Will publicly funded psychotherapy in Canada be evidence based? A review of what makes psychotherapy work and a proposal.

2018 ◽  
Vol 59 (4) ◽  
pp. 293-300 ◽  
Author(s):  
Giorgio A. Tasca ◽  
Joel M. Town ◽  
Allan Abbass ◽  
Jeremy Clarke
Keyword(s):  
Evidence Based ◽  
Publicly Funded

scholarly journals Potential for epistemic injustice in evidence-based healthcare policy and guidance

2020 ◽  
pp. medethics-2020-106171
Author(s):  
Jonathan Anthony Michaels
Keyword(s):  
Decision Making ◽  
Distributive Justice ◽  
Rapid Development ◽  
Evidence Based ◽  
Publicly Funded ◽  
Professional Groups ◽  
Considerable Debate ◽  
Value Judgements ◽  
Evidence Based Healthcare ◽  
Healthcare Technologies

The rapid development in healthcare technologies in recent years has resulted in the need for health services, whether publicly funded or insurance based, to identify means to maximise the benefits and provide equitable distribution of limited resources. This has resulted in the need for rationing decisions, and there has been considerable debate regarding the substantive and procedural ethical principles that promote distributive justice when making such decisions. In this paper, I argue that while the scientifically rigorous approaches of evidence-based healthcare are claimed as aspects of procedural justice that legitimise such guidance, there are biases and distortions in all aspects of the process that may lead to epistemic injustices. Regardless of adherence to principles of distributive justice in the decision-making process, evidential failings may undermine the fairness and legitimacy of such decisions. In particular, I identify epistemic exclusion that denies certain patient and professional groups the opportunity to contribute to the epistemic endeavour. This occurs at all stages of the process, from the generation, analysis and reporting of the underlying evidence, through the interpretation of such evidence, to the decision-making that determines access to healthcare resources. I further argue that this is compounded by processes which confer unwarranted epistemic privilege on experts in relation to explicit or implicit value judgements, which are not within their remit. I suggest a number of areas in which changes to the processes for developing, regulating, reporting and evaluating evidence may improve the legitimacy of such processes.

scholarly journals Effectiveness of the Care of Persons With Dementia in Their Environments Intervention When Embedded in a Publicly Funded Home- and Community-Based Service Program

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Richard H Fortinsky ◽  
Laura N Gitlin ◽  
Laura T Pizzi ◽  
Catherine Verrier Piersol ◽  
James Grady ◽  
...  
Keyword(s):  
Psychological Symptoms ◽  
Pragmatic Trial ◽  
Well Being ◽  
Functional Independence ◽  
Evidence Based ◽  
Publicly Funded ◽  
Long Term Effects ◽  
Community Based ◽  
Activity Engagement ◽  
Behavioral And Psychological Symptoms

Abstract Background and Objectives In the absence of effective pharmacotherapy, there is an urgent need to test evidence-based dementia care interventions using pragmatic trial approaches. We present results from a study in which an evidence-based, nonpharmacologic intervention for persons living with Alzheimer’s disease and related dementia (ADRD) and their informal caregivers, Care of Persons with Dementia in their Environments (COPE), was tested in a Medicaid and state revenue-funded home and community-based service (HCBS) program. Research Design and Methods Using pragmatic trial design strategies, persons living with ADRD and their caregivers were randomly assigned as dyads to receive COPE plus usual HCBS (COPE; n = 145 dyads) or usual HCBS only (Usual Care or UC; n = 146 dyads). Outcomes were measured prerandomization, and 4 and 12 months postrandomization. Outcomes for persons living with ADRD included functional independence, activity engagement, self-reported quality of life, and behavioral and psychological symptoms. Caregiver outcomes included perceived well-being, confidence using dementia management strategies, and degree of distress caused by behavioral and psychological symptoms. Results After 4 months, caregivers receiving COPE reported greater perceived well-being (least squares mean = 3.2; 95% CI: 3.1–3.3) than caregivers receiving UC (3.0; 2.9–3.0; p < .001), and persons living with ADRD receiving COPE, compared to those receiving UC, showed a strong trend toward experiencing less frequent and less severe behavioral and psychological symptoms (9.7; 5.2–14.2 vs 12.7; 8.3–17.1; p = .07). After 12 months, persons living with ADRD receiving COPE were more engaged in meaningful activities (2.1; 2.0–2.1 vs 1.9; 1.9–2.0; p = .02) than those receiving UC. Discussion and Implications Embedding COPE in a publicly funded HCBS program yielded positive immediate effects on caregivers’ well-being, marginal positive immediate effects on behavioral and psychological symptoms, and long-term effects on meaningful activity engagement among persons living with ADRD. Findings suggest that COPE can be effectively integrated into this service system, an important step towards widespread adoption. Clinical Trials Registration Number NCT02365051.

scholarly journals Examining US Public Early Intervention for Toddlers With Autism: Characterizing Services and Readiness for Evidence-Based Practice Implementation

2021 ◽  
Vol 12 ◽  
Author(s):  
Aritz Aranbarri ◽  
Aubyn C. Stahmer ◽  
Meagan R. Talbott ◽  
Marykate E. Miller ◽  
Amy Drahota ◽  
...  
Keyword(s):  
Early Intervention ◽  
Service Delivery ◽  
Autism Spectrum ◽  
Evidence Based ◽  
Publicly Funded ◽  
Implementation Climate ◽  
High Quality ◽  
Children With Asd ◽  
The Us ◽  
Early Intervention System

As the rates of Autism Spectrum Disorder (ASD) increase and early screening efforts intensify, more toddlers with high likelihood of ASD are entering the United States' (US') publicly funded early intervention system. Early intervention service delivery for toddlers with ASD varies greatly based on state resources and regulations. Research recommends beginning ASD-specific evidence-based practices (EBP), especially caregiver-implemented intervention, as early as possible to facilitate the development of social-communication skills and general learning. Translating EBP into practice has been challenging, especially in low-resourced areas. The main goal of this study was to obtain a more comprehensive understanding of public early intervention system structure, service delivery practices, and factors influencing EBP use for children with ASD in the US. Participants (N = 133) included 8 early intervention state coordinators in 7 states, 29 agency administrators in those states, 57 early intervention providers from those agencies, and 39 caregivers of children with ASD receiving services from those providers. Online surveys gathered stakeholder and caregiver perspectives on early intervention services as well as organizational factors related to EBP implementation climate and culture. Stakeholders identified key intervention needs for young children with ASD. In general, both agency administrators and direct providers reported feeling somewhat effective or very effective in addressing most needs of children with ASD. They reported the most difficulty addressing eating, sleeping, family stress, and stereotyped behaviors. Data indicate that children from families with higher income received significantly higher service intensity. While administrators and providers reported high rates of high-quality caregiver coaching (>60%), caregivers reported low rates (23%). Direct providers with more favorable attitudes toward EBP had greater EBP use. In turn, provider attitudes toward EBP were significantly associated with implementation leadership and culture at their agency. Results suggest that publicly funded early intervention programs in the US require additional resources and training for providers and leaders to support improved implementation climate and attitudes toward ASD EBPs. Results also suggest that more state system support is needed to increase use of ASD-specific EBP use, including high-quality caregiver coaching, to better serve toddlers with ASD. Recommendations for implementation strategies are addressed.

The Politics of Management Knowledge in Times of Austerity

2018 ◽  
Author(s):  
Ewan Ferlie ◽  
Sue Dopson ◽  
Chris Bennett ◽  
Michael Fischer ◽  
Jean Ledger ◽  
...  
Keyword(s):  
Health Care ◽  
Political Economy ◽  
Public Services ◽  
Health Care Organizations ◽  
Macro Level ◽  
Evidence Based ◽  
Publicly Funded ◽  
Academic Literature ◽  
Management Knowledge ◽  
Based Medicine

While the implementation of evidence-based medicine guidelines is well studied, there has been little investigation into the extent to which a parallel evidence-based management movement has been influential within health care organizations. This book explores the various management knowledges and associated texts apparent in English health care organizations, and considers how the local reception of these texts was influenced by the macro level political economy of public services reform evident during the period of the politics of austerity. The research outlined in this volume shows that very few evidence-based management texts are apparent within health care organizations, despite the influence of certain knowledge producers, such as national agencies, think tanks, management consultancies, and business schools in the industry. Bringing together the often disconnected academic literature on management knowledge and public policy, the volume addresses the ways in which preferred management knowledges and texts in these publicly funded settings are sensitive to the macro level political economy of public services reform, offering an empirically grounded critique of the evidence-based management movement.

Ungoverned and Out of Sight

2021 ◽  
Author(s):  
Charley E. Willison
Keyword(s):  
United States ◽  
Public Health Problem ◽  
The United States ◽  
Evidence Based ◽  
Publicly Funded ◽  
Physical And Mental Health ◽  
Opioid Use ◽  
Chronic Homelessness ◽  
The Great Recession ◽  
The Face

Homelessness is a public health problem. Millions of Americans experience homelessness each year, more than the number of Americans that suffer from opioid use disorders annually. Homelessness is associated with increased mortality and adverse physical and mental health outcomes. Longer durations of homelessness are associated with the higher mortality rates, severe mental illness, and substance use disorders. Nearly a decade after the Great Recession, rates of homelessness are once again increasing in the United States. In the face of this crisis, this book seeking to explain why different cities in the United States approach solutions to chronic homelessness in different ways. This research finds that homelessness policy is a highly decentralized and fragmented policy space. This often creates conflicting policy solutions, where publicly funded, evidence-based solutions are often undercut by short-term, reactionary responses, including punitive policing, that may actually promote homelessness in the long term. Overall, the limited coordination between fragmented policy interests and strong trends in decentralization of homeless policy governance contribute to reduced policy opportunities for evidence-based, publicly funded responses.

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