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Monday, April 13, 2009

Improving the Evidence-Based Practice Movement

We know that a problem solving approach is outcome-focused, data-driven, integrally linked to intervention, and context-specific.

Evidenced-Based Practice (EBP) as a problem solving approach “refers to a body of scientific knowledge, defined usually by reference to research methods or designs, about a range of service practices (e.g., referral, assessment, case management, therapies, or support services)”. It is directly related to applying data-orientated problem solving to students’ mental health and social-emotional needs. When deciding which type of EBP is appropriate in the school setting, we can take into consideration some of the most effective strategies:

· Parent Management Training (PMT)
· Cognitive Behavioral Therapy (CBT)

(For additional information on PMT and CBT please see the link below:)
· Psychopharmacology (using psychostimulants/medication)

These are only three of many new approaches developing among contemporary literature. With all the different types of methods of intervention and prevention under the EBP umbrella, how do we decide which one will work best for us? Seeing that this method of practice is fairly new, how can we begin to shift the paradigm from traditional to an EBP approach? Do you agree that practicing school psychologists traditionally trained (i.e., relying on clinical judgment rather than the scientific method or the empirical literature) are the primary offenders of underidentification and misidentification of mental health problems in school settings?

This blog was created by Jamie Cowan and Tahina Reyes


Laura M said...

I personally, don't think any of us, as graduate students, are qualified or experienced enough to answer that question. I will leave that question to the people who actually have experience working as school psychologists. I wouldn't possibly presume to know why there is underidentification and misidentification of mental health problems in school settings. I do think that it is probably more complicated than traditional school psychologists relying on clinical judgment.

I don't feel comfortable calling the current employees of our future profession "primary offenders" as if they are doing something wrong and we, as students know so much better than they do. How could we possibly be qualified to comment on this question when we're just students who have never worked even one day as school psychologists?
However, everyone needs to be open to change, progress and new ideas to promote growth in our profession and to better serve students. Implementing new ideas and interventions will probably take time as new students graduate and start working in the system armed with all the latest ideas and research about what works best. It has to be gradual.

Jamie Cowan said...

Perhaps Tahina and I should have worded or posed our questions/thoughts a little differently. By using the word "offenders" we did not mean to imply that we as students know so much more, because I completely agree that as students most of us would not know where to begin with answering some of the questions or putting what we read in the text into real-life practice. What was meant was that throughout the reading of the texts and other research articles there is the controversy of quite often misdiagnosing or overdiagnosing students, we were attempting to tie in thoughts of that in regards to discussing if once we are school psychologists and using EBP will it cut-down on the current misdiagnoses. Our blog was more directed towards giving something to think about and discussion than looking for correct answers to the questions posed.

Angelica said...

I feel that despite the new advances with the EBP interventions and plans, misdiagnosis will still continue to exist due to the other varying factors that underly it, for example, biases in testing, misunderstanding of student observations and unclear results. A school psychologists own cultural views and perspectives also play an important role in within these misclassification problems. I definitely feel that using EBP's as an initial method to decrease this misclassification issue is a great first step. Although it may not completely eliminate the issue, it will definitely give us past research and information to base our focus and attention on. I also feel that school psychologists need to be aware of their own biases and of their techniques in order to overcome some of the biases and misclassification problems that arise. I do not feel it is the 'trained' school psychologist's fault. I do feel that we need to experiment a little with the field and put varying methods into practice to see which method would best positively improve this issue. In regards to the shift and transition from a more traditional approach to an EBP centered approach, I feel that it will occur once more awareness is brought into view. I also feel that with more openness to change, new ideas will be able to be implemented in order to promote positive growth and progress within our field. I do feel that this transition will take some time, however, with cooperation and an open mindedness, it is definitely possible!

Tami said...

No, I do not believe that school psychologsits who were "traditionally trained" are responsible for misclassification of students. I feel that misclassification may still occur at time continues, even with the use of EBP. Misclassficaiton may occur for various reasons, and I do not believe that it occurs soley because of the educational and training backgrounds of the current school psychologsts.

In terms of the various intervention methods under EBP, I feel the we must put these fferent methods into practice to decide which one may work best for us. I also feel that different methods may work best in different situations, depending on the student and his or her background and situation. I believe the shift to an EBP approach will occur once the interventions under EBP are put into use and deemed effective. Once results show that this new approach and paradigm have a positive effect, then the shift will begin to occur. However, it is important to keep in mind that this shift will most likely be gradual, and will not occur over night. I also feel it is important for school psychologists to remain open-minded and willing to try new approaches, keeping in mind what is best for the student.

Jesse S said...

I do not think that current school psychologists are completely responsible for the mis/over-diagnosing of children. School psychologists play a vital role in classifying children but they are only part of a much bigger picture. Teachers, parents, social workers, learning consultants, parents and doctors all play a role in classifying children and each of these parties has their own limitations.
When it comes to the interventions under EBP, I too think that it is necessary to find not only what works best for us but also on the individual level for each child. I think that many of the practices will be found to have a positive influence, however they will not eliminate mis-diagnosing students all together.