Category: Improved Use of Research Evidence
James Boswell, Ph.D.
Associate Professor
University at Albany, SUNY
Albany, New York
Shannon Sauer-Zavala, Ph.D.
Assistant Professor
University of Kentucky
Lexington, Kentucky
Melanie Smith, Ph.D.
Director of Training
The Renfrew Center
Boca Raton, Florida
Bethany Harris, PhD
Graduate Student
State University of New York (SUNY) at Albany
Albany, New York
Syed Aajmain, PhD
University at Albany, State University of New York
Albany, New York
James Boswell, Ph.D.
Associate Professor
University at Albany, SUNY
Albany, New York
Science-practice integration continues to be a core organizing principle of applied clinical psychology. Clinical research generates knowledge about evidence-based practice (EBP) that can be implemented by routine clinicians and systems. Clinicians and systems can also generate knowledge in ecologically valid contexts (Kazdin, 2008). This complement, or converse, of EBP is labeled practice-based evidence (PBE; Castonguay et al., 2021). Stakeholders can implement PBE to inform “local” practice, as well as the broader field (Boswell, 2020). Although several models exist (e.g., practice-research networks), a learning health system (LHS) aims to seamlessly integrate EBP and PBE. Internally collected data and experiences are systematically integrated with external evidence (EBPs), and that knowledge is put into practice in the system, as well as disseminated to relevant stakeholders. Key features of LHSs include: systematic gathering and application of evidence to guide care; employment of methods to share new evidence with clinicians to improve decision-making; capturing and analyzing data and care experiences to improve care; and continually assessing outcomes to refine processes to create a feedback cycle for learning and improvement.
This symposium will provide several examples of EBP-PBE integration. The first two presentations will focus on routine assessment and outcomes data from a system of intensive eating disorder treatment centers that functions as an LHS and has adopted and implemented two EBPs – a comprehensive transdiagnostic cognitive-behavioral therapy (CBT) treatment program (Barlow et al., 2017; Thompson-Brenner et al., 2021), and measurement-based care (MBC; Lewis et al., 2019). The latter innovation was critical to the process of CBT implementation evaluation and continuous quality improvement. In the context of the global pandemic, this system was forced to pivot to telehealth, and this required a shift in both CBT and MBC implementation. The existing LHS infrastructure helped stakeholders monitor the outcomes of the new telehealth program, and created an opportunity to further investigate its MBC tools. Presenters will report results from a pre-post telehealth cohort analysis of patient outcomes, as well as recent findings from a measurement-invariance study of the key system progress monitoring tool (Espel-Huynh et al., 2019). The third presentation will describe results from another LHS context, specifically, a county mental health department serving a large proportion of patients with severe mental illness that had similarly implemented MBC and was forced to shift to telehealth in the pandemic. In addition to addressing potential outcome differences as a function of telehealth (vs. in person), racial/ethnic minority patient pre- vs. post-COVID outcome disparities were also investigated. The final presentation will describe outcome moderator results from a randomized controlled trial that tested the efficacy of matching patients to therapists based on therapists’ historical outcomes derived from routine MBC tools (Boswell et al., 2021). MBC facilitated the collection of therapists’ own PBE, which was then harnessed to improve subsequent care decisions (Constantino et al., 2021).
Presenter: Melanie Smith, Ph.D. – The Renfrew Center
Co-author: Taylor E. Penwell, PhD – University of Louisville
Co-author: Gayle Brooks, Ph.D., CEDS-S – The Renfrew Center
Co-author: Heather Thompson-Brenner, Ph.D., FAED – The Renfrew Center
Presenter: Bethany Harris, PhD – State University of New York (SUNY) at Albany
Co-author: James F. Boswell, Ph.D. – University at Albany, SUNY
Co-author: Hallie M. Espel-Huynh, Ph.D. – Alpert Medical School of Brown University
Co-author: Heather Thompson-Brenner, Ph.D., FAED – The Renfrew Center
Presenter: Syed Aajmain, PhD – University at Albany, State University of New York
Co-author: Bethany Harris, PhD – State University of New York (SUNY) at Albany
Co-author: Adela Scharff, MS – University at Albany, SUNY
Co-author: James F. Boswell, Ph.D. – University at Albany, SUNY
Presenter: James F. Boswell, Ph.D. – University at Albany, SUNY
Co-author: Michael Constantino, Ph.D. – University of Massachusetts, Amherst
Co-author: Alice Coyne, Ph.D. – Case Wester Reserve University
Co-author: David Kraus, Ph.D. – Outcome Referrals, Inc.