Evidenced Based interventions in Mental health
How decisions are made within the treatment of psychological problems requires considerable thought and consideration.The purpose of this analysis is to look at the advantages of evidence based practice and how this can operate from a practical point of view and whether indeed it works as the most efficient and optimal approach to determining suitable treatment for psychological problems.
Workbook 1 – Evidenced Based Practice
The concept of evidence-based practice has gathered considerable pace in the last few decades and creates an acceptance of the idea that all practical decisions relating to medical or psychological treatment should be based on research and existing studies in the area which have been selected.This research should then be interpreted in a direct way and applied to the practical situation presented by using these observations as a theoretical basis (Chambless and Hollon, 1998).
When looking at this from a psychological point of view, which is preferred in this instance, evidence-based practice requires those engaged with this type of work to follow techniques based on research evidence that has already been presented.
Various different criteria and approaches have been used over the years for example Chambless and Hollon in 1998 noted that there are specific criteria which need to be complied with when looking to use any form of empirically supported therapy. According to these criteria, a therapy would be considered to be both effective and efficient if there is evidence available from two different settings that indicate that the proposed treatment has performed better than some other placebo style treatment. To support this the example of cognitive behaviour therapy, which has been proven to be effective across a variety of different patient types, including adults, children and adolescents. However as noted in the research by Chambles and Hollon; there have been instances whereby the criterion has not been applied rigorously or to the highest standard. This can then bring into question whether or not evidence-based practices are efficient, not because the evidence-based practice doesn’t work but because the criteria of admissibility have not been followed correctly.
An arguably more rigorous approach was taken by Saunders et al (2004) that suggest the research report being relied on should be put into six different categories depending on the theoretical background, such as the acceptance of the principal and any evidence of potential harm that is associated with the approach being looked at. In order to receive a classification in this manner, there needs to be some form of descriptive publication including, if necessary a manual as to how the operational aspect of the intervention work. This is arguably a much more rigorous approach as it recognises the various different ways in which evidence based research can then be used in practical decision making (Thomas et al 2010).
Finally it is worth noting that in reality the most likely approach is that suggested by Kauffman’s best practices which are used when looking at intervention experiences that have a similar other fact pattern available for analysis. This is then deemed appropriate evidence and the practitioner will then follow the process that is considered to be the best practice in this particular area at the current point in time. When looking at the practical reality of using this evidence-based research there is a strong argument to suggest that this is the best possible approach as it simply encourages those involved in the provision of medical services to look towards similar situations and to identify how the practitioners have dealt with these problems and learn lessons from any failure to improve the intervention that they themselves then offer. Quite simply, this is the process of learning lessons from other mistakes or indeed learning lessons from the successes of others.
When providing care for individuals with mental health difficulties, one of the key challenges can be to ascertain the level of intervention that is appropriate. There is a key distinction between treatment and facilitated learning when it comes to assisting individuals with mental health difficulties in achieving improvement in certain areas of their treatment. In order to understand the concept of intervention, it is arguably central to understand this distinction. Intervention refers to the point at which the individual practitioner chooses to directly engage and interact with the patient (Rogers, 2003). Arguably, both treatment and facilitated learning are on this spectrum, with treatment being a prescribed and deliberate action by the practitioner whereas facilitated learning is much more geared towards encouraging individuals to learn on their own account whilst being supported by the practitioner, particularly where there are substantial mental health issues which may require ongoing treatment to prevent an irrecoverable mistake from being made (Rogers, 2003).
A typical example of intervention in this type of situation may be that of therapeutic interventions which starts with the process by which the mental health professional themselves and service user develop a relationship that will enable them to discuss the best way forward (Griffiths, 2007).. This in itself can be used for therapeutic intervention, which will then allow the two parties to determine the best possible course of action example it may be that cognitive behavioural therapy is perceived to be the best way for and where this is the case. The combination of the two people will look towards establishing goals and agendas for this therapy. Depending on the nature of the problem and the extent of the damage that has been suffered it may be that professional has to take either a greater or lesser role.
The process of learning is crucially important for both the healthcare professional and the service user themselves in order to ensure that interventions are planned, implemented and regularly reviewed. Any form of treatment should be viewed as an ongoing cycle whereby the next stage is then planned before being implemented and there is a process of learning from the elements that work well and those which could be improved (Ryan, 2012).
As noted in the earlier part of this discussion, intervention involves a two-way dialogue process between the healthcare professional and the service user and therefore there is a continuously movement between the two entities as the professionals look for the best way to achieve the desired result by observing the activities of the service user . The service user is also then learning about the aspects of their treatment, which are being particularly productive with a view to becoming more self-sufficient over a prolonged period of time. When looking at the concept of learning in this broader sense the entire the entire intervention process facilitated learning can develop with both parties. Learning from each other and creating an effective strategy which may involve a completely different form of intervention at some point or another. It is argued here, however, that continuous learning is the central fact or as to whether or not intervention is ultimately a success.
By looking at the analysis above it is concluded that evidence based treatment is likely to offer a much deeper understanding of the treatment options available and crucially the practical likelihood of the success of such treatments. Intervention presents a real challenge as picking the precise point and level of intervention and it is argued here that intervention which is patient led will be more likely to be successful in the long run and should form a central part for this type of treatment.
Chambless, D., & Hollon, S. (1998). Defining empirically supportable therapies. Journal of Consulting and Clinical Psychology, 66, 7-18.
Griffiths, C., (2007).The theories, mechanisms, benefits, and practical delivery of psychosocial educational interventions for people with mental health disordersInternational Journal of Psychosocial Rehabilitation. 11 (1), 21-28.
Kaufman Best Practices Project. (2004). Kaufman Best Practices Project Final Report: Closing the Quality Chasm in Child Abuse Treatment; Identifying and Disseminating Best Practices.
Rogers, A., 2003. What is the DifferenceA New Critique of Adult Learning and Teaching, Leicester: NIACE.
Ryan, P., (2012). Empowerment, Lifelong Learning and Recovery in Mental Health: Towards a New Paradigm. Basingstoke, Palgrave Macmillan.
Saunders, B., Berliner, L., & Hanson, R. (2004). Child physical and sexual abuse: Guidelines for treatments. Retrieved September 15, 2006, fromhttp://www.musc.edu/cvc.guidel.htm
Thomas, M. Burt, M. and Parkes, J., (2010). Chapter 1. The Emergence of Evidence-based Practice, In McCarthy, J. and Rose P. Values-Based Health & Social Care: Beyond Evidence-Based Practice. London: Sage.