Researchers, healthcare providers and health policy advocates still continue to debate what specifically defines evidence-based practice. They argue over the merits of the evidence for various interventions and how the evidence is utilized and integrated.
Yet the fact still remains that the implementation of evidence-based practice measures is becoming a widely-recognized topic because it focuses on how research findings can appropriately be applied to clinical practice.
Evidence-based practice interventions have not only led to advancements in psychotherapy research, but they have also found their way into other disciplines. This has led to more people and more professionals employing this approach in their clinical practice.
There is a movement toward clinical practice that is guided by evidence supporting the efficacy of a particular intervention based on clinical trials, and also factoring in the patient's needs, values and preferences. This all culminates in the decision-making process of how to appropriately address a client's particular problem.
First of all, specific components can be instrumental in developing an evidence-based practice, which should be taken into consideration before the decision is made to apply a specific approach or intervention to any client. Not every treatment can be considered an evidence-based treatment, because it may not have been studied in a controlled, empirical study. This is a major factor that must be taken into consideration before implementing an intervention.
It is important that a therapeutic intervention is informed by evidence demonstrating its efficacy either with at least one randomized control trial that employed good experimental design and techniques, or through a large and well-designed clinical replication series. Also, an investigation should focus on whether the evidence-based practice is the combination or integration of the most well-researched evidence, clinical expertise and patient values.
It is important that one factor does not serve to overshadow the importance of another factor when it comes to formulating a treatment plan for a client. While there may be clear evidence to support the use of a particular therapeutic approach, consideration should also be equally given to patient values and clinical expertise in the treatment decision-making.
The components of existing evidence, clinician's expertise and patient preferences, culture and values are viewed as essential aspects when it comes to selecting the most relevant therapeutic intervention to apply to a particular case. If the collaboration of three of these components are not factored into an evidence-based practice, it can bring up questions about the merit of any particular intervention, technique or strategy.
Furthermore, evidence-based practice resembles the scientific method. Both employ the use of systematic steps that involve asking a question and working to arrive at an answer.
The scientific method asks a question, formulates a hypothesis and performs background research to determine whether there is evidence to support or refute the hypothesis. Within the scientific method, one goes through the process of conducting an experiment to test the hypothesis, collecting data and then analyzing the data to determine whether the hypothesis is true or false.
The same process can be observed with the use of evidence-based practice as the clinician makes hypothesis about a client's problem and which treatment approach to employ. In order for a particular treatment intervention to be considered efficacious, it must undergo an experimental process where research results are collected and analyzed to determine whether the intervention can be employed in clinical practice.
The performance of experimental tests is a key aspect of both the scientific method and evidence-based practice, because the results help clinicians during the decision-making process when it comes to which treatment is supported by evidence.
The value of case conceptualization is that is can prove to be instrumental in helping clinicians to organize and think about clients' presenting issues and the step-by-step process that goes into addressing them. It can help a practitioner to think clearly in order to navigate through the complexities that might be associated with clients' issues.
Case conceptualization is considered to be a comprehensive process that allows for the organization of clinical data while making conceptual tasks operational for the clinician. The practitioner undertakes a mental activity that involves a series of steps, such as identifying pertinent data, the client's presenting problem and any relevant history (social, environmental, internal factors, etc.). During the interviewing stage, the practitioner gathers a large amount of this information.
The practitioner then must work to integrate the information to devise a treatment plan. The assessment method allows for a great deal of case conceptualization, because it allows the practitioner to identify and observe the client's clinically relevant behaviors that might be associated with his/her presenting problem, the events that occur before a specific behavior that have the ability to influence it, and the consequences that can arise from undertaking a particular behavior that either help to maintain, increase or decrease either a desirable or undesirable behavior.
Case conceptualization
The step-by-step process that is associated with case conceptualization which focuses on eliciting client information, formulating hypotheses, and understanding the clients and their treatment is important because it allows for better direction and decision-making process when addressing a client’s problem.
The case conceptualization exemplar serves as an organized method for understanding a client's case and the individualized sections are integrated to come up with recommendation for treatment interventions.
First of all, the problem identification and definition section helps a practitioner to know why a client is coming in for treatment and the question that must be answered by the end of the assessment to appropriately help the client. The problem that is identified should accurately reflect the client’s presenting issue and should define who is observed in the particular client. The client provides his/her reasons for seeking out treatment, and this serves as the basis for what the practitioner has to address.
Secondly, the section of contextual consideration focuses on those ethical, legal, cultural or other factors that should be considered when it comes to formulating a treatment plan for the client. Clients come from all walks of life, so the beliefs, opinions and values of one client can be vastly different from another. A one-size-fits-all method cannot be taken when it comes to addressing clients' problems, so this allows for the development of a treatment plan that is both individualized and specific
For instance, different cultural groups may require different counseling processes, so this has to be taken into consideration when formulating a treatment plan so as to increase the chances of a client meeting his/her treatment goals. Based on the standards that govern a clinician's practice, he/she must abide by certain ethical and legal principles when treating the clients in order for them to continue to practice.
The diagnosis section is becoming more of a requirement, so a classification is given to clients based on the multiaxial system:
- Axis I: Clinical disorders
- Axis II: Personality disorders, mental disorders
- Axis III: General medical conditions
- Axis IV: Psychosocial and environmental problems
- Axis V: Global assessment of functioning
This helps clinicians to plan treatment and predict the outcome. For each axis of the diagnosis, it is important for a clinician to provide clinical justification or reasons for why he or she selected the diagnosis.
The theoretical conceptualization section can provide a clinician with direction when it comes to formulating a therapeutic intervention. The theoretical orientation that a clinician aligns with can serve as the basis for how to approach a client's problem.
The treatment plan section is based on finding out what is the treatment or change intervention that is most likely to be useful to the client. The client's strengths can be instrumental in the change process.
The identification of barriers that might be associated with the successful implementation of the treatment plan can bring to light those impairments that might interfere with a client making a change so this should be taken into consideration because some activities may prove to be a challenge.
The ability to define specific goals can help a client work toward engaging in behaviors that can lead to accomplishing those goals and having identified those obstacles that can affect goal achievement can better prepare the client to tackle them when they do appear.
The interventions are considered those actions the clinician designs to help a client reach a specific objective within a specific time frame (modality/duration). If the objective is not reached after this time frame, a new one may need to be added.
The measure of progress is to be actively performed by the clinician over the course of the treatment. If sufficient progress is not observed, a clinician has to make the decision as to whether to change the approach. The initial treatment plan that is devised by the clinician as well as any subsequent changes that are made should be empirically supported by research evidence that has demonstrated efficacy and successful outcomes.
In conclusion, the sections of the case conceptualization exemplar are related to one another in one degree or another. First of all, the problem identification and definition serves as the basis for the development of all of the other sections. If there is not a problem to address with a client, then there is no direction to take with a case.
The subjective information that is provided by the client can serve as the basis for some of the contextual information. The diagnosis section encompassing Axis I-V, the contextual considerations and the theoretical conceptualization can all culminate in the development of the treatment plan for how to best address the client's problem.
The contextual consideration can help to determine which treatment intervention might be appropriate based on what may be considered acceptable for his/her culture. A client's age or the presence of physical or mental disabilities can also determine the approach that should be taken given these circumstances.
For some clinicians, the selection of a theoretical orientation that best explains the client's problem can prove to be important in developing a treatment plan because there might be data that already exists as to how to address the client's presenting issue.
Overall, the integration of all of the information from all of the sections of the case conceptualization exemplar is focuses on understanding the presenting issues and devising strategies for how to effectively resolve the problem.
