Embed Size (px)
Citation preview
One Sky Center
R. Dale Walker, MD, DirectorMichelle Singer, Communications Coordinator, ICMI Project DirectorDoug Bigelow, PhD, Deputy Director
Evidence-Based vs Culture-Based Dilemma
What is “Evidence”?
Multiple Streams of Evidence
The Learning Healthcare System
Description: A Scientific Framework
Some Culture-Based Interventions
Epistemological gulf Western Traditional AI/AN
Epistemological debate Validity of traditional world view Freedom to live by a traditional world view
Practical debate Controlling by purse strings
Bridging Evidence is? Status of evidence for EBI How to meet reasonable standards of
evidence
Practice Improvement Multiple Streams of Evidence Learning Healthcare System
http://coce.samhsa.gov/cod_resources/PDF/OP5-Practices-8-13-07.pdfhttp://www.iom.edu/CMS/28312/RT-EBM/41894.aspx
1. Intervention/program research Randomized Controlled Trials (RCT) Nonrandomized, uncontrolled Evaluation
Adaptation of Proven Intervention Like a Proven Intervention Basis in Proven Theory, Principles, Facts
Criteria: Fidelity Internal Validity (vs confounding variables) External validity Reliability—repeatability.
Process: Scientific experts Independent judging and rating Compilation and Summary
Therapeutic power of Choice
Self-healing guided by expert healers
Uniqueness of interpersonal relationships
Complexity of factors
1. Individual studies
2. Reviewed collections
3. Lists of model, best, promising, alternative
4. Survivors of meta-analyses
“Best Practices” = highest scientific standards
Balance point Reasonable standards are:
Repeatability Achievable within resources and constraints Allow conclusions without intolerable doubt Low risk of harm, if conclusions are wrong
Adoption requires buy-in
Acceptance Implementation
Adaptation to unique local culture and context
Players Rules, expectations, traditions Resources/collaborations Opportunity to contribute to strategic plan
MI, CBT, SFP, Project Venture, Canoe Journey implementations are unique in every setting
Every replication is an Adaptation
The EBI idea is changing
SAMHSA: “multiple streams of evidence”
IOM: “Learning Healthcare System”
Intervention/program RTC; Evaluation
1. Adaptation of Proven Intervention
2. Analogous to a Proven Intervention
3. Basis in Proven Theory, Principles, Facts
1.Causes
2.
TargetPopulationFor intervention
Intervention
Outcome
Domains:Individual
RelationshipCommunity
Culture
8. Long term
7. Medium term
6.Short term
5. Manual
4.Theory of Action
3. Intervention
strategy
“Operationalization” a way of knowing/believing From black box to detail
Consistency with body of knowledge
Who, what, when, where, how, decisions Repeatability
Social ecology (influences)
Prevention Universal/ selected/
indicated
Risk and Resilience Readiness to
Change Risk taking/seeking Stress vulnerability
Modeling (observational learning)
Instrumental learning Group dynamics Conformity, altruism Listening and support Catharsis Psychopharmacology
• Screening• Gatekeeping• Diagnosis• Treatment• Traditional healing• Traditional
ritual/ceremony• Postvention• Parent/family training• Group work
• School/institution-based• Education/skills• Experiential• Socialization/
acculturation• Public Health
(risk/resilience)
• Services develop/coord• L E/justice/corrections• Community competency• Community change• Culture
Story telling Talking circles Sweat Lodge Ceremonies and
Ritual Purification Passages Naming Grieving
Drumming, singing, dancing
Vision Quest
Flute playing/meditation
Reconciliation
Mentoring
Service learning
GONA
Cultural Enhancement Through Story Telling (Tohono O’odham Res)
AI Strengthening Families Program (U UT)
Across Ages (Mentoring) (Temple U)
Creating Lasting Family Connections Dare to Be You (Ute Res)
With Eagles Wings (N. Arapaho Nat)
Families That Care—Guiding Good Choices
Families and Schools Together (Rural Wisconsin Res)
Parenting Wisely Preparing for Drug Free Years Project Alert Project Venture (NIYLP)
Promoting Alternative Thinking Strategies
Zuni Life Skills (Zuni Pueblo)
http://www.spokane.wsu.edu/ResearchOutreach/wimhrt/research2.asp
Deal with Epistemological Gulf Know limitations of Evidence in EBI Agree upon “Practice Improvement”
Goal Make credibility gains with “Scientific
Framework” for Description Use existing practices and knowledge
as evidence for similar CBI
