by Joye C. Anestis, M.S.
Many individuals disagree with the evidence-based practice movement in clinical psychology and related fields [for clarification, evidence-based practice (EBP) refers to the integration of science & practice, the implementation of empirically-supported treatments (ESTs) and assessment in the context of the client's culture & characteristics (APA Presidential Task Force on Evidence-Based Practice, 2006)]. Some of the barriers to evidence-based practice include clinicians' perceptions of ESTs as lacking individuality & humanity, a lack of training in EBPs (there is a tendency to use only treatments one has received training in & a lack of incentive to learn new treatments), policy issues, lack of institutional support, & perceived lack of consumer demand (Chambless & Ollendick, 2001; Pagoto et al., 2007). Many of these prejudices about EBPs are based on misconceptions and they possess little to no research support.
It appears that another potential barrier to global implementation of EBP is a concern about losing staff members in response to the change. There is a fear that forcing clinicians to learn & implement ESTs as part of EBP would result in higher turnover rates. To systematically examine this question, a study published in the newest edition of the Journal of Consulting & Clinical Psychology examined staff retention after state-wide implementation of evidence-based practices. Aarons, Sommerfeld, Hecht, Silovsky, & Chaffin (2009) report on the impact of enacting SafeCare across the state of Oklahoma. SafeCare is am empirically-supported, home-based intervention for the prevention/reduction of child neglect (Gershater-Molko, Lutzker, & Wesch, 2003; Lutzker & Bigelow, 2002). It also serves to increase positive parent-child interactions. SafeCare features structured, manualized behavioral interventions focusing on 3 components: infant & child health, home safety & cleanliness, & parent-child bonding. The study examined the impact of this treatment, as well as the utilization of fidelity monitoring, on staff turnover. Providers were placed in one of four conditions: SafeCare + fidelity monitoring, SafeCare + no fidelity monitoring, services as usual + fidelity monitoring, services as usual + no fidelity monitoring. The SafeCare + fidelity monitoring condition was the only condition that significantly predicted greater staff retention. So, interestingly, EBP improved retention rates only when combined with fidelity monitoring (in this study, fidelity monitoring consisted of supportive coaching & consultation).
This study speaks to several concerns raised about the utilization of ESTs within EBP. For many clinicians, implementation of EBP requires a large amount of training in new forms of treatment. This study indicates that, when this training is combined with support & consultation, clinicians respond positively. Furthermore, the authors argue that, by providing support & consultation for those in the EBP condition, the common misconception that ESTs are rigid and inflexible can be overcome. One of the things I found most interesting about this article was the provider sample. It's my understanding that turnover is extremely high in difficult public service areas such child services (the authors cite annual turnover rates exceeding 25% in the human services area and exceeding 50% in child & adolescent services). In the present study, the staff provided home-based services for child neglect - so I find it particularly remarkable that they dramatically improved staff retention by utilizing an EBP that was combined with supportive coaching from the fidelity monitor. These results add to a growing literature indicating that, not only does EBP serve clients more effectively & efficiently, but EBP also contributes to clinician motivation and job satisfaction. Hopefully, more data like this will continue to emerge and continue to disprove the misconceptions about EBP.
Joye Anestis is a doctoral candidate in clinical psychology at Florida State University.
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