Clinical treatment guidelines will improve patient care and benefit science and practice, said Steven C. Breckler, PhD, executive director of APA’s Science Directorate and Katherine Nordal, PhD, executive director of the association’s Practice Directorate.
Speaking at an APA Annual Convention session on treatment guidelines, Nordal said that from a practice perspective, the ongoing effort to reform the nation’s health-care system includes a “huge” focus on accountability. Providers need to show insurers and policymakers that their treatments provide good outcomes for patients. That drive for accountability applies both to physical medicine and mental health care, she said, adding that comparative effectiveness research — studies that demonstrate what treatment works for which patient, under what circumstances — is a priority in current health-care reform efforts, she said.
“It’s something we need to be ahead of the curve on because there’s going to be an increasing demand for our use of what the evidence says is good practice in delivering psychological care,” Nordal said.
Arguing for clinical treatment guidelines also requires APA to dispel fears about how practitioners will be asked to use them with their clients, she said. A treatment guideline won’t be a one-size-fits-all cookbook approach, she emphasized. Instead, a guideline will serve as a decision-making aid to help a practitioner decide the best possible course of care for a particular patient, combining clinical judgment, the best available research, and the patient’s individual characteristics and preferences. Longterm, clinical treatment guidelines can help improve patient care by identifying gaps in research and treatment where more work is needed to develop effective interventions.
Representing scientists, Breckler said that while psychology is associated with strong clinical research, methodological rigor and empirically supported interventions, it’s also associated with weak translation of those research results into clinical practice.
“For some reason, the latest research is not infiltrating our practice, and our training models do not always emphasize the scientific foundations of the very interventions that are being taught to our students,” he said.
What seems to be a growing gulf between science and practice should concern researchers because the value society places on scientific research — seen most directly in the form of research funding — is tied to its practical applications being able to address the nation’s problems, Breckler said. Clinical treatment guidelines will help bridge the science-practice gulf by combining a systematic review of the research literature on effective treatment of disorders or conditions with treatment insights from experienced clinicians, he said. While there are some resources available that try to present the best psychological research, the material is not presented in a form that’s immediately useful for a practitioner trying to decide on a specific course of treatment for an individual patient, Breckler said.
“The resources that do exist don’t do a very good job of summarizing the psychological literature. So the bottom line is a collaboration between the clinical science community and the practitioner community can help produce effective treatment guidelines that are faithful to the body of clinical research but delivered in a form that practitioners can actually use,” he said.
Underscoring the importance of the guidelines, Sanford Portnoy, PhD, chair of APA’s Committee for the Advancement of Professional Practice, said that if psychology doesn’t develop these guidelines, others will. As a discipline, he said, psychology needs to define what constitutes good treatment, rather than letting insurers decide what’s best for patients.
“Finally, we’re on the path that we should have been on a long time ago,” Portnoy said.
The committee that will set APA policy on the development of clinical treatment guidelines, the Treatment Guidelines Steering Committee, has yet to be named, said Lynn Bufka, PhD, assistant executive director for research and policy in the Practice Directorate.
Once that committee is appointed and starts its work, treatment guideline development panels will be created. The first guideline will be developed within 18 months after the first guideline writing panel is convened, Bufka said.
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