History and development
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Evidence-based assessment (EBA) refers to the application of research and theory in selecting constructs for a specific assessment purpose, as well as informing the methods and measures used in the assessment process. [1] This approach recognizes that, despite data from psychometrically robust measures, the assessment process inherently involves iterative decision-making. Clinicians formulate and test hypotheses by integrating often incomplete and inconsistent data. [1] EBA has been shown to aid clinicians in reducing cognitive biases in their clinical decisions. [2] Evidence-based assessment is a component of the broader movement towards evidence-based practices.
The concept of Evidence-based assessment (EBA) originated in the field of medicine, [3] and has since been adopted in several other disciplines, notably clinical psychology. The EBA approach is widely recognized as an empirically driven method of clinical decision-making. Cochrane reviews have reported the efficacy of EBA methods. [4]
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Despite the availability of numerous guidelines to assist psychologists in conducting Evidence-Based Assessments (EBAs), professionals often fall short in adhering to these guidelines. Projective tests, for instance, are frequently employed in the assessment of child adjustment. [5] It has been observed that there is considerable variability among professionals in following professional guidelines, leading to instances where evaluators fail to assess general parenting abilities adequately. [6]
Professionals and authorities often erroneously recommend interpreting variability between and within scales that might not have been rigorously tested. For example, due to thorough efforts in establishing norms, reliability, and validity measures, certain measures like the Wechsler intelligence scales for both adults and children are considered as some of the most reliable psychological instruments. Authorities often advise the consideration of subtest scores. However, unlike full-scale IQ scores, subtest scores frequently have lower levels of internal consistency reliability. This results in reduced precision of measurement and an increased likelihood of false positive and false negative conclusions about the assessment.
Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.
In a blind or blinded experiment, information which may influence the participants of the experiment is withheld until after the experiment is complete. Good blinding can reduce or eliminate experimental biases that arise from a participants' expectations, observer's effect on the participants, observer bias, confirmation bias, and other sources. A blind can be imposed on any participant of an experiment, including subjects, researchers, technicians, data analysts, and evaluators. In some cases, while blinding would be useful, it is impossible or unethical. For example, it is not possible to blind a patient to their treatment in a physical therapy intervention. A good clinical protocol ensures that blinding is as effective as possible within ethical and practical constraints.
Applied psychology is the use of psychological methods and findings of scientific psychology to solve practical problems of human and animal behavior and experience. Educational and organizational psychology, business management, law, health, product design, ergonomics, behavioural psychology, psychology of motivation, psychoanalysis, neuropsychology, psychiatry and mental health are just a few of the areas that have been influenced by the application of psychological principles and scientific findings. Some of the areas of applied psychology include counseling psychology, industrial and organizational psychology, engineering psychology, occupational health psychology, legal psychology, school psychology, sports psychology, community psychology, neuropsychology, medical psychology and clinical psychology, evolutionary psychology, human factors, forensic psychology and traffic psychology. In addition, a number of specialized areas in the general area of psychology have applied branches. However, the lines between sub-branch specializations and major applied psychology categories are often mixed or in some cases blurred. For example, a human factors psychologist might use a cognitive psychology theory. This could be described as human factor psychology or as applied cognitive psychology. When applied psychology is used in the treatment of behavioral disorders there are many experimental approaches to try and treat an individual. This type of psychology can be found in many of the subbranches in other fields of psychology.
Forensic psychology is the practice of psychology applied to the law. Forensic psychology is the application of scientific knowledge and methods to help answer legal questions arising in criminal, civil, contractual, or other judicial proceedings. Forensic psychology includes research on various psychology-law topics, such as jury selection, reducing systemic racism in criminal law, eyewitness testimony, evaluating competency to stand trial, or assessing military veterans for service-connected disability compensation. The American Psychological Association's Specialty Guidelines for Forensic Psychologists reference several psychology subdisciplines, such as social, clinical, experimental, counseling, and neuropsychology.
The Doctor of Psychology is a professional doctoral degree intended to prepare graduates for careers that apply scientific knowledge of psychology and deliver empirically based service to individuals, groups and organizations. Earning the degree was originally completed through one of two established training models for clinical psychology. However, Psy.D. programs are no longer limited to Clinical Psychology as several universities and professional schools have begun to award professional doctorates in Business Psychology, Organizational Development, Forensic Psychology, Counseling Psychology, and School Psychology.
Clinical psychology is an integration of human science, behavioral science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.
A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine. They usually include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of their profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.
Evidence-based practice is the idea that occupational practices ought to be based on scientific evidence. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to individuals as well as traditional practices. Evidence-based practices have been gaining ground since the formal introduction of evidence-based medicine in 1992 and have spread to the allied health professions, education, management, law, public policy, architecture, and other fields. In light of studies showing problems in scientific research, there is also a movement to apply evidence-based practices in scientific research itself. Research into the evidence-based practice of science is called metascience.
A hierarchy of evidence, comprising levels of evidence (LOEs), that is, evidence levels (ELs), is a heuristic used to rank the relative strength of results obtained from experimental research, especially medical research. There is broad agreement on the relative strength of large-scale, epidemiological studies. More than 80 different hierarchies have been proposed for assessing medical evidence. The design of the study and the endpoints measured affect the strength of the evidence. In clinical research, the best evidence for treatment efficacy is mainly from meta-analyses of randomized controlled trials (RCTs). Systematic reviews of completed, high-quality randomized controlled trials – such as those published by the Cochrane Collaboration – rank the same as systematic review of completed high-quality observational studies in regard to the study of side effects. Evidence hierarchies are often applied in evidence-based practices and are integral to evidence-based medicine (EBM).
The scientist–practitioner model, also called the Boulder Model, is a training model for graduate programs that provide applied psychologists with a foundation in research and scientific practice. It was initially developed to guide clinical psychology graduate programs accredited by the American Psychological Association (APA).
The Pediatric Attention Disorders Diagnostic Screener (PADDS), created by Dr. Thomas K. Pedigo and Kenneth L. Pedigo, is a suite of computer administered neuropsychological tests of attention and executive functioning. The PADDS is used in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children between the ages of 6 and 12 years. The PADDS software program represents a multi-dimensional, evidence-based approach to ADHD assessment, consisting of the Computer Administered Diagnostic Interview (CADI), the Swanson, Nolan, and Pelham—IV (SNAP-IV) Parent and Teacher rating scales, and the three computer-administered objective measures of the Target Tests of Executive Functioning (TTEF). It calculates a diagnostic likelihood ratio, where each data source is allowed to contribute to (or detract from) the prediction of the diagnosis, as well as normalized relative standard scores, t-scores, z-scores, and percentile ranks for comparison to the non-clinical reference group.
A clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an adjunct or alternative approach to the more categorical approach of psychiatric diagnosis. In clinical practice, formulations are used to communicate a hypothesis and provide framework for developing the most suitable treatment approach. It is most commonly used by clinical psychologists and is deemed to be a core component of that profession. Mental health nurses, social workers, and some psychiatrists may also use formulations.
Shared decision-making in medicine (SDM) is a process in which both the patient and physician contribute to the medical decision-making process and agree on treatment decisions. Health care providers explain treatments and alternatives to patients and help them choose the treatment option that best aligns with their preferences as well as their unique cultural and personal beliefs.
The primary care behavioral health (PCBH) consultation model is a psychological approach to population-based clinical health care that is simultaneously co-located, collaborative, and integrated within the primary care clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in primary care.
The Child Mania Rating Scales (CMRS) is a 21-item diagnostic screening measure designed to identify symptoms of mania in children and adolescents aged 9–17 using diagnostic criteria from the DSM-IV, developed by Pavuluri and colleagues. There is also a 10-item short form. The measure assesses the child's mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month. Clinical studies have found the CMRS to be reliable and valid when completed by parents in the assessment of children's bipolar symptoms. The CMRS also can differentiate cases of pediatric bipolar disorder from those with ADHD or no disorder, as well as delineating bipolar subtypes. A meta-analysis comparing the different rating scales available found that the CMRS was one of the best performing scales in terms of telling cases with bipolar disorder apart from other clinical diagnoses. The CMRS has also been found to provide a reliable and valid assessment of symptoms longitudinally over the course of treatment. The combination of showing good reliability and validity across multiple samples and clinical settings, along with being free and brief to score, make the CMRS a promising tool, especially since most other checklists available for youths do not assess manic symptoms.
The General Behavior Inventory (GBI) is a 73-question psychological self-report assessment tool designed by Richard Depue and colleagues to identify the presence and severity of manic and depressive moods in adults, as well as to assess for cyclothymia. It is one of the most widely used psychometric tests for measuring the severity of bipolar disorder and the fluctuation of symptoms over time. The GBI is intended to be administered for adult populations; however, it has been adapted into versions that allow for juvenile populations, as well as a short version that allows for it to be used as a screening test.
The GRADE approach is a method of assessing the certainty in evidence and the strength of recommendations in health care. It provides a structured and transparent evaluation of the importance of outcomes of alternative management strategies, acknowledgment of patients and the public values and preferences, and comprehensive criteria for downgrading and upgrading certainty in evidence. It has important implications for those summarizing evidence for systematic reviews, health technology assessments, and clinical practice guidelines as well as other decision makers.
Eric Arden Youngstrom is an American clinical child and adolescent psychologist, professor of psychology and neuroscience, and psychiatry, at University of North Carolina at Chapel Hill. He is a Fellow of the American Psychological Association. His research focuses on evidence-based assessment, and assessment of bipolar disorder across the life span.
Allegiance bias in behavioral sciences is a bias resulted from the investigator's or researcher's allegiance to a specific school of thought. Researchers/investigators have been exposed to many types of branches of psychology or schools of thought. Naturally they adopt a school or branch that fits with their paradigm of thinking. More specifically, allegiance bias is when this leads therapists, researchers, etc. believing that their school of thought or treatment is superior to others. Their superior belief to these certain schools of thought can bias their research in effective treatments trials or investigative situations leading to allegiance bias. Reason being is that they may have devoted their thinking to certain treatments they have seen work in their past experiences. This can lead to errors in interpreting the results of their research. Their “pledge” to stay within their own paradigm of thinking may affect their ability to find more effective treatments to help the patient or situation they are investigating.
