The Evidence-based Practice of Applied Behavior Analysis Ronnie Detrich Wing Institute

The Evidence-based Practice of Applied Behavior Analysis

Ronnie DetrichWing Institute

Acknowledgments

Significant contributions from:

Tim Slocum, Utah State UniversitySusan Wilczynski, Ball State UniversityTrina Spencer, Northern Arizona UniversityKatie Wolfe, University of South CarolinaTeri Lewis, Oregon PBIS Network

Goals for Today

Have a conversation about comprehensive view of evidence-based practice.

Discussion Questions

• What does the term evidence-based practice mean to you?

• What counts as evidence?• What is a practice?

The Research to Practice Gap and Evidence-based Practice

• Long standing concern that decisions about interventions influenced by sources other than evidence. In medicine, it has been estimated that 10-25% of

decisions are based on high quality evidence.

• If evidence is not informing decisions, then question becomes what is. appeals to philosophy anecdotes opinions of experts

Evidence-based Practice and the Research-Practice Gap

• Across disciplines, great concern about the discrepancy between what is known from research about effective treatments and the interventions practitioners routinely employ.

• EBP is basis for closing the gap.

Why Do We Need Evidence-based Practice?

550 named interventions for children and adolescents

BehavioralCognitive-behavioral

Empirically evaluated

Evidence-based interventions are less likely to be used than interventions for which there is no evidence or there is evidence about lack of impact.

Kazdin (2000)

Research to Practice Issues

• The lag time from efficacy research to effectiveness research to dissemination is 10-20 years. (Hoagwood, Burns & Weisz, 2002)

• Only 4 of 10 Blueprint Violence Prevention programs had the capacity to disseminate to 10+ sites in a year. (Elliott & Mihalic, 2004)

How Does EBP Narrow the Research to Practice Gap?

• Practitioners must make decisions “now” even when research evidence is absent or incomplete.What is to be the basis for decisions?

• Decisions informed by best available evidence allows practitioners to: SelectAdapt to fit local circumstancesModify on the basis of progress monitoring data

• These decisions require professional judgment.

Evidence-based Practice as Federal Policy

“Where evidence is strong, we should act on it. Where evidence is suggestive, we should consider it. Where evidence is weak, we should build the knowledge to support better decisions in the future.”

(Zients, 2012)

Roots of Evidence-based Practice

• Evidence-based practice has its roots in medicine.Movement has spread across major disciplines in human

services.PsychologySchool PsychologySocial WorkSpeech PathologyOccupational Therapy

Roots of Evidence-based Practice

• Professional organizations began validating interventions as evidence-based.Mid 1990’s

Society for the Study of School PsychologyAmerican Psychological Association

More recentlyWhat Works Clearinghouse (Institute for Education Science)Campbell CollaborationCoalition for Evidence-based PolicyNational Autism Center

Roots of Evidence-based

• Most professional organizations have ethical guidelines emphasizing services are based on scientific knowledge.

Ethical Basis for Evidence-based Practice

• American Psychological AssociationPsychologists’ work is based on the established scientific

and professional knowledge of the discipline.

• National Association of School Psychologists School psychologists use assessment techniques,

counseling and therapy procedures, consultation techniques, and other direct and indirect service methods that the profession considers to be responsible, research-based practice.

• The Behavior Analyst Certification BoardThe behavior analyst always has the responsibility to

recommend scientifically supported, most effective treatment procedures. Effective treatment procedures have been validated as having both long-term and short-term benefits to clients and society.

What is Evidence-based Practice?

• At its core EBP movement is a consumer protection movement. It is not about science per se. It is a policy to use science for the benefit of consumers. “The ultimate goal of the ‘evidence-based movement’ is

make better use of research findings in typical service settings, to benefit consumers and society….”

(Fixsen, 2008)

Evidence-based Practice as a Decision-making Framework

What Is Evidence-based Practice?

• EBP is a decision-making approach that places emphasis on evidence to: guide decisions about which interventions to use;evaluate the effects of an intervention.

Professional Judgment

Best available evidence

Client Values

Sackett et al (2000)

Professional Professional JudgmentJudgment

Best Available Best Available EvidenceEvidenceClient ValuesClient Values

Two Ways of Thinking about EBP

• An intervention found to have strong research support. (Cook, Tankersley, & Landrum, 2009)

• Decision making process that informs all professional decisions. (Sakett, Straus, Richardson, Rosenberg, & Haynes, 2000)

One Term, Two Meanings=Terminological Confusion

• Using same term (EBP) to describe two different constructs creates confusion:Empirically supported treatments (EST)=interventions that

meet defined standards of quality and quantity.Evidence-based practice=decision making process.

Limitations of Lists of EBP

Benefits• Source for effective interventions.

Limitations• Must define what counts as a

practice. Manualized multi-component

interventions? For many clients there are no

validated packages. In such instances, evidence cannot be

a guide. Micro-practices such as social

reinforcement? So broad, there is too much evidence

and much of it not likely to be relevant to current clinical problem.

Must be operationalized to be meaningful.

• Any appraisal of evidence must begin with a clear definition of the unit of analysis. Otherwise comparing unequal units.

Impossible to make coherent statements about evidence-base

Advantages of Decision-making Framework

• Supports a cogent and transparent description ofEvidence considered, including direct and frequent

measurement of client behaviorWhy this evidence was identified as “best available.”How client values influenced the decision-making process.The ways in which clinical expertise was used to

conceptualize the case and integrate the various considerations.

• Provides a common framework for collaborating with professionals from other disciplines.

Evidence-based Practice and Applied Behavior Analysis

• EBP is framework for guiding decisions of practitioners.• Decisions are based on the integration of:

Best available evidence Client values and context Professional judgment

• Consistent with foundational principles of applied behavior analysis: Data-based decision making Consideration of client values Considerations of contextual fit Commitment to research-based treatment

Evidence-based Practice as Decision-making Framework

• EBP is an effort to improve decision-making in applied settings: by explicitly articulating the central role of evidence in

these decisions thereby improving outcomes.

The Challenge For Practitioners

• Solve a specific problem for a specific client in a specific context. Research base will be more or less relevant. Research base can vary from abundant to nonexistent.

The Practical Problem

• Even with insufficient evidence decisions must be made. What are practitioners to do?

Make the best possible inferences from imperfect evidence? (While recognizing that uncertainty is inevitable.)

Make decisions without relying on evidence?

Evidence-based Practice as Framework for Decision-making

If evidence-based practice is to be a pervasive model for decision making…then we need ways to identify and integrate the best available evidence when the evidence is imperfect.

Dilemma for Practitioners

• Practitioners must make many decisions daily.• EBP assumes there is evidence for all decisions and

that the relevant evidence is accessible.• How do practitioners incorporate evidence into all

decisions?

The challenge of Best available Evidence

Best Available Evidence

• What do we mean by “best”?Quality: research methods and outcomesRelevance: close match with our applied question in terms

of:ParticipantsTreatmentOutcomesContext

Amount: number of participants, studies, investigators

• What do we mean by “best available”?We should use the best of what is available,

This may mean using extremely high quality evidenceOr it may mean using evidence that is less certain.

“Unlimited skepticism is equally the child of imbecility as implicit credulity.”

Dugald Stewart

• The best available evidence should pervade the practice of Applied Behavior Analysis.What is the “Best Available Evidence” for ABA practice?How do we systematically identify it?

Quality

Low High

Relevance

Better evidence

Relevance(P, T, O, C)

Best evidenceBest evidence

Quality

Low High

Empirically-Supported Treatment

Need to GeneralizeUncertainty

Quality

Low High

Unit of analysis dilemma

Highly Specific:StudentsForm of

TreatmentTarget OutcomeContext

Conclusion:There is no reliable evidence.

Quality

Low High

Broader:StudentsForm of

Conclusion:There is some reliable evidence.

But relevance is a little less clear.

Quality

Low High

Very Broad:StudentsForm of

Conclusion:There is plentiful reliable evidence.

But relevance is unclear.

Is Reading Mastery 1 an effective program for beginning readers?Is Reading Mastery an effective reading program for beginning readers?Are Direct Instruction reading programs effective for beginning readers?Are direct instruction reading programs effective for beginning readers?

Little research available specific to Reading Mastery 1More research availableEven more research availableEven more research available Expansion has changed the initial question

Reading Mastery

Continua of Evidence

Quality of the Evidence

Personal Observation

Expert Opinion

Current “Gold Standard”High Quality

Randomized Controlled Trial

Uncontrolled Studies

General Consensus

Single Case Designs

Semi-Randomized Trials

Well-conducted Clinical Studies

Quantity of the Evidence

Janet Twyman, 2007

Meta-analysis (systematic review)

Single Case Replication (Direct and Parametric)

Single Study

Various Investigations

Repeated Systematic Measures

Convergent Evidence

Threshold of Evidence

Accessing the Best Available Evidence

1. Systematic reviews – The foundation Identifies empirically supported treatments

2. Alternative types of review Improve our ability to glean recommendations from imperfect

literature

3. Other units of practice - beyond the package Using what we know about intervention elements and principles

4. Progress Monitoring The best evidence about what works for this particular case

1. Systematic reviews

What Counts as Evidence?

• The term “evidence-based” has become ubiquitous in last decade.The is no consensus about what it means.

At issue is what counts as evidence. Federal definition places emphasis on experimental

methods.Preference for randomized trials.

Definition has been criticized as being positivistic.

• Ultimately depends on the question being asked.Even behavior analysis allows for qualitative evidence

(social validity measures).

• In evidence-based practice the goal is to identify causal relations between interventions and outcomes.Experimental methods do this best.

• Even if we accept causal demonstrations to be evidence, we have no consensus.Randomized Clinical Trials have become the “gold

standard.”There is controversy about the status of single participant

designs.Most frequently criticized on the basis of external validity. What Works Clearinghouse has established standards for single

participant designs.

Identifying Empirically-supported Interventions

• Identification is more than finding a study to support an intervention.

• Identification involves distilling a body of knowledge to determine the strength of evidence.

Systematic Reviews

• Systematic EBP review (e.g., WWC, BEE, NAC) Establish standards for:

Identifying research baseo Participantso Interventionso Comparisonso Outcomeso Settings

Quality of evidence Quantity of evidence

Unit typically limited to “programs” (treatment packages)

There are no agreed upon standards. It is possible for an intervention to be evidence-based using one

set of standards and to fail to meet evidence standards using an alternative set.

• Two approaches to establishing standardsThreshold approach:

Evidence must be of a specific quantity and quality before intervention is considered evidence-based.

Hierarchy of evidence approach:Best available evidence approach. Strength of evidence falls along

a continuum with each level having differential standards.

• Two approaches to establishing standardsThreshold approach:

Evidence must be of a specific quantity and quality before intervention is considered evidence-based.

Hierarchy of evidence approach:Best available evidence approach. Strength of evidence falls along

a continuum with each level having differential standards.

Empirically supported InterventionEmpirically supported InterventionEmpirically supported InterventionEmpirically supported InterventionEmpirically supported InterventionEmpirically supported Intervention

Most likely with threshold approach

Most likely with hierarchy approach

Effective IneffectiveEff

Positive

Negative

Positive

NegativeAsse

Actual EffectivenessActual Effectiveness

Effective IneffectiveIn

Choosing Between False Positives and False Negatives

• At this stage of developing empirically-supported interventions it is better to have more false positives than false negatives.

With false negatives, actually effective interventions will not be selected for implementation.

As a consequence, less likely to determine that they are actually effective.

With false positives, progress monitoring will identify interventions that are not effective.

“Best Available Evidence”Systematic Reviews

• Transparency & objectivity of process

• Rigorous review methods

• Reduced risk of false positives

• Rely on very high quality evidence

• Often fails to identify any problem-relevant intervention

• Unit = packages• Not informed by lower

quality evidence• Higher risk of false

negative.

Strengths Limitations

“Best Available Evidence”Narrative Reviews

• Allows for broad generalization from specific studies to implications for practice.

• Can incorporate many sources of evidence and logic/theory

• Lack of transparency regarding: Identifying relevant

research base. Selecting practices. Selecting experts.

• No strength of evidence rating

“Best Available Evidence”Best Practice Panels

• May include diverse perspectives: Researcher Practitioner Consumer

• Allows for broad recommendations

• Tend to include factors other than research

• Diversity may make consensus difficult

• Process may be more political than scientific

• Standards for identifying “best practice” may be unclear

• May lack transparency at all levels

• Tend to include factors other than research

“Best Available Evidence”What Works Practice Guides

• Allows for expert interpretation of research

• Interpretation linked to systematic review

• Includes “level of evidence” ratings – rating system is transparent.

• Requires greater generalization from specific research

• Depends on particular experts employed

• Process of generating recommendations is not transparent

“Best Available Evidence”What Works Practice Guides

14 Practice Guides78 Total Recommendations

Other Sources Of Evidence

Practice Elements/Kernals

• Interventions comprised of component parts. Many interventions for similar problem contain the same

elements (praise to interventions for non-compliance). Practice element=commonly occurring component of

interventions for a specific problem. Determined by frequency count.

Kernals=component of multi-component interventions. Must be experimentally verified as effective.

Practice Elements/Kernals and Uncertainty

• Elements/Kernals have never been evaluated in the current intervention. How do the current elements interact with each other? What is the proper dosage of each element?

Principles of Behavior and Instruction

• Fundamental units of our science.• Have resulted in significant improvement for many

social problems.

Principles and Uncertainty

• Principles are broad statements.• Decontextualized from any context.• For intervention, principles must be applied in a

specific way in a specific context.• The effectiveness of principles-based intervention is

uncertain because the existing literature may not be relevant to the current situation.

Client Values and Context

• 4.02 Involving Clients in Planning and Consent.Behavior analysts involve the client in the planning of and consent for behavior-change programs.

• 4.03 Individualized Behavior-Change Programs.(a)Behavior analysts must tailor behavior-change programs to the unique behaviors, environmental variables, assessment results, and goals of each client.

• 4.06 Describing Conditions for Behavior-Change Program Success. Behavior analysts describe to the client the environmental conditions that are necessary for the behavior-change program to be effective.

4.07 Environmental Conditions that Interfere with Implementation. (a)If environmental conditions prevent implementation of a behavior-change program, behavior analysts recommend that other professional assistance (e.g. assessment, consultation or therapeutic intervention by other professionals) be sought.

(a)If environmental conditions hinder implementation of the behavior-change program, behavior analysts seek to eliminate the environmental constraints, or identify in writing the obstacles to doing so.

Client Values

• Goals for intervention• Acceptability of interventions• Evaluation of impact of intervention

All reflect dimensions of social validity

Social Validity to Guide Intervention

Professionals’ Notions• Families most interested in

children displaying specific developmental skills associated with routines.

• Focus on communication skills.

Parents Preferences• Completing routines in

timely manner.

Strain, Barton, & Dunlap, 2012

Treatment

EvidenceValues

Basis for Choosing TreatmentSzatmari (2004)

Do Nothing

NoneUnethical

Clinical Paralysis

Do Nothing

Clinical Paralysis

Unethical

Toss a Coin

NoneUnethical in light of evidence

Do Nothing

Clinical Paralysis

Unethical

Toss a Coin

Unethical in light of evidence

None None

Training

NoneOutdated

lotsCurrent

Do Nothing

Clinical Paralysis

Unethical

Toss a Coin

Training

Outdated

Etiology

limitedDifficult

Do Nothing

Clinical Paralysis

Unethical

Toss a Coin

Training

Outdated

Etiology

limitedDifficult

Not very humane

effective

Not very humane

Do Nothing

Clinical Paralysis

Unethical

Toss a Coin

Training

Outdated

Etiology

limitedDifficult

Not very humane lots

Developmental Social cognitive

Not yetLove it

Developmental social cognitive

Love it Not yet

Inform Parents of Options

Do Nothing

Clinical Paralysis

Unethical

Toss a Coin

Training

Outdated

Etiology

limitedDifficult

To be Ethical:

ABANot very humane

Effective

Context

2.09 (c) In those instances where more than one scientifically supported treatment has been established additional factors may be considered in selecting interventions, including, but not limited to efficiency and cost effectiveness, risks and side-effects of the interventions, client preference, and practitioner experience and training.

Contextual Fit

• Not all settings can support all interventions. • Ability to implement a function of:

TrainingResourcesAcceptability of intervention.Environmental constraints.

• Making interventions a good contextual fit increases high quality implementation.Environments can be assessed for their current practices

and routines.

Clinical Expertise/Professional Judgment

Questions

• How many decisions do you make in a day?• Of those decisions, how often do you consult the

research literature?• If not consulting research literature what is basis for

decision?

The Clinical Problem

• Practitioners must make many decisions every day about services for clients.

• There is an ethical responsibility to make decisions in a way that most likely improves outcomes for clients.

• What is to be the basis for those decisions? Expertise is necessary and inevitable.

Definition of Evidence-based Practice

• Evidence-based practice:a framework for decision makingdesigned to improve outcomes for clients

• Evidence-based practice is the integration of: best available evidence, clinical expertise, client values and context,

as a basis for decision-making.

Client Values & Context

Clinical Decision

Clinical Expertise

Available Evidence

Clinical Expertise

Clinical Decision

Clinical Expertise

Clinical Decision

Available Evidence

Clinical Expertise

• To date, most of the attention has been given to best available evidence.

• Goal today: understand what clinical expertise is, the necessity and inevitability of it,and the limitations of it.

What is Clinical Expertise

Clinical expertise: competence attained by psychologists through education, training, and experience that results in effective practice.

(APA Task Force, 2006)

Why Clinical Expertise is Necessary

“Evidence doesn’t make decisions, people do.”(Haynes, Devereaux, Guyatt, 2002)

“The formalized experience of science, added to the practical experience of the individual in a complex set of circumstances, offers the best basis for effective action.”

Skinner (S&HB, 1953)

Why Clinical Expertise is Necessary

“When we do not know, we guess. Science does not eliminate guessing, but by narrowing the field of alternative courses of action it helps us to guess more effectively.”

Skinner (S&HB, 1953)

Clinical expertise is not the enemy;It is the means by which evidence contacts clients.

Why is Clinical Expertise Inevitable?

• All clinical problems are contextual.

“Clinical expertise is used to integrate the best research evidence with clinical data (e.g., information about the patient obtained over the course of treatment) in the context of the patient’s characteristics and preferences to deliver services that have a high probability of achieving the goals of treatment.”

APA Task Force, 2006

Why Clinical Expertise is Inevitable

“In those instances where more than one scientifically supported treatment has been established, additional factors may be considered in selecting interventions, including, but not limited to, efficiency and cost-effectiveness, risks and side-effects of the interventions, client preference, and practitioner experience and training.”

BACB Professional and Ethical Compliance Code 2.09c

“Clients have the right to effective treatment (i.e., based on the research literature and adapted to the individual client).”

BACB Professional and Ethical Compliance Code 2.09a

“The type of assessment used is determined by clients’ needs and consent, environmental parameters, and other contextual variables.”

BACB Professional and Ethical Compliance Code 3.01a

Why Is Clinical Expertise Inevitable?

• Practitioners always work under conditions of uncertainty.No outcomes are certain.

“The application of research evidence to a given patient always involves probabilistic inferences.”

(APA Task Force, 2006)

Components of Clinical Expertise

• Ethical practice• Knowledge of the research literature and its

applicability to particular clients• Incorporation of the conceptual system of ABA • Breadth and depth of clinical and interpersonal

skills• Integration of client values and context • Recognition of the need for outside consultation• Data-based decision making• Ongoing professional development

Slocum, et al., (2014)

Limits to Clinical Expertise

• Humans are flawed decision makers.

“Whenever psychologists involved in research or practice move from observations to inferences

and generalizations, there are inherent risks of idiosyncratic interpretations, overgeneralizations, confirmatory biases, and similar errors in judgment.”

APA Task Force, 2006

• “Biases” are efficient and often correct. Trouble comes when they are not critically examined.

Variables Influencing Clinical Expertise

Variables That Influence Clinical Expertise

Clinician History

• History of reinforcement and punishment for clinical behaviors

• Professional values (i.e., outcomes that function as reinforcers)

Experience alone is not sufficient for establishing clinical expertise (Dawes, 1994; Tracey et al., 2014)Deliberate practice (Ericsson, 2006)Availability of accurate feedback (Shanteau, 1992)

Client Outcomes

Client outcomes may reinforce or punish particular clinical behaviors

e.g., relying on parental report to identify reinforcers vs. conducting a preference assessment

But, clinicians may vary in sensitivity to client outcomes as consequences

Personal history, clinician history, rule-following (Hayes et al., 1986)

And, consequences are not optimal for shaping behavior Client outcomes are often delayed Often not a direct, causal relation between one clinician behavior

and a client outcome

Organizational Context

• Establishes motivating operations What outcomes are reinforcing?

• Sets rules and contingencies that can support or hinder clinical expertise and ethical practice “One size fits all” assessments and curricula Number of clients on caseload Available resources, access to research Use of decision-making flowcharts Data shares and feedback on decision-making

Geiger, Carr, and LeBlanc (2000)

Personal History

• History of reinforcement and punishment that shapes personal values (i.e., reinforcing outcomes)

• Influences receptiveness to principles of behavior and ethical standards of ABA

“Spare the rod, spoil the child” “You can catch more flies with honey than vinegar”

4.08a: Behavior analysts recommend reinforcement rather than punishment whenever possible. Professional and Ethical Compliance Code for Behavior Analysts (2015)

Training Program

• Preservice Training Coursework

Quality and quantity Rules (e.g., definitions and prescriptive recommendations) Contingencies (case-based learning, decision-making practice)

Supervised Experience Implementation of assessments and interventions Repeated application of decision-making in context Explicit feedback

• Continuing Education Contact with research and evolving ethical standards *Most do not have elements of deliberate practice

Behavior Analyst Certification Board

Direct and indirect influences on clinical expertise at various levels•Content standards: Task list, exam•Approval of course sequences and university supervision practica•Ethical and disciplinary standards•Supervision standards•Continuing education requirements

State and National Organizations

• Additional content standards and ethical guidelines for personnel preparation

• Conferences for ongoing professional development*Most do not have elements of deliberate practice

• Advocacy

Laws, Policies & Insurance Requirements

May constrain, or set the occasion for, organizations to support clinical expertise

Funding and reimbursement ratesMandated or prohibited assessments and practicesNumber of hours prescribed/reimbursed

Developing Clinical Expertise

• Minimum of 10 years of intense practice to develop expert performance.

• Deliberate practice: Immediate informative feedbackKnowledge of resultsRepeatedly perform the same or similar tasks

(Ericsson, Krampe, & Tesch-Romer, 1993)

• Create organizational culture that support decisions incorporating best available evidence and client values and context

• Create opportunities for deliberate practice in Specific clinical skills Decision-making

• Training programs/organizational contexts Set the occasion for explicit decision-making (“think-aloud”) Give immediate feedback Evaluate effects of the decision Incorporate decision aids

• BACB Recent changes: Task list update, ethics course, ethics

CEUs, enhanced standards for supervisionPossible considerations: Incorporate deliberate practice

• Laws and policiesProvide adequate reimbursement to enable reasonable

caseloadsRequire person-centered planning or family priorities in

treatment plans for reimbursement

Putting It All Together

Evidence-based Practice of ABA: Decision-making Framework

• Decisions are based on the integration of: Best available evidence Client values and context Professional judgment

Spencer, Detrich, & Slocum, 2012

Required fo

ethical p

ractice

Problem to be solved considering client

values and context

Empirically supported treatments

Other Lit ReviewsProfessional Judgment

Kernels

Other Lit Reviews

Elements

Other Lit Reviews

Kernels

Elements

Principles

Other Lit Reviews

Kernels

Elements

Progress Monitoring

Other Lit Reviews

Kernels

Elements

Progress

Monitoring

The End

Can We Get There From Here?

Sidman, The Behavior Analyst, 2006: “To make the general contributions of which our

science is capable, behavior analysts will have to use methods of wider generality, in the sense they affect many people at the same time- or within a short time, without our being concerned about any particular members of the relevant population.”

Systematic Reviews

• Reduced biasTransparency ObjectivityRigorous methods

• Reduced risk of false positivesExclusive reliance on

high quality evidence

• Often fail to identify sufficient evidence

• Not informed by lower quality evidence

• Higher risk of false negative.

Data-based decision making

Unit of analysis is individual

Unit of analysisis populations

Evidence isderived from experiments

Evidence isderived fromsystematic

reviews

Behavior Analysis

Evidence-based Practice

Practitioner mustknow laws of behavior

and how to apply

Practitioner must know how to implement

effectively

Similarities and Differences Between Behavior Analysis and Evidence-based Practice

Assumptionthat science

produces best outcomes

for consumers

• Most established standards for validating interventions as evidence-based give advantage to randomized trials for establishing the strength of the evidence.Often single participant designs have no standing or

significantly lower standing than RCT.

Quality

Low High

Better evidence

Empirically Supported Treatments

Quality

Low High

Empirically-Supported Treatment

Need to GeneralizeUncertainty

Quality

Low High

Evidence-based InterventionEvidence-based InterventionEvidence-based InterventionEvidence-based Intervention

Outcomes for Workshop

• Participants will be able to describe the two perspectives on evidence-based practice.

• Participants will be able to describe different types of evidence that can be used in decision-making.

• Participants will be able to describe why professional judgment is necessary and list at least two potential problems with judgment.

• Participants will be able to describe how client values shape decisions by professionals.

• Participants will be able to describe how context can influence decisions made by practitioners.

The practical problem

• Practitioners must often make decisions with insufficient empirical support.

• What are they to do?Make the best possible inferences from imperfect

evidence? Make decisions without using systematic evidence?

The practical problem

• If Evidence-Based Practice of ABA is to be a pervasive model for professional decision-making…

then we need ways to identify the best available evidence when the evidence is imperfect.

The Evidence-based Practice of Applied Behavior Analysis Ronnie Detrich Wing Institute

Documents

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Data-based Decision Making Cultures: Four Assumptions Ronnie Detrich Wing Institute Association for Positive Behavior Support St. Louis March 26, 2010

Treatment Integrity: Necessary but Not Sufficient for Improving Outcomes Ronnie Detrich Wing Institute

Association for Behavior Analysis Conference Sustainable Programs: In Search of the Elusive Randy Keyworth Ronnie Detrich Jack States

THOUGHTFUL SUSTAINABILITY Teri Lewis Oregon State University Ronnie Detrich Wing Institute David StandifordOregon State University ABAI, San Antonio, Texas

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