With Steven D. Hollon, PhD
Evidence-based care has become something of a buzzword in behavioral health. There are many benefits of applying empirically tested methods to behavioral health, just as pharmaceuticals are tested and demonstrated to be effective. Not least of which is the ability to provide clients with treatment programs that offer a proven path to recovery.
Dr. Steven D. Hollon, past president of the Association for Behavioral and Cognitive Therapies (ABCT) and recipient of the Distinguished Scientific Award for the Application of Psychology from the American Psychological Association (APA), was chair of the steering committee advising the APA on the development of clinical practice guidelines. He shares his advice on how behavioral health clinicians can apply evidence-based care to their practices.
1. Read Guidelines
It might seem like stating the obvious but reading published guidelines and seeing how they can be applied to your own practice is the starting point. Clinical practice guidelines are intended to promote practices that are based on the best available evidence. This does not mean that methodologies other than those recommended are necessarily ineffective. It just means that they have not yet been adequately tested and proven effective.
When applying clinical guidelines, one would typically start by applying a somewhat generic treatment that has been shown to help the average individual. You can then assess how the client responds by adjusting the treatment accordingly. As with so many parts of behavioral health, applying any generic guidelines is a balancing act between what might be best practice for a ‘typical’ client and what is needed for your specific client.
American Psychological Association https://www.apa.org/practice/guidelines The American Psychological Association (APA) generates client-focused clinical-practice guidelines, using a multidisciplinary development panel based on a comprehensive systematic review of the evidence.
National Institute for Health and Care Excellence https://www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/iapt One of the most robust programs for reviewing and publishing clinical guidelines is found in the United Kingdom. The National Institute for Health and Care Excellence (NICE) has systematically reviewed the evidence for the effectiveness of a variety of interventions. The resulting guidelines are being used in a national training program, the Improving Access to Psychological Therapies (IAPT,) to apply these findings at scale.
2. Collect outcomes from your clients
Reading and implementing the approaches suggested in clinical guidelines only goes part of the way towards implementing an evidence-based approach to your practice. The next step is collecting data from your own clients so that you can adjust your approach based on quantifiable evidence as opposed to your own subjective impression. As clinicians are likely to overestimate the effect of their interventions, it is important that you collect an unbiased assessment of outcomes, from the clients themselves.
Collecting client outcomes could include administering measures of depression and anxiety, like the PHQ-9 and the GAD-7 (respectively) on a regular basis (as is done in IAPT). Just as a routine checkup at your primary care physician includes taking your temperature, so behavioral health providers should ‘take their clients’ emotional temperature.’ The PHQ-9 and GAD-7 could be administered as part of the face-to-face session but also completed before or after the session.
Some clinicians might be concerned that regularly collecting client outcomes will result in a significant administrative burden. However, there are a number of digital tools that can help to automate the process allowing for easy collection of client progress.
3. Compare trends over time
Once you have a reliable gauge of your clients’ emotional and psychological state at any point in time, you are in a position to compare their progress over time. There are a number of different factors that can be considered in addition to the results of the PHQ-9 and GAD-7 as determined by the interests of the individual practicing clinician (Lambert, Whipple, & Kleinstauber, 2018). Detailed note-taking after a session, and tracking how a client has progressed will help you to formulate a treatment plan that is based on empirical evidence.
Eleos Health A new development in the world of behavioral health, the Eleos platform is a useful tool for collecting outcomes and gaining greater insights into consumer progress. The platform uses therapy-specific voice analysis to provide insights into interactions that might otherwise be missed. These actionable insights provide much-needed data to drive evidence-based practice. It also automates the collection of client outcomes, sending relevant tests to clients between sessions. This information is then collated and presented to the clinician on a HIPAA compliant dashboard for easy review and treatment planning. This allows clinicians to practice measurement-based care with ease. The process of note-taking is also streamlined as the system automatically generates a compliance-based baseline for progress notes reducing the time spent from 15 min per note before Eleos to 7 min per note with Eleos, on average.
4. Invest in your own training
The knowledge pool of evidence-based approaches is constantly growing. While reading and incorporating the best practice presented in national guidelines is important, there exists a vast bank of knowledge beyond these guidelines. Investing in your own training does not need to be expensive or cumbersome. There exist a number of online resources created to help behavioral healthcare providers expand their knowledge and skills.
The Oxford Center for Anxiety Disorders and Trauma https://oxcadatresources.com/ World leaders in the treatment of PTSD and anxiety disorders, the Oxford Center for Anxiety Disorders and Trauma offers a range of free training materials including video, training manuals, client questionnaires, and therapy materials.
The Council for Training in Evidence-Based Behavioral Practice https://ebbp.org/ Created by representatives from fields through behavioral health, including psychology, medicine, nursing, social work and public health, the Council for Training in Evidence-Based Behavioral Practice offers a range of online training modules to help bridge the gap between research findings and clinical practice.