The training literature suggests that ongoing support (e.g., consultation) following initial training enhances training outcomes, yet little is known about the critical components of ongoing support and the lasting effects of ongoing support. The present study examined components of consultation calls that were provided to 99 community clinicians following training in the delivery of cognitive-behavioral therapy (CBT) for youth anxiety. The 104 recorded consultation calls were coded for content and consultative methods present. A subset of the training sample (N = 50) completed a 2-year follow-up interview during which they reported on their implementation rates of CBT since ending consultation. They also completed measures assessing CBT knowledge and attitudes toward evidence-based practices (EBPs). It was hypothesized that active learning (i.e., role-plays) would predict therapist adherence, skill, self-efficacy, and satisfaction at postconsultation, but regression analyses found no significant relation. However, level of clinician involvement during consultation calls significantly positively moderated the relation between active learning and clinician skill. Analyses of the follow-up data indicated (a) high implementation rates of CBT and (b) maintenance of overall attitudes toward EBPs, willingness to implement EBPs if mandated, views regarding the appeal of EBPs, and beliefs regarding the clinical utility of EBPs. A significant decline in CBT knowledge and openness toward EBPs was observed. Consultation call attendance positively predicted therapist CBT knowledge, overall attitudes toward EBPs, and attitudes regarding the appeal and clinical utility of EBPs at the 2-year follow-up. Implications, strengths and limitations, and future directions are discussed. / Psychology

Since it was first articulated, the Risk-Need-Responsivity model (RNR; Andrews, Bonta, & Hoge, 1990) has been extensively researched and is regarded as an empirically supported model for providing effective correctional treatment. It is comprised of three core principles: the risk principle, which provides direction for who should receive treatment; the need principle, which identifies intermediate treatment targets; and the responsivity principle, which states how treatment programs should be structured. The RNR model is purported to be relevant for all offender populations, including female offenders (Dowden & Andrews, 1999a), juvenile offenders (Dowden & Andrews, 1999b), violent offenders (Dowden & Andrews, 2000), and sexual offenders (Hanson, Bourgon, Helmus, & Hogdson, 2009). Yet, the majority of RNR research has examined the risk and need principles, and the responsivity principle remains understudied. The responsivity principle includes two sub-principles: general and specific (Andrews, & Bonta, 2010). The current research explored the general responsivity principle, which states that programs should use theoretically relevant models for individual change, specifically cognitive-behavioral and cognitive-social learning models (Andrews & Bonta, 2010). The following techniques are consistent with these models: "role-playing, modeling, repeated practice of alternative behaviors, cognitive restructuring to modify thoughts/emotions, skills building, or reinforcement" (Andrews & Bonta, 2010, p. 50). Despite empirical support, the RNR model has received minimal application to juveniles, and it has not been widely tested in the substance abuse treatment context. Additionally, it is not clear whether adherence to the RNR model is relevant for reducing substance use outcomes in youth. Adolescent substance abuse treatment programs were designed to address substance use among juveniles, and have been widely researched to determine their effectiveness; yet their effectiveness remains understudied among juvenile offenders. These studies include examinations of specific treatment interventions used, such as Multisystemic Therapy. Many of these interventions are considered to be "evidence-based treatment" (EBT), but there is a wide variety of repositories that classify interventions as "evidence-based" with varying criteria used to classify them. The juvenile drug treatment court model (JDTC) was specifically developed to address substance use and crime among juvenile offenders; however, findings from empirical studies have not demonstrated a strong treatment effect. To address these gaps in the literature, secondary analyses were conducted on data collected from 132 adolescent outpatient substance abuse treatment programs (AOPs) and 10 juvenile drug treatment courts nationwide. This research was an application of the general responsivity principle in the AOP and JDTC context to determine the impact of responsivity adherence on the odds of rearrest and substance use severity. The analyses also included an examination of evidence-based treatment (EBT) in both samples to determine the influence of EBT use scores on the odds of rearrests and substance use severity scores. To examine the AOP sample, multilevel models were used to examine the individual- and program-level impact of responsivity adherence and EBT use. To examine the JDTC sample, multivariate analyses were used to examine the individual-level impact of responsivity adherence and EBT use. Overall, responsivity adherence was not significantly associated with rearrests among AOP participants, nor was it significantly associated with substance use severity scores. Additionally, the odds of rearrest were significantly greater among individuals who received interventions with a higher EBT use score; though, there was no association between the average EBT use scores across programs and the odds of rearrest. There was no significant association between individual- and program-level EBT use scores and substance use severity. Among JDTC participants, an increase in responsivity adherence was associated with an increase in the odds of rearrest and substance use severity. A similar association emerged between EBT use scores and both outcomes, wherein increases in EBT use scores were significantly associated with an increase in the odds of rearrest and substance use severity. The results of the analyses suggest the need for further specification of both general responsivity adherence and "evidence-based" treatment for use in future research and theory; specifically, further elaboration of the general responsivity-adherent techniques and clear criteria for classifying interventions as "evidence-based treatment." The findings also imply that certain types of treatment interventions are more compatible with the JDTC model than other interventions. Additional analyses suggest the possibility that general responsivity adherence and evidence-based treatment may not be unique constructs. Future research may benefit through exploring evidence-based treatment as a criterion for adherence to the general responsivity principle. / Criminal Justice

Trustworthy clinical practice guidelines assist health care professionals in selecting the management options that optimize patient health outcomes. The development of trustworthy guidelines requires the consideration of many aspects and the involvement of multiple contributors, often working in groups. The guideline panel plays the key role in the development process as it is responsible for prioritizing topics that should be covered as part of the guideline effort, formulating questions, reviewing the evidence, developing and agreeing on the recommendations, and endorsing the final guideline document. Ensuring transparency throughout the process by appropriately organizing and documenting panel activities is an essential standard that is used to assess the credibility of a developed guideline and its resulting recommendations. The adoption of conceptual frameworks that systematically guides panel members in their decision-making process (e.g. the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks) can aid in the formulation of methodologically sound recommendations. In this dissertation, I used the example of a guideline on diagnosis and treatment of autism spectrum disorders to describe how rigorous research methods can support guideline panels in the development process from early stages to the formulation of recommendations. In another prominent guideline development effort with the American Society of Hematology, I have identified two steps in the process where panel members may benefit from further support and addressed these gaps by conceptualizing and developing novel approaches. The first approach comprises modelling baseline risk estimates for patient-important outcomes when only surrogate data is available. The second approach proposes a method to estimate decision thresholds for judgments on health benefits and harms using the GRADE EtD framework. While these approaches are tailored to address specific guideline panel needs, guideline methodologists could use the underlying concepts to find solutions to aid guideline panels in other steps of the development process. / Thesis / Doctor of Philosophy (PhD) / Clinical practice guidelines assist health care professionals in selecting management options that can best improve the health outcomes of their patients. The development of trustworthy guidelines is a complex process that requires the contribution of several entities. The guideline panel, which typically comprises different experts (clinicians, patient representatives, experts in research methodologies) plays the key role in this process as it is responsible for selecting the most important questions to address in the guideline, reviewing the evidence supporting an option, agreeing on the recommendations, and endorsing the final guideline document. To ensure that the process of developing guidelines is transparent and that the recommendations are credible, it is important that panel activities are well documented and follow rigorous methods. Structured frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) approach, have been developed to systematically guide the panel members and to minimize the error that could be introduced while making decisions. In this thesis, I describe the development of an approach and its application for comprehensive guideline development by the Italian National Health Institute, to describe rigorous guideline development and propose two novel approaches to further assist panel members in enhancing their guideline development. The first of these two enhancements to guideline development describes how to derive a modelled estimate of the risk of having certain health conditions when this data is not directly available in the medical literature. The second of the two enhancements is a method to support guideline panels in judging how substantial the desirable and undesirable effects of health interventions are. Both approaches were tailored to fit specific needs but can be adapted to inform the improvement of other steps in the guideline development process.

In the past decade the push for utilization of evidence-based practice (EBP) in mental health has increased dramatically. Due to managed healthcare, lowered spending on state and federal mental health budgets, and requirements by funding agencies such as Medicaid, it is imperative that mental health clinicians (MHCs) be trained in and utilize EBPs to improve funding and ensure continuity of best practice in clinical interventions with clients. Minimal research exists on MHCs and their knowledge and use of EBPs. The present study examined MHCs' perceptions, knowledge, training, and utilization of EBPs, with a specific focus on Dialectical Behavior Therapy (DBT). To date, it is the most prominent and effective EBP for treating Borderline Personality Disorder (BPD) and associated parasuicidal and suicidal behaviors. Current research supports its effectiveness in treating a myriad of other commonly treated disorders. The exploratory study provides insight into MHCs level of interest in receiving more EBP awareness and DBT training. Results indicate that though clinicians have received training in EBP and DBT, most of that training has been encouraged through career settings. Age of the clinician, years in practice, and type of training background are predictors of level of education, knowledge and training. Results show the majority of clinicians are interested in EBP, aware of the impact EBP can have on treatment effects, and report desire to have more training in EBPs and DBT specifically. These results could provide a necessary bridge between disciplines to allow clinicians, irrespective of training, to provide the most clinically effective treatments to clients. / Ph. D.

This study explored evidence-based education in health professions education through three interrelated manuscripts. First, a scoping review of evidence-based medical education examined the use of the term “evidence-based” in the literature and the presence of evidence-based practices. The review analyzed numerous studies to understand how evidence-based education is defined and applied within the medical education community, highlighting key trends, gaps, and inconsistencies in the application of evidence-based principles. Next, a study employed an agile evidence-based instructional design (AVIDesign) model to create an evidence-based course in palliative care for medical students. This model integrated iterative development processes with evidence-based educational strategies, emphasizing flexibility and responsiveness to feedback. Utilizing transdisciplinary collaboration between faculty and instructional designers (ID), the study examined the use of the model to develop a course for medical students in palliative care. Results include faculty and ID perspectives on using the model, along with student and expert feedback on the materials developed for the course. The final study utilized the AVIDesign model to develop interactive branching case scenarios for a pediatric nursing course. These scenarios were designed to provide nursing students with evidence-based learning experiences that simulate the complexities of pediatric care. By incorporating interactive elements and multiple potential outcomes, the cases aimed to enhance clinical reasoning skills. The study involved continuous collaboration with pediatric nursing experts and instructional designers to refine the scenarios, ensuring they were both educationally effective and engaging for students. Together, these manuscripts illustrate the effectiveness of employing evidence-based design, agile methodologies, and collaborative input to create effective educational interventions in the health professions. They underscore the importance of acquiring, appraising, and applying evidence in developing effective learning interventions.

L’expertise scientifique joue un rôle croissant dans la fabrique du politique dans les démocraties. Elle contribue à façonner et orienter les problèmes publics et leurs solutions, de façon relativement autonome par rapport à l’élection des décideurs. Ce rôle est justifié par la complexité grandissante des problèmes et solutions dans les sociétés techniques. Dans cette thèse, nous investiguons les fonctions de l’expertise scientifique jugée crédible par les décideurs. A contrario des prétentions universalistes de la Knowledge Literature et de l’Evidence-Based Policy, nous construisons une théorie de moyenne portée des usages spécifiques, d’une forme d’expertise particulière, dans un contexte donné. Un tel triptyque permet de réconcilier deux approches contradictoires de l’usage de l’expertise. L’une « externaliste » promue par l’analyse des politiques publiques explique son utilisation par le contexte. L’autre « internaliste » défendue par une variété de courants, la justifie par les caractéristiques propres de l’expertise. Pour ce faire, nous investiguons l’utilisation que font en France dans les années 2000 les ministères de la santé et de l’agriculture des expertises collectives INSERM et INRA – méthode d’expertise proche des revues systématiques de la littérature. Dans cette perspective, nous objectivons successivement : les critères d’appréciation des expertises collectives tels qu’utilisés par les décideurs, les types d’usages qu’ils attendent et font de ces expertises, les contextes dans lesquels ils les mobilisent. Notre investigation est aussi l’occasion de clarifier les indicateurs des types d’usage en même temps que les facteurs contextuels les favorisant. Nous mettons en lumière les effets d’autorité et de vérité des expertises collectives sur les acteurs du débat public et de cadrage sur les problèmes publics et leurs solutions. Nous rendons aussi compte de la façon dont l’expertise gagne sa crédibilité scientifique (et son producteur une légitimité scientifique ou réputation) auprès des décideurs. Croisant les travaux de la sociologie des sciences, et des études de la communication, nous établissons que la crédibilité de l’expertise dépend de la conjugaison d’investissements de forme et de fond. Nous montrons que ces dispositifs rhétoriques et pratiques ne sont pas librement accessibles mais exigent des connaissances et compétences particulières. Renouant avec la sociologie de l’expertise, nous constatons que la nature et la réputation de la méthode et des instituts sont le produit d’une histoire longue dans laquelle les chercheurs – leurs positions et représentations, leurs réflexions, actions et interactions – jouent un rôle clef. Sur un plan empirique, notre thèse constitue une des pièces du puzzle de l’émergence des expertises collectives et revues systématiques de littérature en France au cours des vingt dernières années.D’un point de vue méthodologique, notre thèse mobilise une variété de méthodes : qualitative (entretiens individuels, observations ethnographiques, travail d’archive, études de cas) et quantitative (statistiques descriptives, analyse de correspondances multiples et classification hiérarchique ascendante). / Scientific expertise plays a growing role in the policymaking process in democracies. It shapes public problems and their solutions relatively autonomously from the election process. This role is explained by the increasing complexity of problems and solutions in technical societies.In this thesis, we investigate the function of scientific expertise that is deemed credible by policymakers. Unlike scholars in the Knowledge Literature and the Evidence-Based Policy movement, we do not intend to express universalist claims. Instead, we build a middle range theory: one of a type of use of a specific kind of expertise within a particular context. This triptych (type of use-type of expertise-type of context) permits us to reconcile two contradictory approaches of the use of expertise: one “externalist” explains the type of use of expertise by the particular context in which it is used, another “internalist” explains the type of the use by the intrinsic qualities of the specific kind of expertise.In order to do this, we investigate how policymakers within the French ministries for Health and Agriculture use INSERM and INRA collective expertise – an expertise method close to systematic literature reviews.We successively display: the specific criteria policymakers use to assess the credibility of expertise, their intended and effective use of such knowledge, the context in which they order an experts’ report. Our investigation allows us to test and organize a set of indicators and contextual factors of the type of use.We demonstrate that these INSERM and INRA collective expertise appear as an authoritarian and truthful discourse to actors involved in the public debate. They frame public problems and their solutions.We also explain how expertise gains its scientific credibility in the eyes of policymakers. On the basis of recent works in the fields of science and technology studies and communication studies fields, we establish that the credibility of INSERM and INRA collective expertise derives from the implementation of rhetorical and practical devices in their production. We show that such devices are not ready-to-use: their implementation requires a set of knowledge and know-how.We also demonstrate that the very nature and reputation of the expertise and its producers are the result of a long process in which researchers play a key role: their career, position, representation, thoughts, actions and interactions.This thesis constitutes a missing piece in the systematic exploration of the growth of collective expertise and systematic literature reviews in France in the last twenty years.It is based on a variety of qualitative methods (interviews, observations, archive, case studies) as well as quantitative methods (statistics descriptive, factor analysis, hierarchical cluster analysis).

<p>Lärande är enligt forskare centralt för att åstadkomma utveckling och förändring med hjälp av coaching. Av den redan bristande evidensbas som idag finns för coaching, utgörs endast en liten del av forskning om detta lärande. Med anledning av detta gjordes en studie för att undersöka yrkesverksamma coachers uppfattningar om lärandet som sker i coachingprocessen, samt deras uppfattningar om coaching som profession. Urvalet bestod av yrkesverksamma coacher, certifierade av branschorganisationen ICF. Metoden som valdes var kvalitativa intervjuer. Resultatet visar att coacherna ser lärande som essentiellt för att effekter ska kunna uppnås. Coachernas tidigare utbildning och yrkesbakgrund speglas i deras syn på yrket och de har olika uppfattningar om vad coaching är. De formella yrkeskraven och den vetenskapliga relevansen analyseras.</p>

Lärande är enligt forskare centralt för att åstadkomma utveckling och förändring med hjälp av coaching. Av den redan bristande evidensbas som idag finns för coaching, utgörs endast en liten del av forskning om detta lärande. Med anledning av detta gjordes en studie för att undersöka yrkesverksamma coachers uppfattningar om lärandet som sker i coachingprocessen, samt deras uppfattningar om coaching som profession. Urvalet bestod av yrkesverksamma coacher, certifierade av branschorganisationen ICF. Metoden som valdes var kvalitativa intervjuer. Resultatet visar att coacherna ser lärande som essentiellt för att effekter ska kunna uppnås. Coachernas tidigare utbildning och yrkesbakgrund speglas i deras syn på yrket och de har olika uppfattningar om vad coaching är. De formella yrkeskraven och den vetenskapliga relevansen analyseras.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background ABSTRACT In the chiropractic profession, it has been an established goal to utilise evidence-based practice (EBP) in clinical practice in order to empower chiropractors to develop effective treatment protocols. However, the extent to which chiropractors are utilising EBP, and the factors associated with its implementation in practice is unknown. The lack of research in this regard suggests that further studies need to be undertaken within the chiropractic profession in South Africa in order to fully understand the relationship of factors which contribute to the adoption and application of EBP by chiropractors in clinical practice. Therefore, the aim of this study was to investigate the knowledge of, attitudes towards, perceptions of and perceived barriers towards EBP by chiropractors within the eThekwini municipality. Method A pre-validated cross sectional descriptive survey was administered to chiropractors practicing within the eThekwini municipality (n = 101) by hand delivery. The questionnaire was validated by means of a focus group and pilot testing. Participants gave informed consent prior to participation. Data were analysed using using SPSS Statistics 24.0 and Statgraphics Centurion 15.1 (2006) to determine the descriptive and inferential statistics while the open- ended questions were analysed qualitatively using manifest coding. Results A response rate of 51% (n=51) was obtained. The majority of respondents were male (51%), mean age of 37.8 years, practicing for less than 19 years, working in full time practice (76.5%) between 40 and 49 hours per week (45.1%). The majority of the respondents had a positive attitude and perception towards EBP with respondents showing a willingness to improve skills (72.6%) and utilisation (52.9%) of EBP. Respondent 15 explained that “it is very important to have the skills in order to utilise EBP. Once you have the skills, utilising EBP becomes easy”. Responses highlighted that respondents are engaging with scientific literature when necessary and possess the skills necessary to utilise EBP. The majority of respondents believe that they had a strong academic foundation in their knowledge and skills related to accessing and interpreting information, yet 47.1% reported not having received formal training in search strategies to access literature. However, most felt confident about their knowledge and skills to utilise EBP. Insufficient time (66.7%), lack of generalisability of the literature findings to their patient population (49.0%) and the inability to apply research findings to individual patients with unique characteristics (45.1%) were the three top barriers identified. Respondent 12 described: “most articles are vague or time consuming and searching for relevant, up to date and reliable articles is a difficult process that can take a lot of time” as a possible barrier to utilising EBP. Conclusion The respondents in this study had a favourable attitude towards, and perception of, EBP and its usefulness to chiropractic practice. However, like other healthcare professionals they felt that they had insufficient time to utilise EBP. This study also highlighted the importance of academic institutions providing the necessary skills required to utilise EBP. It is recommended that workshops focusing on EBP principles and training are arranged to assist practitioners in integrating EBP into practice / M

La thèse se positionne dans un ensemble de travaux portant sur les rationalisations contemporaines des organisations de santé, et se focalise sur les pratiques des médecins hospitaliers au sein de réunions de concertation pluridisciplinaire en cancérologie. Nous développons une hypothése selon laquelle la dimen- sion prudentielle, conjecturale de l'activité médicale est en tension avec les dynamiques de rationalisation qui traversent l'organisation. En étudiant les techniques qui structurent les savoirs médicaux et qui équipent les pratiques délibératives et interprétatives des médecins, nous analysons une tension spécifique qui se produit au cœur des pratiques conjecturales ethnographiées. La thése expose les différentes conceptions de l'incerti- tude qui sont formalisées dans les dispositifs techniques qui équipent les savoirs et les pratiques médicales, où les prises de position objectiviste et épistémique divergent et doivent être articulées au sein de processus communicationnels, délibératifs et interprétatifs. / This thesis belongs to the field of rationalization studies in healthcare organizations. Its focus is on medical practices observed in multi-disciplinary meetings in the oncology ward of a hospital in South West France. We hypothesize that tension exists between the prudential and conjectural dimension of medical activity and the rationalization dynamics present across the organization. Technologies exist that structure medical knowledge and practices. They equip deliberative and interpretative medical practices. By studying these technologies, we can analyze a specific tension that exists in the depths of the observed conjectural practices. The thesis shows the different conceptions of uncertainty that are formalized in the technological dispositifs equiping medical knowledge and practice. It highlights those areas where objective and epistemic positions differ, and which therefore require articulation inside communicational, deliberative and interpretative processes.