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MCP: Resources for Community Psychology Master Students: Evidence Based Practice

Evidence Based Practice in Psychology

Evidence Based Practice in Psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. The purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. (American Psychological Association)

Includes resources for:
* Best research evidence
* Clinical expertise
* Patients' characteristics, values, and context
* Clinical implications
* References

APA Policy Statement on Evidence-Based Practice in Psychology
(This statement was approved as policy of the American Psychological Association (APA) by the APA Council of Representatives during its August, 2005 meeting.)


Also check-out "Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know" in the Journal of Clinical Psychology (2007, vol 63, 7, pg 611-631).


Other commonly-used terminology used within EBPP is Empirically Supported Treatments: ESTs (what are these?) and Evidence-Based Psychological Interventions: EBPIs.


This guide will help you understand how and where to find evidence based information.

Use the tabs located above this box to:

  • Create a focused research question and search statement using the PICO worksheet.
  • Understand why it's important to identify your clinical study category.
  • Use the hierarchy of evidence to determine the strength of evidence of a published research report.

Before beginning a database search for evidence based information, write out your research topic as a focused question that summarizes what you're looking for. This important step helps you articulate your thoughts and helps you identify what you need before you begin searching for information. This saves you time and helps you create a targeted and organized database search.

You will want to include some very important concepts in that focused question that summarizes your topic. The PICO mnemonic will help you identify those key concepts. These concepts will eventually translate into the search terms that will be incorporated into your database search for evidence based information. Need a refresher on the basics of constructing a database search statement? This handout will help.

Use the PICO worksheet to identify the important concepts in your research topic. Don't forget to brainstorm synonyms and create a word bank of potential search terms. Searching with synonyms is the key to finding good information!

PICO concepts:

P (Patient population) What are the patient’s most important characteristics? (Consider their age, gender, and culture) or P (Problem) What is the primary problem?

I (Intervention) What main intervention are you considering?

C (Comparison) What will the main intervention be compared to?

O (Outcome) What are you trying to accomplish?

There are many types of research studies found in the published research literature. This hierarchy of evidence represents some of the more common types of quantitative studies that you will find in databases such as PsycINFO, CINAHL,  or PubMed MEDLINE.


TRIP (Turning Research Into Practice) Database  (Free) [Mentioned on the above graphic]

Simultaneously searches evidence-based sources of systematic reviews, practice guidelines, and critically-appraised topics and articles -- including most of those listed above and many more. Also searches MEDLINE’s Clinical Queries, medical image databases, e-textbooks, and patient information leaflets.

 

Read the APA policy statement on EBP to learn more about Evidence Based Practice principles and how they apply in psychology.

The following excerpt from the APA Policy Statement outlines the different research designs that contribute to evidence based practice and the type of questions they can be used to address.

  • Clinical observation (including individual case studies) and basic psychological science are valuable sources of innovations and hypotheses (the context of scientific discovery).
  • Qualitative research can be used to describe the subjective, lived experiences of people, including participants in psychotherapy.
  • Systematic case studies are particularly useful when aggregated (as in the form of practice research network) for comparing individual patients with others with similar characteristics.
  • Single-case experimental designs are particularly useful for establishing causal relationships in the context of an individual.
  • Public health and ethnographic research are especially useful for tracking the availability, utilization, and acceptance of mental health treatments as well as suggesting ways of altering these treatments to maximize their utility in a given social context.
  • Process–outcome studies are especially valuable for identifying mechanisms of change.
  • Studies of interventions as these are delivered in naturalistic settings (effectiveness research) are well suited for assessing the ecological validity of treatments.
  • RCTs [randomised controlled trials] and their logical equivalents (efficacy research) are the standard for drawing causal inferences about the effects of interventions (context of scientific verification).
  • Meta-analysis is a systematic means to synthesize results from multiple studies, test hypotheses, and quantitatively estimate the size of effects.

Questions related to the care of a patient typically fall into defined clinical scenarios or clinical categories. You will want to identify which category your research question falls under when searching for evidence based information.

Why is this important? Because each scenario is best addressed by a specific type of study. Identifying the clinical scenario helps you understand which types of studies to look for in a database. Some databases like CINAHL and PubMed MEDLINE even have filters that allow you to limit your search according to your clinical scenario! That saves you time and energy.

Common scenarios include: Therapy (Intervention), Diagnosis, Etiology/Harm, Prognosis, and Meaning

Melnyk and Fineout-Overholt (2015) provide guidance on which types of studies best address these scenarios. The studies are listed in order of strength, with the strongest source of evidence listed first (level 1). Synthesis or compilations of multiple studies typically provide the best evidence and are always level 1.

Therapy (Intervention) or Diagnosis
1.  Systematic review or meta-analysis of randomized controlled trials (RCTs)
2.  RCTs
3.  Non-RCTs
4.  Cohort studies or case-control studies
5.  Meta-systhesis of qualitative or descriptive studies
6.  Qualitative or descriptive single studies
7.  Expert opinion

Etiology/Harm or Prognosis
1.  Synthesis of cohort study or case-control studies
2.  Single cohort study or case-control studies
3.  Meta-synthesis of qualitative or descriptive studies
4.  Single qualitative or descriptive studies
5.  Expert opinion

Meaning
1.  Meta-synthesis of qualitative studies
2.  Single qualitative studies
3.  Synthesis of descriptive studies
4.  Single descriptive studies
5.  Expert opinion

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Books and eBooks

Databases

The best research evidence for a topic is typically found in the published research literature - which Alverno students can access through the library's databases. The PICO worksheet will help you brainstorm search terms and develop an organized search strategy.

Alverno librarians recommend these databases for finding evidence based information in Psychology: PsycINFO, PubMed MEDLINE, the Cochrane Library, and CINAHL,.

You will need the 14 digit barcode found on your Alverno student ID if logging in from off campus.

Need more information? Use the tabs located about the search box for some helpful tips.


PsycINFO provides access to citations, abstracts, and fulltext articles from the professional Psychology literature as well as from other related disciplines. It is found on the Alverno Library's Databases by Subject or Databases A-Z page.

Information on using PsycINFO is available here and PsycINFO tutorials are available here and here

To find find evidence-based reviews in PsycINFO:

  • Search by subject headings: Evidence-Based Practice and Best Practices are both recognized subject headings.  Combine both of these subject headings with a specific psychological term.
     
  • Limit by Methodology: Systematic Review is a Methodology limiter, so is Meta Analysis. There are many more.

This powerful and comprehensive database provide access to citations for millions of articles published in the biomedical research literature. The database has multiple features that allow users to refine a search - including Clinical Queries, which provides tools for finding evidence based resources.

First, a word of caution. PubMed MEDLINE is a free database available to anyone with an internet connection. Alverno students should always access this database through the library's website. This will provide access to publications found in Alverno's subscription databases, as well as articles available free to the public.

Tips for using PubMed's Clinical Queries:

1.  Access PubMed MEDLINE through the Alverno Library's Databases by Subject or
Databases A-Z page.

2.  From the PubMed homepage, click the Clinical Queries link located towards the center of the page and enter your search terms in the search box.

3.  PubMed will apply two filters (Clinical Study Categories and Systematic Reviews) to retrieve citations for evidence based articles from its vast MEDLINE database.

4. The Clinical Study Categories column displays citations filtered to a specific clinical study category. By default, articles related to therapy will display. Use the drop down menu to change the clinical category.

5.  The Systematic Review column displays citations for systematic reviews, meta-analyses, reviews of clinical trials, and other evidence-based resources.

6.  Review the citations and click on a link to access the article's abstract. If you accessed the database through the library website, you should see a blue "Online Full-Text" icon if the article is available in an Alverno database.

7.  Need help maneuvering through PubMed? Fortunately, the National Library of Medicine provides tutorials that will help you understand how to use this powerful database. Alverno librarians recommend the "Quick Tours". These are perfect for busy nursing students and provide just the right amount of information for most research needs.

The Cochrane Library is a collection of six databases that contain different types of high-quality, independent evidence to inform healthcare decision-making. The jewel among these databases is the Cochrane Database of Systematic Reviews.

Alverno students can access the full text Cochrane Systematic Reviews through the Cochrane Library database which is available on the Databases by Subject or Databases A-Z page.

First, a word of caution: The Cochrane Database of Systematic Reviews is a fairly small collection and it's possible that a Cochrane review may not exist on your topic - especially if it's obscure.

Tips for searching the Cochrane Database of Systematic Reviews:

1.  The Cochrane Library database is fairly easy to search. Simply enter your search statement in the default search box and click "Go". Your results will include only Cochrane systematic reviews - if they exist for your topic.

2.  The Cochrane Database of Systematic Reviews labels each review as either Protocol or Review. A Protocol icon indicates a plan or set of steps to be followed in a study (the review is not complete). A Review icon indicates that the Cochrane review has been completed. 

3.  The Cochrane Database assigns other icons to clarify the status of a review. Definitions for each icon type are listed below:

  • Methodology = A full-systematic review of methodological studies
  • Diagnostic = A full-systematic review of studies assessing accuracy of diagnostic tests
  • Overview = An overview of multiple Cochrane intervention reviews addressing the effects of two or more potential interventions for a single condition or health program
  • Prognosis = A systematic review of prognosis studies that address the probable course or future outcome(s) of people with a health problem
  • Qualitative = A systematic review that synthesizes Qualitative evidence to address questions on aspects other that effectiveness
  • Conclusions changed = There has been an important change to the conclusions of the review published in the most recent issue
  • New search - A new search has been conducted for an existing review as published in the most recent issue
  • Major change = The protocol has been amended to reflect a change in scope published in the most recent issue
  • Withdrawn = The review or protocol has been withdrawn, which may be because it was considered to be out of date. Reasons for withdrawal are specified in the document
  • Comment = The review include comments. Readers can submit comments, which are incorporated into the review together with answers and feedback from the review authors.

CINAHL (Cumulative Index of Nursing and Allied Health Literature) provides access to a wide range of articles published in the nursing journals. CINAHL is found on the Alverno Library's Databases by Subject or Databases A-Z page. You can use the database's Advanced Search feature to limit a search to evidence based resources.

First, a word of caution. Adding Advanced Search limits to a database search lowers the number of articles you will retrieve. Be judicious when building limits into a search. Adding too many limits can result in very few or even zero articles.

Tips for using CINAHL's Advanced Search feature:

1.  From the CINAHL homepage, click the Advanced Search link just beneath the search box. This will bring up a screen with multiple limits (filters) that can be incorporated into an CINAHL search. Several of these allow you to limit your search to evidence based resources only.

2.  The Clinical Queries filter allows you to select and limit a search using some of the common clinical study categories.

3.  The Evidence-Based Practice filter allows you to simply check a box and limit a search to evidence based resources.

4.  Finally, there is a box titled Publication Type. This allows users to select and limit a search to a specific type of research study. For example, you could limit a search to Level 1 synthesis reports such as meta-analysis or systematic reviews. Hold down the Ctrl key on your keyboard to select more that one publication type.

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Tutorials

Introduction to Evidence-Based Practice (Duke University Medical Center Library and the Health Sciences Library at the University of North Carolina at Chapel Hill)

 

Evidence Based Practice (University of Minnesota Health Sciences Libraries)

   

References for this LibGuide

Ciliska, D. (2006). Evidence based nursing: How far have we come? What’s next? Evidence Based Nursing, 9(2), 38-40.

Introduction to evidence-based practice. (2014). Retrieved from Duke University Medical Center Library & Archives website: http://guides.mclibrary.duke.edu/ebmtutorial

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare. Philadelphia, PA: Lippincott.