Ron Levant on His EBP Task Force

Some practitioners have asked about my rationale for leading an APA Presidential Initiative on Evidence Based Practice on (EBP), aimed at developing an APA Policy on EBP. Others have expressed fears that the results would be used against practitioners by managed care and malpractice lawyers. To respond, I would start by pointing out the larger societal context. The EBP movement in US society is a juggernaut racing toward accountability in medicine, psychology, education, public policy, and even architecture. The zeitgeist today is to require professionals to base their practice to whatever extent possible on evidence. Thus, psychology needs to define EBP or it will be defined for us. We cannot afford to sit on the sidelines

In fact, EBP is already being defined for us. We heard about the current impact of EBP on Medicaid in the states last year at the State Leadership Conference. What is happening is that the Division 12 lists of “Empirically Validated” (later “Empirically Supported”) treatments have been adopted by many local, state and federal funding agencies, which now require the use of empirically-validated treatments. They are also being used by managed care and insurance companies to control costs by restricting the practice of psychological health care. As some of you know, the Division 12 lists were developed using very narrow scientific criteria (e.g., RCT’s). Not taken into account were broader definitions of research evidence and the other two pillars of what the Institute of Medicine has come to define as the foundation of Evidence Based Medicine, namely clinical expertise and patient culture, values and preferences.

My Presidential Initiative, aims to both broaden the range of research evidence and assert that evidence based practice in psychology is also based on clinical expertise and patient culture, values and preferences. My Presidential Initiative Task Force is attempting to arrive at a consensus that APA can use to influence health care policy, which will certainly have an impact on the landscape of practice and payment for services. We are trying to hammer out ground rules that protect practice while keeping pace with advances in research.

If we do not do this, that does not mean the issue will go away, but only that someone else will dictate what treatments, combinations, and variations are acceptable. We have MORE leverage with insurers and courts of law if APA has a clear statement preserving the right for a clinician to make the final decisions.

(Editor’s Note – Ron Levant will be a taking a hiatus from his “Washington Update” Column for 2005, but will return after his APA presidency is completed)

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