman, 2009;Slocum, Spencer, & Detrich, 2012).
SYSTEMATIC REVIEWBy understanding criteria used in systematicreviews, evidence-based practitioners can criticallyevaluate whether or not they find a systematicreview credible.
SYSTEMATIC REVIEWQuality Experts evaluate the quality of a study because theyknow that not all published studies provide strongevidence. This may be based on:–––––Research designDependent variableTreatment fidelityParticipant ascertainmentGeneralizationThere is no universal inclusion criteria.
WHEN IS IT CREDIBLE?Quantity It is only when a treatment effect has been reproduced that theresults are considered credible. Experts establish a criteria regarding the number of studiesneeded to determine whether or not a treatment is effective, priorto completing a systematic review.
INFORMED TREATMENT SELECTIONSystematic reviewsshould includeinformation aboutharm or side effectsso that informedtreatment selectiondecisions are made.KEEPCALMND MA CEINFO MED. ·ECISIONS(Khan, Kunz, Kleijnan, & Antes,2003).
CONSISTENCY OF OUTCOMES After the quality and quantify of all studieshave been evaluated, the outcomes must becombined to determine consistency of outcomes. Studies using the same treatment are put intoa single category (e.g., Treatment X).
TREATMENT EFFECTIVENESS Categorizetreatments and resultsare compared againsta criterionrepresenting the levelof effectiveness. Ex. Two or more When the criterion ismet, a treatment isdeemed effective. When the criterion isnot met, it might bedescribed asexperimental or ashaving no evidence.
WHAT DO EVIDENCE-BASEDPRACTITIONERS DO?Ask additional questions EVEN WHEN treatment isidentified as effective.– The individuals from the review might have ASD,but could be– a different age– at a different developmental level than the targetclient– the setting or the person implementing thetreatment might be different– the behavior targeted in the research is different
ASK A SERIES OF QUESTIONS LIKE Is there enough evidence that the treatmentworks for individuals who:are the same particular age ordevelopmental level as my client?2. need to increase/decrease a specificbehavior (e.g., adaptive skills, problembehaviors)?3. are in a specific setting?1.
WHAT TO DO:The evidence-based practitioner must useprofessional judgment to evaluate theusefulness of all sources of informationthat apply for the clientcurrently being served.
THE BEST AVAILABLE EVIDENCECould also be found within A systematic review for individuals that has beensupplemented by a systematic review that includesadditional populations.
CRITICAL CONSUMERS Evidence based practitioners need to understandhow experts evaluate the strength of the evidencesupporting a treatment. Systematic reviews consistently focus on the quality,quantity, and consistency of research outcomes.However, the criteria scholars use to determinethis varies considerably across systematic reviews.(Slocum, Spencer, & Detrich, 2012).
THE BEST AVAILABLE EVIDENCESound like a lot of work? I agree Evidence-based practitioners might find this from: I recommend practitioners who really want to A systematicthat An examinationknow howreviewto applythe sciencebehind the of thehas“evidence”data brokendownformgroups articles that arebased on relevantincluded in thefeatures(e.g., age,target - perhapssystematic Get togetherregularlyvia review tobehavior,etc.).videoconference– and sharewhat theyhavedeterminehowdifferent the researchparticipants and Invite scholars from your researchuniversitiesto aresettingparticipate and/or guide you.from our client’ssituation.been reading. Share areas of confusion and acknowledge bothstrengths of research and limitations.
DaNGeROUSMore of us versus them
Researchfindings maynot apply foryour client.Even clienthistory anddata might notbe accurate.
BEST AVAILABLE EVIDENCEExtract what is useful – but question theaccuracy of all sources of evidence.
Whopickswewhatskills WhoWhothinksshouldWhointeractswent intotheirwithawill work on basedclientbe on the skillsare thetreatmentsthatthatimprovemakechildrenchildis sick?in a child’sourcurrentlyclient’s qualityofmiserable?repertoire?life? Do we consider how chronicWhy aren’twemedicationWhy treatmentsaren’t weAre t willbe morelikelywith ickto producea skillin mind?selection?basedclient’scan beusedonacrossallcurrentskills,Whydon’t we cogiverelevantenvironments? Dowe considerknowledge? morbidthem morechoices inLet’s abilities,choose those!conditionswhichwillwhenwetreatmentpick Canwe actuallybuild treatments?Can’twe findabe used?some thatskillsisbytreatmentimplementingone WhatWhyaboutdon’t basicwe pickacceptableto our clients?intervention versus lyfatigueand havestamina?preference as a byproduct? Whatabout mentalhealth issues?
We can only fairly judge thebelievability of the evidence ANDconsider the client andcontextual factors if we are allpart of “US”ClientFactorsContextualFactorsBest AvailableEvidence
But when we come to the tableas “US” versus “THEM”
The child suffers because we failed touse the evidence-based practiceapproach to treatment selection
--gJ., -Ic;,,When we are “us” versus “them” we will allface more stress and burnout – I want goodhelping professionals to be fulfilled in their jobsas well as help the children we went into ourfields to help!
or you can take the road less travelled. the one whereyou committoRealizewheneveryoneyouare atbeingapart inof “US”forktheroad. the one andquality doof life say, “My way isthe only rightway!!”
Because when we value all believable evidenceand seriously consider client and contextualfactors, those kids will move mountains!
Reach me at:Susan M. Wilczynski, PhD, BCBA-DBall State [email protected] visit me at my otherpresentations today: How to make EB decisionsusing a checklist (11:15) Diversity and EBP (1:30)
Susan M. Wilczynski, PhD, BCBA -D. Ball State University. US VERSUS