Gina Green - Evidence-based practice and and Peer Reviewed Practices

• best available evidence, combined with clinical expertise and consumer preferences
• organized in medicine and being called for in other disciplines
• are EBPs really evidence-based?
  • lost of kinds of evidence
  • some evidence is better than others
  • studies need to be scientifically sound
• many populate interventions for autism being promoted and "remarkably effective"
  • popularity does not equal proof
  • enthusiasm does not equal evidence
• why scientific evidence?
  • lots of less than adequate evidence
  • wasted time, money, energy
  • exploitation of vulnerable people
  • physical and emotional harm
  • lost opportunities to make real advances - we have to stop and "prove" others - impedes progress
• scientifice method - strongest evidence comes from (how did they get it?)
  • DIRECT testing of the intervention - on the people were receiving it
  • controlled experiments are crucial
    • groups or individuals
    • rule out validity threats
  • care in selection/assessment of participants
  • careful measurement - objective, accurate and reliable + treatment integrity
  • independent replication is crucial
  • peer reviewed and publication and scientific journals
• other evidence
  • indirect, subjective evaluations
  • surveys, questionnaires, personal accounts
  • UNCONTROLLED descriptive studies - not as conclusive
  • theories and speculations based on above or less
    • presented as evidence-based
  • inadequate comparisons of control and treatment groups
    • single group without control
    • fewer than 3 replications in single Ss
  • retrospective "chart reviews" (unless controls for bias are in place)
  • Conference presentations (few are peer-reviewed)
  • reports in self-published books or journals
  • discussion, theoretical, and position papers
  • self-report, anecdotal, testimonials, handouts, media reports, web
• protocols for EBP
  • team of expert reviewers and methodologists
  • will review the peer-reviewd empirical research
  • rate the scientific rigor of the studies adopted
    • use good science
    • measures both the dependent and independent variable
    • description/assessment described using valid and reliable methods
    • significance, generalization, and maintenance
  • reviewers take a bunch studies
    • info about costs
  • reliability is assessed
  • all are put together and recommendations are made
    • stronger studies increase
  • promising interventions are identified
  • consumer guidelines
    • peer reviewed
    • update and revise periodically
  • decreases bias
• EBP and autism
  • NY Department of Health (1999)
  • used us public health review guidelines
  • still most comprehensive but now outdated
  • National Autism Center (www.nationalautismcenter.org)
    • 0-21
    • focused interventions
    • packaged interventions
    • comprehensive interventions
    • anticipated completion date - June 2008 (this hasn't happened as of 1/09)
  • National Research Council - not as much
    • was somewhat biased - preconceptions
    • dud not used validated EBP protocol
    • recommendations seemed to be based on preconceived notions
• Summary of EBP
  • anecdotal - Floor Time, SCERTS? RDI
  • ineffective - sensory integration
  • harmful - AIT
  • limited scientific evidence - PECS, VB LEAP, TEACCH, incidental teaching - needs more data
  • substantial - ABA
• EBP and ABA
  • many ignore anything beyond randomized trial
  • ABA is often ignored - need more evidence
    • we need to educate others
    • encourage use in EBP studies
  • need to learn most rigorous methods
  • define gold standards for SSs
    • baseline/treatment, replication, measurement, continuous measurement,validity
  • we need to develop our own EBP
• organizational advocacy by behavior analysts
• some successes - CalABA symposium, New Zealand
• sound evidence protects us - keeps us from wating resources
• SUPPORT AND DEMAND THESE EFFORTS - ADVOCATE!
• only a few principles, lots of ways to respond.