cpa-sm.gif (1004 bytes) DISCUSSION DOCUMENT

Empirically Supported Treatments in Psychology: Recommendations for Canadian Professional Psychology
Task Force on Empirically Supported Treatments (Section on Clinical Psychology of the Canadian Psychological Association)


Appendix B. Key Organizing Principles for Practice Guidelines (adapted from Hayes, 1997)

From the Behavioral Health Industry Associations:
  • Clinical practice guidelines developed via cooperative between industry and key scientific, professional, and consumer associations is a very attractive product.
  • The development of clinical practice guidelines should involved the active participation of a variety of industry constituencies.
  • When target areas are identified, clinical practice guidelines have to be developed quickly (within 3-6 months) to keep pace with developments in the industry
  • Practically useful clinical practice guidelines have to be simple and focus on the "critical few" core clinical processes.
  • Clinical practice guidelines need to focus on processes and procedures, not the discipline of the provider.
  • Clinical practice guidelines must avoid any appearance of proprietary, discipline, profession, guild, or self-serving interests.
  • Clinical practice guidelines should focus on the evidence and avoid any attempt to dictate health care policy per se at the industry level.
From the Professional Associations:
  • Clinical practice guidelines must not be academic tomes, but products designed to help practitioners make decisions in the context of daily clinical practice.
  • Clinical practice guidelines must be user friendly in how they present core clinical concepts.
  • Clinical practice guidelines cannot become a "straight jacket" that supplants individual clinical decision-making and the development of new and creative clinical approaches.
  • Clinical practice guidelines are the most applicable when they focus on the broad context of clinical assessment and decision making and the details of clinical implementation up to the practitioner.
  • Clinical practice guidelines cannot appear to reflect specific guild or association interests.
  • Clinical practice guidelines cannot favor any particular type of treatment (i.e. drugs vs. psychotherapy, long-term vs. short-term psychotherapy), unless there is a there and agreed upon evidence base for such a recommendation.
From the Scientific Associations:
  • Scientifically base clinical practice guidelines must be grounded in a systematic and careful method of assessing and interpreting the existing data base.
  • Clinical practice guidelines should focus on effective assessment, treatment, and prevention processes and procedures, not on disciplinary interests.
  • Clinical practice guidelines should incorporate recommendations about how to assess clinical functional outcomes and over what time frames.
  • Clinical practice guidelines must be based in a coherent mechanism for describing the "strength" of clinical practice recommendations, based upon the available evidence.
  • Clinical practice guidelines can include expert opinion, when the clinical topic is critical and the evidence is either scant or inconclusive, but these recommendations must be clearly distinguished from those based on scientific evidence and steps should be taken to subject such recommendations to empirical test as soon as possible.
  • Clinical practice guidelines should have a self-correcting function that is tied to research in the field.
  • Clinical practice guidelines should be updated periodically based upon changes in the evidence base or in expert opinion.
From the Consumer Associations:
  • Clinical practice guidelines need to be built to attend to the best interests of the client and his or her immediate family members.
  • Consumers of behavioral health services must be a significant source of information about preferred outcomes of those services.
  • Clinical practice guidelines should not make treatment recommendations that place of undue hardship on significant others as a part of treatment.
  • Clinical practice guidelines should not make recommendations that in effect deny a client access to care, even if there is no effective treatment available.
  • Clinical practice guidelines should state clear parameters for appropriate assessment of clinical and functional outcomes and recommend procedures for assessing those outcomes.
From Sponsoring Agencies and Associations:
  • Clinical practice guidelines must be built through a consensus process that include all of the major constituencies in the behavioral health industry.
  • Clinical practice guidelines must be built in a cost-efficient way that included the option of incorporating existing practice guidelines.
  • Clinical practice guidelines must help with the process of dissemination of science regarding effective behavioral health problems.
  • Clinical practice guidelines should exist in some type of national center or clearinghouse, whose main goal is to coordinate development, refinement and dissemination.
  • Clinical practice guidelines should be developed by behavioral health constituencies, not by governmental agencies per se.

Next: Appendix C


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