Why using PCOMS EBP is the best way forward in psychotherapy!
Most people are familiar with the thalidomide disaster of the early 1960s. Thalidomide, a drug developed in Germany and marketed as a treatment for morning sickness, had been distributed in numerous countries. It was scheduled to be released in the United States as soon as it received FDA approval, a near certainty. That is, until the responsibility for approving the drug was given to Frances Kelsey. Thalidomide had undergone what was considered to be sufficient research and testing protocols in those days and had passed with flying colors. Kelsey, who had spent her earlier career as a research scientist, noted elements of the data that reminded her of her own research and thereby raised red flags. She dragged her feet on the approval, insisting that more research was warranted. Her stance on looking at the evidence didn't earn her any popularity contests. After all, experience showed that the drug was perfectly fine. Then, the â€œthalidomide babiesâ€ began to appear in all of the countries where thalidomide had been approved for use. Kelsey is credited with averting a major disaster in the United States.
The thalidomide disaster resulted in the Kefauver Amendments to the Food, Drug and Cosmetic Act of 1938. By requiring more evidence, the amendments enabled the FDA to make changes to the research protocols that lead to drugs being approved for clinical use. The amendments also required drug manufacturers to provided evidence of drug efficacy.
The entire thalidomide story is a story of using evidence to make decisions. Not experience. Not gut feelings; But real, hard evidence. In so many aspects of our lives, we think nothing of expecting others to base their decisions on evidence.
When you take your car into the shop, do you want your mechanic making decisions on how to repair your automobile based upon his gut feelings? Or do you want your stock broker making decisions about your financial investments based upon her gut feelings? Most people want such decisions to be evidence-based.
For psychotherapy, this means using the best research findings to make therapeutic decisions. Using intuition to determine the progress a client is making defeats the purpose of having an evidence-based practice. Using objective forms of ongoing assessment allows the clinician to monitor client progress and make credible evaluations of the efficacy of the treatment protocol, as well determine whether changes are needed or if the therapeutic goals have been achieved. Put another way, the systematic measurement of outcomes makes any therapeutic intervention evidence-based.
There are currently two outcome measurement tools listed in SAMHSA's National Registry of Evidence-Based Programs and Practices.The Partners for Change Outcome Management System (PCOMS) and its web-based version MyOutcomes®are listed because a large body of research has demonstrated a doubling in the effectiveness of treatment while simultaneously reporting reduced dropout, deterioration rates and reduced service delivery costs. PCOMS Tran-theoretical approach has been successfully implemented in a wide variety of service settings, with diverse clinical populations, all over the world.