 So I'd like to welcome everybody to today's presentation on using research to enhance your practice a lot of times when we think about research We think about those journals that just sit on the shelves in the library that we had to use when we did our Master's thesis or our doc work or whatever it was But we don't ever really go back to them again And it's such a shame because there's a lot of really awesome information there that we could glean Useful tools from or tidbits from that could help us better serve our clients So that's really what we're talking about today, and I would encourage you as we go through to think about Things that you variables you might want to measure in your client population Not only treatment success, you know going through the entire course without dropping out But also maybe types of symptom remission or even looking at special populations if you work with Clients that have chronic pain as well as depression and then you work with clients who don't have chronic pain, but do have depression looking at the differences between those two groups and what types of Treatments may be differently effective between those two or between those two groups So we'll talk about those as we go through We're going to briefly review statistical terms and concepts like I was saying before class started We are not going to get that deep down into the weeds We're going to stick with the really practical stuff because when you read an article when you go down to the results section they tell you if it was significant or not and in peer-reviewed journals and you know Reputable publications like I'm going to show you today. You can generally Take it at face value if they say there was a significant effect there was but we're going to talk about well But what does that mean even if it was significant for this group of people? Does that mean it applies to my clients? We'll explore the reasons to use research and places to review research So reasons to use it. Let's just start with you know, why am I here today? Identify new treatments that can benefit your clients. We read about things but by the time the media and you know Journalists have gotten to this stuff and they've put it out on the internet or they've gotten it to the mass media It's kind of old news. It's probably been in the journals for six months or a year So we might be able to get more on the cutting edge Especially if we have clients who are not making the progress that we would hope we might want to go in and see You know, what does the research say about treating clients that have concurrent depression and fibromyalgia for example? So we can look at new treatments that are coming out We can evaluate the veracity of claims about treatment effectiveness and one example I have here I don't want to stay connected right now This article talks about new medications for the treatment of depression and you know It's a really well-written article, but just saying you come across any old article on the internet Not necessarily one on a site that you know does their own internal peer review You want to make sure That when you go to the end of the article there is a list of References for further reading and they represent clinical journals I mean there can be some just general books or articles in there But you want to make sure that there has been some peer-reviewed research to back up those claims if we're thinking about using it with Clients so in this particular case there are several The journal of primary psychiatry Nature medicine, you know yada yada, so then you can go and read those articles yourself This one says full text, which means the full text is freely available So this one also and I'm going to show you how to do more research if you wanted to Look at that so It's important to evaluate the veracity of claims because a lot of times things come out and they say you know For example if you take This particular supplement it will cure your depression or it will Significantly improve your anxiety. Well, it might be true But how do we know and who did the test and was it was the research done in A way that promoted reliability and validity We want we can use research to ensure Existing treatment approaches are effective with your client population and when we talk about meta analyses We'll talk about how there's you know That's one little hiccup with a meta analysis because they combine a bunch of studies And it's very difficult to get a homogenous population in a meta analysis So if you've got a relatively homogenous population you work with primarily Upper income Caucasian females with depression and fibromyalgia. I mean that's a really specific population there Then we want to make sure that the research that you're looking at Applies to them a lot of research to general research is done on college students And you know if you're not working with college students, then that's not going to help There's also a lot of research that's done and you'll see in some of these searches that we do Overseas in Iran And you know other places Iran comes up a lot and they do a lot of research So what is the applicability of that research to our client population if we're talking about medication? Versus psychosocial treatments. There may be some differences, too So you want to be an informed consumer and you can use research methods to enhance the effectiveness and efficiency of your practice so for example, you may have Be working with clients with depression and there are multiple different methods for addressing depression and you decide Okay, let's look at letting you know our control group will let you know this group of patients experience the interventions that we normally use but then we're going to use a manualized practice not necessarily an evidence-based practice because we already talked about how those can be really expensive to learn and get signed off on but manualized Practices and we're going to use that it's a 12 week manualized intervention And you can look at it and compare these two groups the ones who went through the manualized program versus the ones who just worked with a Therapist and see if there's a difference in how long it takes for improvement the types of improvement the client satisfaction Yada yada, so there's a lot of different things that you can look at to improve Effectiveness and efficiency another way that you can use research and it's a lot easier to do When I worked as a manager, I had 18 clinicians working under me and they all had their strengths and so looking at Which clients did better with which particular? therapists I would be able to match clients to a therapist a little bit easier now some of it is just knowing like I had one Male therapist who worked with trauma So if I had clients with trauma, I would assign them to him unless you know There were some other issues that I thought would do better with a female Therapist that also worked with trauma, but they had very different approaches So using research looking at client satisfaction surveys. I identified some trends and that helped me with my initial patient placement and Did they always stay was I always spot on no You know sometimes we had to transfer because it was not a good fit But most of the time their treatment effectiveness and and their happiness with treatment was was pretty good So these are ways you can use research to help if you are in the public sector And you're getting state or federal funding to your agency your agency already does research They have to keep track of outcome measures successful completions Who is How many crisis center admissions? Sent six months in one year after they leave treatment, etc. There's a lot of data points That the funders want to collect so your agency may already be doing a fair amount of research But it like I said if you are working in a small practice, it doesn't mean you can't do research yourself and find ways To an enhance and improve your practice. So if you're seeing Attrition in one particular group, you know, you can look at that and go okay Let's look at what's going on here and try to figure out what is unique about that group that Correlates with the dropout rate. So brief review of terms validity Does the are you measuring what you say you're measuring? So if we're looking at effectiveness of a clinician For example in treating depression, how are we measuring that? What are what measures are we using to look at the improvement of the depression? Are we looking at the back depression inventory? What instruments are we using to measure that and are they valid and reliable for? Measuring depression Reliability means Is it you know over time does this thing still measure depression reliably? Can we count on it to? Continuously measure depression One thing we talk about is test retest reliability So if somebody has takes a test today and then you know They don't have any other interventions and they take the same test again a week from now They should score about the same if they've had no interventions in the meantime So we want to make sure that that's true and you can also do internal consistency and I'm getting down in the weeds here You don't care that much about it so you want to make sure that you're measuring what you think you're measuring and you want to make sure that You can do it repeatedly. So after this study is over you could do the same study again with the next group of people and Produce similar results You want to look at your population and this is a huge one for you to pay attention to Who are you working with a lot of research will tell you that if they looked at the age the The age the gender and the ethnicity of the participants to help you figure out does this fit my population For example We're going to get to this Article again in a minute This one looks at the efficacy and safety of SSRIs SNRIs and placebo in common psychiatric disorders a meta-analysis of children and adolescents Okay. Well, so we want to know what was the age range of the children and adolescents because adolescents technically can go up to 24 and And what was the youngest child that they were looking at if you're working with? you know six to ten year olds is this going to apply and You know in my heart, I would hope that six to ten year olds are not on antidepressants, but I know that's not necessarily the case so we want to look at Does the article and does the information pertain to your specific group of people and if not is it generalizable? You want to look at the sample size and Case studies are valuable for providing insight But if you really want to know the effectiveness of a treatment, you really want to look for a sample size that's greater than 30 So and and that's for one variable for every variable. Ideally you would have another 30 more So if they're studying multiple variables, the sample size should be significant When I had when I did my dissertation I had five variables I was looking at and my sample size was a hundred and eighty so you really want to make sure that your sample size is robust enough to Capture what you're looking at and it's going to help a lot with your reliability because if you have five people if One of those people has an off day. It's going to skew your data if you have 30 people and one person has an off day They're going to look like an outlier, but it's probably not going to skew your data as significantly I Know we carry I mean carrying a case load of 30 is you know all that unheard of please tell me because it's Almost not ethical. I can't think of that would be six clients a day. That's a lot and I know that in community mental health sometimes The push is to bill 30 hours a week but if you're billing if you're looking at the clients you're treating right now Your sample size may be a little bit smaller just because you don't normally carry a case load of 30 people that are Meet this criteria and and that's okay I mean you're not trying to get published in a referee journal You're trying to understand your own practice and what works with clients and what may contribute to attrition Blind and double-blind studies now when we do counseling It's not not possible to do a double-blind study a blind study is when the client or the Participant doesn't know whether they're getting the placebo or the treatment the double-blind study means that the person doing the Treatment and the person receiving the treatment neither one of them knows which one is placebo or the control group and which one is the treatment You can't do counseling without knowing what you're doing. I hope so you're not going to ever do a double-blind study But in a blind study for example, like I said before you may have 15 clients with depression that go through your normal course of treatment You just you meet with them you do their assessment you use rogerian or cognitive behavioral or whatever approach you use and you know Proceed as you have always done and ethical fine. They're getting treatment. You're not withholding anything great this other group of 15 people gets the manualized program that's 12 weeks and You know, you're not telling them well, you're getting a different treatment than this person over here because it's none of their business But they don't know necessarily that they're getting something significantly different Blind and double-blind studies become more important when we're talking about medication if the researcher knows which medication is Real and which is the sugar pill which is the placebo then they can inadvertently communicate to the recipient that you know, this is this is just a sugar pill or this is the actual treatment and it should be working and You know, a lot of times researchers don't do that intentionally it comes through their Nonverbals because for example, they may really believe in the medication and if they think they're giving the medication and it's not showing the results They expect they may show more distress on their face So you really want to look for double-blind studies when you're looking for effectiveness of medication the ABA design This is no treatment. This is what we're looking at. This is treatment the B and this is no treatment So if we don't do anything, we just keep going as we're going right now How is John doing? What is the progression? What is what are his depression symptoms? Maybe the treatment is to also add Going to support group meetings. So he goes to support group meetings for 12 weeks and you see if there's a significant difference in the rate of improvement of symptoms and Then you remove the treatment again if you really want to see if it was effective and see if his progress slows down You could do that most of the time if his progress is improved We're not going to take anything away, but and there are some inherent Issues with that when we're talking about mental health because ideally somebody's progressing And we want to see them continue to progress and once they've gotten past the initial Benefits then progress slows towards the end as they're solidifying their their treatment goals So we want to take that into account too ABA design is less Important in terms of research that you might do to enhance your own practice What you do want to look at is always making sure that you've got a control group and a treatment group Regression analysis are things that you can run and I will show you two online tools that you can use To identify the strength of the relationship between two or more variables so if you want to look at the strength of the relationship between How likely is it that if a person is? depressed and presented with and And had and presented with cognitive behavioral treatment How likely is it that they will improve you can look at if they are depressed and have fibromyalgia Which treatments are effective with them? So there are a lot of different things you can look at with the regression analyses, but basically it's a way of predicting What elements need to come together and align to create this condition right here? regression analyses can be fun because then you that's great for prevention tools because you can look and that's how they determine risk and protective factors You can look back and go well when people had four out of these five characteristics. They typically developed Major depressive disorder at some point in their life and you can say okay Well, if that's true, then let's look at intervening with the in those variable areas Meta-analyses. Oh, I already had it pulled up come back down here Meta-analyses are basically when researchers get together and they take studies that have already been done on a particular topic and this one We're still on the efficacy and safety of SSRIs yada-yada with children and adolescents so the researchers found as much research as they could on this topic and then They looked and they had a study selection. They wanted to make sure that it was randomized double-blind and placebo controlled So we've already kind of talked about that in order to make sure that The participants Had the same work kind of all starting on the same footing and the people that were taking Either SSRIs or SNRIs in youth Diagnosed with depressive disorder anxiety disorder obsessive compulsive disorder or PTSD Any other trials or any trials using other antidepressants Or tricyclic antidepressants or MAOIs those were excluded. So all we're looking at is the SSRIs and SNRIs in this age group So that gives you an idea, but what did you notice was missing? We don't have a Grouping so to speak and you'll find more information down later in the article about the different participants but it's a pretty wide range of Ages and we also don't have information about Gender is not they're not sorted out by gender and they're not sorted out by Race or ethnicity. So those are other issues that may confound it. So we're getting a broad idea for Children and adolescents in general if you wanted to know more and your particular population was working with Hispanic Americans then you'd want to tailor Your search a little bit to look at that, but this will give you a general idea Because we know that SSRIs and SNRIs have gotten a really bad Reputation and they actually have a black box warning on them for not using with children and adolescents because it can cause suicidality So that's one of the things that these researchers were looking at Now as a general consumer, you know, you're not planning on writing a dissertation on it You are just trying to figure out what's going to help your clients maybe one of your clients is 14 years old and was just put on an SSRI So you want to know a little bit more about, you know, what was the doctor thinking? Well, you may come across this article and go hmm. Well, let me let me look at it and see if you know These drugs actually can be effective Conclusion and relevance, you know, you want to look at the beginning To see who were the Subjects does this apply? Okay, so we've determined it does you're working with an adolescent or child Then you can just scroll down to conclusions and relevance SSRIs and SNRIs are more effective than placebo How however the effect is small and disorder specific Yielding larger effect. So it was you know, you see more improvement with Clients that have anxiety disorders than other conditions The response to the placebo is large, especially in those with depressive disorder So those with the depressive disorder, even if they were given the placebo also showed a Large improvement And serious adverse events were significantly more common in both groups than with placebo So that kind of gives you a summary now when you scroll down to the bottom If you haven't been in the research in a while, I won't go to each article this much It talks about limitations and then the conclusion section is much more detailed the what we were just looking at was the abstract of The conclusions if you want to get a little bit more down into the weeds you can come down here Like I said, if it's a peer-reviewed journal if it's showing up on PubMed or one of these sites that I'm going to show you You can probably take at face value if the researcher says yeah, it was a big effect or no There was no effect Or it was not a significant effect. So anyway enough with that study meta-analyses are also good for getting broad understandings of different issues like depression in The Asian American population or depression in people with fibromyalgia And then you can get further down into specificity in the weeds as you go The effect size and we're going to talk about this in terms of Well looking at research and looking at evidence-based practices But basically the short version is the effect size the higher the effect size the higher the correlation That's you know, I kind of distilled it down from what I originally was going to present to y'all Oops So in we've looked at the National registry of evidence-based and promising practices. We're going to look at The practices that are out there on bullying and we see that a lot of programs have ineffective outcomes But there's this one cool kids child and adolescent anxiety management program Has good results with anxiety disorders internalizing problems and may be helpful With these yellow check marks. So if you're working with kids that have anxiety issues, this might be a good choice But how strong is the effect size? What are we looking at? Is it worth your time to get your agency invested in it? Well, they used a confidence interval of 95 percent which again the short version is they can say with 95 percent certainty These results are accurate and The average effect size was point five five, which is you know better than average That's a significant effect size Generally, and I have it down here. Whoops. I took it out already an effect size of less than Point two is a very small effect size, but a point five five is significant So that would be a good one for that particular symptom Where do we find this research? Well pub med is one of the first places to start So the pub med you get here and you can do your initial search Let's look at the research out there on depression and bulimia. Well, that gives us a lot of stuff and What I like to do is I go through and I look at Freeful text whoops not full text but freeful text Because I don't have access to a University really close where I could go look at full text articles online So freeful text articles That are no more than five years old that are based on humans, otherwise we'll get a lot of rat studies and So that narrows it down, but that's still not necessarily giving me everything that I want so I might go to advanced and I find the most effective is To look in the title and abstract If you use the entire article, it's really easy for certain words like depression to come up So if you use title and abstract and you use the and modifier Let's just look at depression bulimia and ssri So we find a comparative analysis of effectiveness tolerance and cost of second generation antidepressants. This one's in france, but For what I was looking for It may give me what I'm looking at And it's talking about prosac in terms of its use and a couple of the other ssri's so Let's go with generalizability Well, it's in these are these are people in france, but how different Are is the biological makeup of people in france versus people in the u.s Um So we can probably use this as a launch pad to go back and search Maybe fluoxetine Because we know that fluoxetine is used with people with depression. So you're going to come up with a lot of that but what about using it in um patients that have Bulimia And it gives you what articles it has This isn't giving you I'm using something that's really narrow. We can look at And you can narrow down by english as well. So you don't come up with articles that are written in french This one talks about physical activity and exercise and chronic pain adults so What kind of alternative in interventions might your clients with chronic pain be able to use Determinance of quality of life and patients with fibromyalgia So this is looking at using a modeling approach to identify What things are most important to helping patients with fibromyalgia Feel like they're living a high quality of life So you can go and read that if you happen to have a client that is struggling with fibromyalgia And you know, they're seeing you because they're depression or something So it gives you an idea and it gives you a way to start looking and yeah, you've got to go through Some articles that seem totally unrelated However, you will find a fair amount of things that Do seem to do seem to fit and you just got to play with it a little bit You'll find your groove and which filters that you like to use That make it most useful for you Now directory of open source journals Whoops here it is. I already got it open This is another great site and so let's look for I just want to look for journals and we're going to talk about depression and full tech language English So these are journals that you can read for free and Access reviewed articles so clinical neuropsychiatry for example Let's look at depression research and treatment that sounds like more like what most people would be interested in um So this one is published in Egypt So some of the generalizability may be not so good, but it gives you a place to start The language in is in full text and this one start Exercise for adolescents with depressive disorders a feasibility study. So how feasible is it that it's going to work? And if you want to look at that You can read the entire Read the entire article So it gives you a place to get Good information, you know how they say that, you know, not everything on the internet is true And and that is very very true and there are a lot of claims that go out by, you know, well-meaning people i'm sure About how to address depression how to do this how to do that Well, let's go back to the horse's mouth so to speak and look at where's the evidence Where's the research before people start chasing Something and a client comes to me and they say I've heard that if I start taking this supplement That it's going to significantly cure my depression and I don't have to take my antidepressants anymore My first response is talk to your doctor. Don't change your meds on your own But then my second thought Is to take that information Because I probably don't know Diddly squat about that supplement and I go to these Sites and I start researching it to see is there any evidence for that And I will occasionally print out articles or abstracts or a bibliographic list that has clickable links for my clients and Point them in the direction of research that's easy to understand. I'm not going to give them something that is a You know super super difficult to understand journal article Because that would just be frustrating another even easier way Is google scholar and I closed that one. I think nope here it is Now google scholar you have to know to google google scholar in order to get into this database I don't know why they don't make it easily accessible from the main google homepage But google scholar is basically your Card catalog if you will of a lot of research that's already been done. So where we've already been looking This is an easy way to start. So we'll look at so looking at articles that match depression treatment and adolescence It tells you who wrote it what journal it was published in and where you can find it Now not all of these are going to be Freeful text, but it gives you a place to start So here's another one looking at prozac for acute treatment of depression in children and adolescents Cognitive behavioral treatment for depressed adolescents the effect of psychotherapy for depression and children a meta analysis The meta analysis might be cool because it can probably give you some ideas about what different types of psychotherapeutic interventions Have been used and that was actually done by the NIH. So it's probably freely available Nope, that's going to come up with under psych net Most of these you can access if you can get to a university They will have Subscriptions to these different databases. So if you can get into a university library You can access some of these. Let's see Let me look one more time. Oh, there we go came up this time And the full article is right here. We're obviously not going to read all the way through it, but it would give you More information about the interventions That were used this one says cognitive treatments fared no better than non-cognitive approaches. So that's Interesting in terms of working with children and adolescents and if you work with children that probably makes sense to you Um predictors and moderators have acute outcome in the treatment of adolescents with depression So that gives you another idea of different variables You want to look for if you've got adolescents coming in for What variables are most important to address in order to enhance? their success rate And yes, I spend way too much time reading these people ask me what I read for fun. I'm like journal articles Okay, so moving on those are three places that you can find legitimate peer reviewed articles that you can You know say with certainty that these studies were done relatively well and Some conclusions can be drawn and and not go well You know, I'm not sure if it's quack science or not but So those are three places that you can look a lot of the stuff is free already paid for by your tax dollars So make use of it Don't be afraid of the fact that it's a journal article. Like I said If you want to read all of the stuff about the selection and the methods and the statistical results you can However, for most of our purposes knowing the population Knowing kind of what they did and then jumping down to the conclusions Is all we really need in order to make an educated opinion About whether it's effective for us. So, you know, you don't have to worry about our squads and alphas and You know chi squads and all those other things that show up in the results section that make your eyes go kind of crissy crossy All right, so maybe you're wanting to do some research in your practice and you're wanting to measure depression Let's just stick really easy There are two places well three places, I'll show you but two main places you can go to find Validated instruments the boroughs mental measurements your book and tests in print and they're both on the same website, which makes it really nice Now this is another one you've got to go to a library in order to access but boroughs Um Has tests all the tests in there including descriptive information to professional review reviews and reviewer references So they have to meet a certain quality to be in the mental measurements your book and they have to have had um professional reviews done and and you know Be really squared away instruments. The other one Is tests in print And it's also done by a borough center for testing Test in print is a comprehensive bibliography to all known commercially available tests Currently in print in english in the united states. So if you wanted to find what assessment instruments are out there for Persistent depressive disorder i'm going to get that one of these days and not want to call it dysthymia anymore But what tests are out there that will look at persistent depressive disorder if any then you could go to tests in print And you know, they're going to be books in your library that they actually have the old-fashioned paper type things um, but you can also get into the database from a University library or you can buy them, but you can see they're really expensive. So unless you're doing a lot of testing It's probably not worth it um Another place that you can find some tests And i'm going to skip ahead Is uh SAMHSA the substance abuse and mental health services administration um, a lot of their taps and uh treatment improvement protocols You want to go all the way down to the improvement protocols not the cap keys. That's the cliff notes version and scroll down to um I know Tip 42 has some in them And if you're working with people with co-occurring disorders and you're looking for good assessment instruments, for example You could come to this treatment improvement protocol And they have screening and assessment instruments in the appendices in the back Or they tell you about the ones that are most useful and how to access them Can be downloaded from project cork website This one you can you need to go to psych cork. It tells you what the fee for use is um Project cork. Whoops core server not found now Every once in a while that will happen Anyhow you can find a lot of questionnaires and inventories In the back of these books as well and sometimes if you really want to You know kind of cut corners You can go and find the original publication of the Validation data on the instrument And you'll it will give you a copy of the instrument and the scoring key and everything um So if you can't find it anywhere else that is one place that you might be able to Go it takes a little bit of digging to find it, but you can do that so That's for instruments. Like I said, if you're doing your own research and you want to have a standardized instrument Or you're developing your own instrument. Maybe you Have seven different tools you use right now and you want to condense them all down into one Well in order to do that you need to measure that against other tools to make sure that Your instrument is valid. So You would want still want to have some Validated instruments to test against Um Sampsa is another good place to find research. We're already there um I already told you about the tips or the treatment improvement protocols And basically Sampsa has already done all the research and they put it into books for us and let's go back to Sampsa store for just a second and look at that You go to series And then you go down to treatment improvement protocols So you can find Basically meta analyses that have been put into layman's terms on group therapy services for primary care clinicians case management Treatment for people with physical and cognitive disabilities and even if you don't typically work with people who have substance use disorders A lot of the tips and information they give in here for working with persons with um Physical and cognitive disabilities is really helpful. They also have a program tip 57 Talks about how to provide trauma-informed care in behavioral health services So this is one that oh, I love this particular treatment improvement protocol But it's just there for the taking so we need to know where these Resources are that we can go and go. Oh my gosh. That is just such an awesome resource to have Sampsa also provides toolkits. Sorry jumped off of that one too fast So if you want to implement a program like an opioid overdose prevention program They have a toolkit for you and it's all set up It helps you know what you need to do Facts for community members essential steps for first responders information for prescribers safety advice for patients and family members and recovering from opioid abuse it is golly golly um The full tool you can download the full toolkit document which in this case is 28 pages It's not huge But it gives you all the guess what tools to implement this program And there they have a bunch of toolkits. You just need to Um Search through it a sort of community treatment problem gambling Um promoting mental health and preventing suicide So there's a lot of stuff here. You see why I get so excited about these different repositories Uh family psycho education evidence-based practices toolkit. Woohoo. It's an ebp and it's free So that's really cool Another one that you may not Probably or not familiar with because this is based out of canada the registered nurses association of ontario Has a bunch of best practice or clinical guidelines that are really helpful. Obviously we're not doing um medical work, but they do have Resources in here for helping patient nurses Face with patients assessment and management pain is a good one. I've read that one If you've got clients with diabetes, this is a good place to go Care transitions crisis intervention both of those are excellent um resources if you've got a client maybe who is um Going into residential treatment for a while or having to transition to a long-term care facility Delirium dementia and depression in older adults assessment and care. This is going to apply To us, um, there's going to be some information about medication in there But there's also a lot of counseling that nurses do. So there's obviously Like 15 pages here that you could go through and find different research-based practices The apa The american psychiatric association also has practice guidelines And they're for free You just scroll down here and you say What are we looking at and psychiatric guidelines quick reference guide? You can look at their guideline for acute stress and PTSD now since it's put out by the american psychiatric association guess what it's going to be a lot heavier on What pharmacological interventions and kind of hospital-based interventions work best? But it's good for us to know that way when we have a client come in who has PTSD And they're on x and so medications and yada yada. We understand the rationale behind it and The final way to find good guidelines Whatever browser you want to use you don't have to use google for this one But just google the term um So whatever you're looking for depression alcoholism fibromyalgia, whatever disorder you're targeting And the phrase best practices And you will come up with evidence-based practices Highlights and overviews of best practice from the british medical journal um british medical journal psychiatry online So this is a quick way to find what best practices are out there for treating a particular disorder Conducting your own research Like i said earlier you want to sample size of at least 30 if possible not necessarily always possible Make sure to define your variables. So if you're looking at comparing the effectiveness of group versus individual counseling You want to make sure that all things are being equal what if they're in group counseling How many hours a week are they being seen versus how many hours an individual? and So if you're comparing three hours of group per week to three hours of individual per week, which is more effective Or are you comparing and it's you know possible to do three hours of group versus one hour of individual which one You know, do you get more bang for your buck for? You can compare self-help books versus counseling You can compare clients that you give a self-help manual and they work through it as homework versus clients that just do counseling in office and the occasional Out of a homework assignment that you give them You can look at clients coming through your program who are on medication versus those are that are not on medication and what their outcomes seem to be Now you're going to have to define you're going to Ask yourself. Is it the medication? when it comes when the information comes out maybe The clients that were On medication showed a much greater improvement. So then you want to go back and say Was it the medication or was there also something else that was going on with this population? Always look for confounds always look for that other variable that wasn't controlled for that made all the difference And like I said earlier, you can use research to match client profiles with particular therapists So you know that therapists A tends to do better with this particular type of client maybe adolescence Because some people bond really well Some people really do well with clients with borderline personality disorder for example more power to them Eliminate confounds like concurrent diagnosis So if you're looking at group versus individual treatment for depression You want to make sure that the people that you're measuring everybody that you're looking at the only diagnosis They have is depression because if you've got some depression and anxiety and depression and PTSD and Other things in there. It's going to muddy your results a little bit Um other confounds could be age and culture, you know, you can't compare adolescents to adults as in terms of what's effective because what's going to be effective is probably different And that can also be Looking at the geriatric population versus People in their 30s and 40s different things are probably Going to be effective with the different age groups Culture and we're going to talk a lot about culture in the coming weeks A lot of cultures don't do well Because it's not culturally sensitive in group therapy Group therapy group therapy. They can do fine in psycho educational groups, for example But they're not going to be as productive in intensive group therapy So you want to eliminate any confounds that might skew your results Design your own study. Who are your participants? So you're you're getting a clearer idea of who you're going to look at Who are your clients if you're going to look at your clients in general, you know How are they defined? How will you implement it is everybody going to go through this for you know, all your clients will go through it for Six months and then at the end of six months you will go back to Doing it the old way kind of an av design Or are you going to split your clients? So half of them that are randomly assigned to this particular approach And half of them are randomly assigned to the other What instruments are you going to use to measure it? What is the age and attention of participants? So sometimes, you know, you got to Pick things up a little bit because you can't expect a 14 year old to focus on a hundred question questionnaire It needs to be much shorter How will you maintain participation and get people to go through the entire course of treatment so you can get good data Consider having all study designs reviewed by an independent reviewer or review board This is for ethics and legality just to make sure there's nothing that you're overlooking that could be harmful to the client And ensure patients provide informed consent to participate. So if you're introducing a treatment To a group, um, you may want to consider having them Sign an informed consent if you are collecting data on them It is ethical to have them signed an informed consent, even if it's just for your own use Ideally if you're going to, um, Have something come out of that data you want to make sure that everybody signs the informed consent You can measure variables by using objective tests the instruments that I showed you Or and or your analyses if you're talking about drug testing You can you use likert scales for client self-report, but with a likert scale you want to focus on symptom goals ideally so days without crying or Time that you are happy or You know, whatever you want to use anchors on your like likert scales and avoid odd numbers to get the best results So for example, um If you ask a person, you know, how did you feel today and one is either lousy one is lousy Um It could be rarely, you know, how often are you crying now? Rarely. Well, how often is rarely 20% or less. Okay. So are you crying 20% of the time or less? Another way you could define it would be One day a week So one day a week. I'm having a really bad day. So I'm not having having them that often Or less than three hours a day So obviously don't give them all of these But try to find some sort of anchor so clients know I always hate when I see a likert scale and it says sometimes often Never or very often. I'm like How do you define give me a percentage? I like percentages that makes me happy But that will get you much more reliable results if you provide some sort of an anchor So patients understand that you know How how depressed were you to how long were you depressed today 20% of the day 50% of the day Up to 80% of the day or more than 80% of the day And that'll kind of give them a little bit of wiggle room And these numbers one day a week or less than three hours per day Correspond to that percentage because some people are going well. What's 20% of a day? Yeah So then conduct the research gather the data and analyze the data and stat pages dot info and quantitative skills dot com slash cisa Are two places that you can go to do rudimentary statistical analyses for free online So if you get really into that stuff These are the places that you want to start Before you invest in something like the statistical package for the social sciences or spss, which A lot of us used when we were in grad school It does beautiful graphs if you like doing graphs and all that kind of stuff spss is the way to go but Again, that's another huge investment not only to learn how to operate the software but cost of the software You can also create your own instruments But you want to test for internal reliability, you know, sometimes you take a test and you're like you just asked me this basic same question four times Well, that's testing for internal reliability to make sure that These different questions that are getting at this concept. We get the same answer for them So we want to make sure that the questions are testing what they're doing Um test retest reliability if you give it to somebody on friday, then you give it to them on monday it tests the same and You know, obviously clients are going to have to agree to that because they may look at it and go. I just did this friday And concurrent validity and that's when you take a standardized test that has already been proven And you take your test that hasn't been proven yet and you give them both to your client jimbab And you say take both of these so you're you've got an instrument that you created to measure depression and the beck depression inventory, for example Give them both to the client. He completes both of them Theoretically both of them should come up with the same result And if they don't then there's no concurrent validity if they do Then you've got concurrent validity and you can be pretty certain that your Your instrument also measures depression So research can be used to identify new treatments that can benefit your clients evaluate the veracity of claims about treatment effectiveness Ensure existing treatment approaches are effective with your client population And you can use research methods to enhance the effectiveness and efficiency of your practice There are multiple sources to help you identify effective instruments and best practices We went through those you can go click on the links and poke around And you can also conduct your own research to monitor program and intervention effectiveness um So again, some of the ways that you might look at using it for increasing Efficiency in your practice would be for example looking at if I pulled these Eight topics that I generally go over with everybody an individual out and I had them do it in a psycho educational group Or by watching a psycho educational video and completing the worksheet Versus going over it in individual Is it as effective? if so Then they can do that when they're at home and bring it back into individual and you can spend more time doing counseling and potentially Shorten the counseling time so you can see more clients. So Alrighty That is all I have for you today. Thank you guys for sticking with me. Are there any questions and your Brain is probably going. Oh, yeah, I remember why I didn't like stats in high school or in college. Um Alrighty everybody. I don't know what populations and issues you particularly serve in your practice I encourage you to go poke around in some of those things and see what resources what gems you can uncover that can Help you and potentially help your clients Have a great day and I'll see y'all tomorrow. We're going to be talking about communicating with persons with cognitive disabilities