Evidence-based practice in psychology: Context, guidelines, and action.

A science-based approach to understanding health and disease emerged gradually over the past two centuries, while the modern evidence-based approach to health care emerged only about a half-century ago. The evidence-based approach to practice in health service psychology (HSP) gained significant traction after the American Psychological Association (APA) adopted it as policy in 2005, and in 2021, APA approved the first comprehensive set of guidelines for practicing HSP in an evidence-based manner. Several authors of this 2021 set of guidelines along with an additional subject matter expert wrote the current article. This article outlines the development of evidence-based practice in psychology, discusses the strengths and weaknesses of each of the three components of evidence-based practice (i.e., best available research, clinical expertise, and patient characteristics, culture, and preferences), and highlights the complexity involved in integrating related considerations during clinical decision making. The article then discusses strategies for the systematic application of this approach in HSP to improve the effectiveness of behavioral health care and strengthen population health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Where do psychologists turn to inform clinical decisions? Audience segmentation to guide dissemination strategies.

Background: Audience segmentation is an analysis technique that can identify meaningful subgroups within a population to inform the tailoring of dissemination strategies. We have conducted an empirical clustering audience segmentation study of licensed psychologists using survey data about the sources of knowledge they report most often consulting to guide their clinical decision-making. We identify meaningful subgroups within the population and inform the tailoring of dissemination strategies for evidence-based practice (EBP) materials. Method: Data come from a 2018-2019 web-based survey of licensed psychologists who were members of the American Psychological Association (APA; N = 518, response rate = 29.8%). Ten dichotomous variables assessed sources that psychologists regularly consult to inform clinical decision-making (e.g., colleagues, academic literature, and practice guidelines). We used latent class analysis to identify segments of psychologists who turn to similar sources and named each segment based on the segment's most salient characteristics. Results: Four audience segments were identified: the No-guidelines (45% of psychologists), Research-driven (16%), Thirsty-for-knowledge (9%), and No-reviews (30%). The four segments differed not only in their preferred sources of knowledge, but also in the types of evidence-based posttraumatic stress disorder (PTSD) treatments they provide, their awareness and usage intention of the APA PTSD clinical practice guideline, and attitudes toward clinical practice guidelines. Conclusion: The results demonstrate that licensed psychologists are heterogeneous in terms of their knowledge-seeking behaviors and preferences for knowledge sources. The distinctive characteristics of these segments could guide the tailoring of dissemination materials and strategies to subsequently enhance the implementation of EBP among psychologists.

Audience segmentation is a dissemination strategy that categorizes a group of intended users or audience into meaningful subgroups based on their beliefs, behaviors, and/or other characteristics. Like many other scientific or medical fields, clinical psychology also struggles to use clinically tested psychological treatments (or EBPs) in everyday practice due to practical challenges. To help address such barriers, professional organizations like the American Psychological Association (APA) publish clinical practice guidelines that practitioners can use to learn more about EBPs. However, even these clinical practice guidelines are not often used, so this study employed the audience segmentation analysis to better understand psychologists' diverse attitudes, behaviors, and preferences regarding clinical practice guidelines and other clinical information sources. Our study found four distinct subgroups within approximately 600 APA-registered psychologists based on their preferred source of knowledge: the no-guidelines (45% of psychologists), research-driven (16%), thirsty-for-knowledge (9%), and no-reviews (30%). Each subgroup also varied in the types of evidence-based treatments they provide, as well as their awareness, willingness to use, and attitudes toward clinical practice guidelines. This result shows that licensed psychologists are not a uniform group and that dissemination strategies should be adjusted to each subgroup's characteristics to maximize the effort to increase the use of EBPs among psychologists.

Toward the data-driven dissemination of findings from psychological science.

The public health impact of psychological science is maximized when it is disseminated clearly and compellingly to audiences who can act on it. Dissemination research can generate knowledge to help achieve this, but dissemination is understudied in the field of implementation science. As a consequence, the designs of dissemination strategies are typically driven by anecdote, not evidence, and are often ineffective. We address this issue by synthesizing key theory and findings from consumer psychology and detailing a novel research approach for "data-driven dissemination." The approach has 3 parts: (a) formative audience research, which characterizes an audience's awareness about, adoption of, and attitudes toward an intervention, as well as preferences for receiving information about it; (b) audience segmentation research, which identifies meaningful subgroups within an audience to inform the tailoring of dissemination strategies; and (c) dissemination effectiveness research, which determines the strategies that are most effective. This approach is then illustrated using the dissemination of the American Psychological Association's (APA, 2017) Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults as a case study. Data are presented from a 2018-2019 survey of licensed APA-member psychologists who treat adults with PTSD (n = 407, response rate = 29.8%). We present survey findings on awareness about, attitudes toward, and adoption of the guideline and find significant differences across these domains between psychologists who do and do not regularly use clinical practice guidelines. We conclude by discussing future directions to advance dissemination research and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Critical Need for a Population Health Approach: Addressing the Nation's Behavioral Health During the COVID-19 Pandemic and Beyond.

The COVID-19 global pandemic highlights the necessity for a population health approach to identify and implement strategies across systems to improve behavioral health. Adopting a population health approach helps to address the needs of the total population, including at-risk subgroups, through multiple levels of intervention and to promote the public's behavioral health and psychological well-being.

Improving the reach of clinical practice guidelines: An experimental investigation of message framing on user engagement.

Despite strong evidence for the efficacy of PTSD treatments, most affected individuals are not receiving these treatments, in part because they may not know that evidence-based treatments exist. The American Psychological Association published a website to disseminate information about their Clinical Practice Guideline for treating PTSD. In Study 1, Google Optimize was used in a field study to examine whether altering the subheadings to three of the website pages would increase site visitor engagement. On the main page and page describing treatments, no subheading alterations improved engagement. On the Patients and Families page, the subheading "say goodbye to symptoms" improved engagement on three outcome variables, including clicking a link to find a psychologist (though there were a small number of clicks). In a preregistered conceptual replication in a sample not actively seeking information about the PTSD guideline (N=578), results did not replicate. Results highlight challenges of evidence-based treatment information dissemination.

Critical Concerns When Incorporating Telepractice in Outpatient Settings and Private Practice.

OBJECTIVE: Technology continuously advances with new innovations and the evolution of existing devices, requiring health service providers to adapt and keep up with these changes in order to provide optimal services to their patients. Expertise limited to a single technological modality or device will quickly become outdated as new revisions, updates, and alternatives are released into the marketplace. METHODS: This article presents several of the critical concerns and issues practitioners must consider when evaluating their current and future uses of technology within their provision of outpatient or private practice services, particularly as it relates to direct care. Current literature and use of key telepractice resources, such as those from the American Telemedicine Association and the American Psychological Association, are presented, to provide practitioners with advanced knowledge and considerations for evaluating technology within their own practice settings. RESULTS: Practitioners can be prepared to remain on top of this "arms race" of technology when they focus on the critical issues related to the selection and use of technology devices, applications, and modes of use; for example, Internet, phone, email, or text message. Two vignettes illustrate how practitioners may implement technology in their practices. CONCLUSIONS: Technology can be readily incorporated into outpatient settings to augment practitioners' delivery of health services and improve their experience in clinical practice.

Development of clinical practice guidelines.

Clinical practice guidelines (CPGs) are intended to improve mental, behavioral, and physical health by promoting clinical practices that are based on the best available evidence. The American Psychological Association (APA) is committed to generating patient-focused CPGs that are scientifically sound, clinically useful, and informative for psychologists, other health professionals, training programs, policy makers, and the public. The Institute of Medicine (IOM) 2011 standards for generating CPGs represent current best practices in the field. These standards involve multidisciplinary guideline development panels charged with generating recommendations based on comprehensive systematic reviews of the evidence. The IOM standards will guide the APA as it generates CPGs that can be used to inform the general public and the practice community regarding the benefits and harms of various treatment options. CPG recommendations are advisory rather than compulsory. When used appropriately, high-quality guidelines can facilitate shared decision making and identify gaps in knowledge.

Mental health assessment in rehabilitation research.

Assessment in mental health research has evolved from focusing on symptoms and diagnosis to addressing a broad range of change, including psychosocial functioning. This is consistent with developments in the areas of psychosocial rehabilitation and the increase in recovery-oriented intervention models for mental disorders. We reviewed the status of assessment in mental health research, providing an overview of symptom and diagnostic assessment that is the cornerstone of most mental health research assessment. We then focused on measurement that can be applied across diagnostic groups and on functioning as a key mental health outcome. We reviewed the International Classification of Functioning, Disability, and Health and its implications for improvements in assessment. We provided an example of a new assessment, the Inventory of Psychosocial Functioning, which highlights key issues in the measurement of functioning. We then addressed improving research assessment, including issues of assessment in diverse populations and the need to capitalize on new data sources and new assessment technologies to advance assessment in mental health research. Finally, we reviewed and discussed areas for research and quality improvement, drawing on examples from the Department of Veterans Affairs to illustrate potential opportunities.

Psychologist suicide: Incidence, impact, and suggestions for prevention, intervention, and postvention.

Psychologist practitioners are not immune to some mental health problems, including suicidality, for which they provide services. In the aftermath of two recent psychologist suicides, the American Psychological Association's Advisory Committee on Colleague Assistance (ACCA) initiated the formation of a conjoint ad hoc committee consisting of members from ACCA, the American Psychological Association (APA) Practice Directorate, and the Section on Clinical Emergencies and Crises (Section VII of APA's Division 12) to investigate the incidence of psychologist suicide and its impact on colleagues, students or interns, patients or clients, and the profession. The committee reviewed the extant empirical literature on suicide rates for psychologists, evaluated unpublished data on psychologist suicide provided by the National Institute of Occupational Safety and Health (NIOSH), interviewed colleague survivors, reviewed published case reports of the impact of therapist suicides, and linked their findings to the literature on professional distress, impairment, and self-care. The committee concluded that there is evidence suggestive of an elevated risk of suicide for psychologists in past decades. It further concluded that there is a need for further research to confirm if there is a heightened risk of suicide for psychologists in the present day, and to determine factors that might contribute to such risk. Accounts from colleague-survivors suggest that the impact of a psychologist's suicide can affect many people including family, colleagues, students, and patients or clients. This article offers suggestions for possible preventive approaches, for intervention with potentially at-risk colleagues, and for postvention efforts in the wake of a colleague suicide.

Responses of a Sample of Practicing Psychologists to Questions About Clinical Work With Trauma and Interest in Specialized Training.

This study reports on selected findings from a survey conducted by the American Psychological Association Practice Organization, which assessed the number of hours per month that practicing psychologists estimated they spent treating trauma survivors and their interest in additional clinical training on trauma-related issues and topics. Respondents reported 14.3 mean number of hours spent working with trauma survivors over the past month. Of the 76% of the sample who treated any trauma patients, the mean was 16.9 hours. Although trauma psychology is not currently an integral component of the standard curricula in graduate-level education, generalist psychology practitioners are treating trauma-related concerns in their clinical practices. It is imperative therefore to ascertain if they are adequately trained in specialized trauma recognition, assessment, and treatment. The fact that almost 64% of survey respondents expressed interest in participating in educational endeavors to learn more about trauma-related clinical topics suggests that such a need exists and that more training opportunities, including ongoing continuing education offerings, should be organized.

Psychophysiological correlates of generalized anxiety disorder with or without comorbid depression.

It remains uncertain whether generalized anxiety disorder (GAD) and major depressive disorder (MDD) represent two separate diagnostic entities. The goal of this study was to examine whether comorbid MDD distinguishes individuals with GAD on a psychophysiological level during an experimentally-induced worrying procedure. Participants included 39 individuals with GAD, 14 of whom met the criteria for MDD. During the experimental procedure, participants were asked to worry or relax after an initial baseline phase while measuring their heart rate, high frequency heart rate variability (HF-HRV), skin conductance level, and subjective level of anxiety. The two groups did not differ in their subjective anxiety, heart rate response, and skin conductance levels. However, participants with comorbid MDD had greater HF-HRV values throughout the experiment than did those without MDD. At baseline, HF-HRV was significantly correlated with a self-report measure of depression. These results suggest that individuals with comorbid GAD and MDD can be distinguished based on HF-HRV from individuals with GAD but without MDD. These results support the distinction between GAD and MDD.

Three model curricula for teaching clinicians to use the ICF.

PURPOSE: Three systematic programmes to train health professionals to use the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) are described, along with efforts to evaluate their effectiveness. METHODS: The first programme was a randomized study comparing the effects of a 2-hour instructor-led programme and a self-directed learning module on ICF-related knowledge, attitudes, and coding skills among occupational therapy graduate students. The second programme was a series of intensive 3.5-day workshops for public sector rehabilitation professionals in South Africa. The third programme involved a series of internet-based teaching modules regarding the ICF for graduate students in rehabilitation counselling. RESULTS: The first project found that both instructor-led and self-guided training formats were effective in improving basic ICF-related knowledge, but only instructor-led training led to a significant improvement in coding skill. It also had more positive effects on ICF-related attitudes. This approach to learning assessment was generalizable to multidisciplinary health professionals in South Africa, who achieved a relatively high degree of coding accuracy after the 3.5-day workshop. Participant evaluations supported the structure, content, and length of the training. Students in the third programme also reported a very positive learning experience and positive views of the ICF. CONCLUSIONS: An empirical basis is important for identifying the best and most efficient training methods for particular audiences and specific purposes. The length and format of training can be differentially related to specific training goals (i.e., knowledge, attitudes, and coding skills). Interactive distance learning methods may help to overcome the weaknesses of self-directed training in comparison to face-to-face training.

Parity and the use of out-of-network mental health benefits in the FEHB program.

Two current congressional bills mandate parity for benefits for mental disorders with benefits for medical/surgical conditions in private insurance when mental health benefits are provided; the bills differ in regard to benefit levels and access to out-of-network coverage. This study assessed clinicians' and beneficiaries' participation in managed care networks in the national capital area under the Federal Employees Health Benefits (FEHB) parity program. Approximately one-third of the clinicians studied participated in FEHB networks, and only 44 percent of FEHB patients received care from network clinicians. Out-of-network mental health benefits are an important policy consideration to ensure access to mental health treatment under parity proposals.