May is BPD Awareness Month
Nancy Gordon, LCSW
Welcome to the first edition of the FBPDA Clinician’s Corner Blog. Our goal is to provide monthly (or more frequent) articles written by mental health providers about topics of interest to FBPDA readers. Since my passion is to increase and provide adherent, evidence-based treatment to consumers and family members, and I’m involved in the DBT-Linehan Certification Committee, I’d like to talk about the importance of evidence-based treatment. I’ll write a separate article about the status of certification process for DBT in a separate article.
So, just what does “Evidence-Based” mean?
The most common definition of Evidence-Based Practice (EBP) is from Dr. David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett D, 1996) The Steps in this process include:
|1. Start with the patient — a clinical problem or question arises from the care of the patient|
|2. Construct a well built clinical question derived from the case|
|3. Select the appropriate resource(s) and conduct a search|
|4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)|
talk with the patient
|5. Return to the patient — integrate that evidence with clinical expertise, patient preferences and apply it to practice|
|Self-evaluation||6. Evaluate your performance with this patient|
Steps in the EBT Process from http://guides.mclibrary.duke.edu/content.php?pid=431451&sid=3529499
In order to “appraise and evaluate” there needs to be a way to track and measure progress. Research has shown that treatment outcomes are better when therapists use assessment tools to measure if the treatment is working or not. This could be through a tracking form like a diary card, a treatment plan, or more specific standardized assessment tools that therapists have available which have been shown by research to be valid and reliable for measuring whatever the tool is designed to measure.
Research to understand mental health issues, the brain and what treatments work is relatively new. “The mission of the National Institute of Mental Health (NIMH) is to reduce the burden of mental illness and behavioral disorders through research on mind, brain, and behavior. It is through NIMH’s research that strives to foster evidence-based interventions that are financially feasible, effective, available, and acceptable to persons living with mental disorders from diverse populations. ”(THE ROAD AHEAD: RESEARCH PARTNERSHIPS TO TRANSFORM SERVICES A REPORT BY THE NATIONAL ADVISORY MENTAL HEALTH COUNCIL’S SERVICES RESEARCH AND CLINICAL EPIDEMIOLOGY WORKGROUP MAY 12, 2006)
There is a National Registry of Evidence-based Programs and Practices (NREPP) created by the Substance Abuse and Mental Health Services Administration (SAMHSA). NREPP is a searchable online registry of more than 320 substance abuse and mental health interventions. NREPP was developed to help the public learn more about evidence-based interventions that are available for implementation. There is a rigorous review process to be accepted as an evidence-based practice or intervention by SAMHSA.
Don’t you want to insure that you are providing or receiving quality treatment that has been researched to be effective?
But just because someone SAYS they do evidence-based treatment, how do you know they are? Tune in next month to learn about the certification process to insure that the evidence based treatments are really being provided the way they were developed.