Understanding the common elements of evidence-based practice: misconceptions and clinical examples.

Science has fostered renewed optimism in mental health practice over the last decade through advances in the development of treatment supported by research (Kazdin and Weisz, 2003; Task Force on Promotion and Dissemination of Psychological Procedures, 1995; Wilson, 1995). The challenge that continues to confront both the scientific and applied domains of psychology and psychiatry is the widespread promotion and implementation of empirically supported treatments in general, and in children_s mental health in particular (Barlow, 2000; Chorpita et al., 2002; Schoenwald and Hoagwood, 2001; Weisz et al., 1995). With more than 500 documented treatments available for children and adolescents (Kazdin, 2000), how do practicing clinicians begin to identify the appropriate evidence-based interventions for their clients? On the one hand, it would appear that practitioners could consult the literature to learn more about efficacious interventions for particular problem areas. On the other hand, the increasing proliferation of guidelines, lists, and definitions that has followed has been rather complex (e.g., Chorpita et al., 2002; Lonigan et al., 1998; Schinke et al., 2002; Weisz, 2003), and in some ways has paradoxically increased the complexity of identifying Bbest candidate[ interventions for treating children_s disorders. Contributing to the complexity of identifying evidence-based interventions is ambiguity surrounding the meaning of the term Bevidence-based.[ Traditionally, albeit a recent tradition, the term has denoted specific treatment protocols with a particular degree and type of empirical support (e.g., Chambless and Hollon, 1998). Thus, the Bmanualization[ of interventions (e.g., Coping Cat, Kendall, 1990; Defiant Children, Barkley, 1997) has lent itself to a method of defining evidence-based treatments. At this manual level of analysis, practitioners may choose from a variety of specific treatment programs that have demonstrated their efficacy in research trials. However, evidencebased, manualized treatments often have overlapping strategies, and it is difficult for practitioners to determine the relative appropriateness of one given treatment manual over another for particular clients and situations (Kazdin et al., 1990).