Although many of you may not be interested in the psychometric details of the ORS and SRS, it does bear importantly on whether there are seen as credible. Jeff Reese and I (Duncan & Reese, 2013) recently exchanged views with Halstead, Youn, and Armijo (2013), debating when a measure is too brief and when it is too long. Here is our paper. First regarding when a measure is too brief: There is no doubt that 45 items, 30 items, or even 19 items is psychometrically better than 4 items, and that the increased reliability and validity of longer measures likely result in better detection, prediction, and ultimate measurement of outcome. But how much better is the really the question. Are these differences clinically meaningful and do they offset the low compliance rates and resulting data integrity issues from missing data? These are the questions that require empirical investigation to determine how brief is too brief, although from my experience, the verdict has already been rendered. But when is a measure too long? The answer is simple: When clinicians won’t use it.
The Partners for Change Outcome Management System: Duncan & Reese, 2015Barry Duncan
Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their effectiveness (Walfish, McAlister, O'Donnell, & Lambert, 2012). Systematic client feedback offers one solution (Duncan, 2014). Several feedback systems have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only two have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration’s National Registry of Evidence based Programs and Practices: The Outcome Questionnaire-45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of the Partners for Change Outcome Management System, the psychometrics of the PCOMS measures, its empirical support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large scale data collection, to re-prioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.
The Norway Couple Project: Lessons LearnedBarry Duncan
Couple therapists in routine practice may find it difficult to apply findings from an increasingly expanding and complex body of couple therapy research. Meanwhile, concerns have been raised that competency in evidence-based treatments is insufficient to inform many practice decisions or ensure positive treatment outcomes (American Psychological Association
Presidential Task Force on Evidence-Based Practice, American Psychologist, 2006, 271). This article aims to narrow the research/practice gap in couple therapy. Results from a large, randomized naturalistic couple trial (Anker, Duncan, & Sparks, 2009) and four companion studies are translated into specific guidelines for routine, eclectic practice. Client feedback, the therapeutic alliance, couple goals assessment, and therapist experience in couple therapy provide a research-informed template for improving couple therapy outcomes.
The original validation of the CORS for kids and the ORS for adolescents. Allowed the benefits of client based outcome feedback to expand to youth and family and paved the way to the current RCT with kids in the schools.
Our recent article about therapist effects in couple therapy. So what distinguished one therapist from another? Demographics didn’t matter but 2 other things did. First, that tried and true but neglected old friend, the alliance accounted for 50% of the differences among therapists. Those who formed better alliances across clients got better outcomes. And therapist specific experience with couples accounted for 25% of the differences. So, experienced therapists can take some solace that getting older does have its advantages—as long as it is specific to task at hand.
The Partners for Change Outcome Management System: Duncan & Reese, 2015Barry Duncan
Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their effectiveness (Walfish, McAlister, O'Donnell, & Lambert, 2012). Systematic client feedback offers one solution (Duncan, 2014). Several feedback systems have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only two have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration’s National Registry of Evidence based Programs and Practices: The Outcome Questionnaire-45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of the Partners for Change Outcome Management System, the psychometrics of the PCOMS measures, its empirical support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large scale data collection, to re-prioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.
The Norway Couple Project: Lessons LearnedBarry Duncan
Couple therapists in routine practice may find it difficult to apply findings from an increasingly expanding and complex body of couple therapy research. Meanwhile, concerns have been raised that competency in evidence-based treatments is insufficient to inform many practice decisions or ensure positive treatment outcomes (American Psychological Association
Presidential Task Force on Evidence-Based Practice, American Psychologist, 2006, 271). This article aims to narrow the research/practice gap in couple therapy. Results from a large, randomized naturalistic couple trial (Anker, Duncan, & Sparks, 2009) and four companion studies are translated into specific guidelines for routine, eclectic practice. Client feedback, the therapeutic alliance, couple goals assessment, and therapist experience in couple therapy provide a research-informed template for improving couple therapy outcomes.
The original validation of the CORS for kids and the ORS for adolescents. Allowed the benefits of client based outcome feedback to expand to youth and family and paved the way to the current RCT with kids in the schools.
Our recent article about therapist effects in couple therapy. So what distinguished one therapist from another? Demographics didn’t matter but 2 other things did. First, that tried and true but neglected old friend, the alliance accounted for 50% of the differences among therapists. Those who formed better alliances across clients got better outcomes. And therapist specific experience with couples accounted for 25% of the differences. So, experienced therapists can take some solace that getting older does have its advantages—as long as it is specific to task at hand.
Duncan & Sparks Ch 5 of Cooper & DrydenBarry Duncan
THIS CHAPTER DISCUSSES
•
Systematic feedback and the Partners for Change Outcome Management System (PCOMS)
•
PCOMS as a way to truly privilege clients, include them as full partners in decision-making and operationalize social justice and a pluralistic approach
Feedback condition achieved nearly four times the amount of clients reaching reliable or clinically significant change. Nearly a 50% less separation/divorce at rate at follow up.
This is the validation study of the Group Session Rating Scale (GSRS). In a nutshell, this study found more than acceptable reliability and validity with not only an alliance measure but also with group climate and cohesiveness scales. The GSRS was also predictive of last session outcomes. An RCT comparing PCOMS to TAU in group therapy has been submitted.
PCOMS: A Viable Quality Improvement Strategy for Public Behavioral HealthBarry Duncan
This is the latest from the research team of the Heart and Soul of Change Project, published in the Journal of Consulting and Clinical Psychology. This study demonstrated that PCOMS is not only a viable quality improvement strategy but also that services to the poor and disenfranchised provided in a public behavioral setting, contrary to earlier research, can be as effective as those delivered in randomized clinical trials.
PCOMS as an Alternative to Psychiatric Diagnosis (Duncan, Sparks, & Timimi, 2...Barry Duncan
Part of an incredible series about diagnostic alternatives by the Journal of Humanistic Psychology edited by Sarah Kamens, Brent Dean Robbins, & Elizabeth Flanagan
This is the 6 month follow up study of the Norway Feedback Trial of couple's impressions of couple therapy. Found that feedback couples had less complaints about service delivery (a component of the alliance) and most clients found feedback helpful.
This 2 page article, which appeared in The Iowa Psychologist, provides an ultra brief summary of what makes therapy effective (the common factors) and how we can get better at what do: namely, add PCOMS, harvest client existing resources, and rely on that neglected old friend, the therapeutic alliance.
Slone, N. C., Reese, R. J., Mathews-Duvall, S., & Kodet, J. (2015). Evaluating the Efficacy of client feedback in group psychotherapy. Group Dynamics: Theory, Research, and Practice, 19, 122-136. doi:10.1037/gdn0000026
The first quasiexperiemental study of the ORS/SRS in a telephonic EAP company. Doubled outcomes and improved retension. Set the stage for the RCTs that followed
Article just out in Psychotherapy in Australia. Incorporating the latest research about what works in therapy to address what makes a "master" therapist.
PCOMS works with kids too!
Cooper, M., Stewart, D., Sparks, J., Bunting, L. (2013). School-based counseling using systematic feedback: A cohort study evaluating outcomes and predictors of change. Psychotherapy Research, 23, 474-488.
When children and teens present with behaviour and emotional problems the lure of a quick fix is
understandable and drugs present a ready-made solution. Therapists are often hesitant to talk about
medication and defer to medical professionals. In this paper DUNCAN, SPARKS, MURPHY and MILLER
highlight the explosion in the use of psychotropic medications for children and teens. This trend flies in the
face of the American Psychological Association’s recommendation of the use of psychosocial interventions
as the first intervention of choice with children and teens. The reliability and validity of psychiatric diagnoses is
questioned, in particular against a background of fluctuations in child development and social adaptations,
and a compelling critique is provided of the current research findings on the effectiveness of psychotropic
medications including antidepressants and ADHD medications. Therapists are urged to shed their timidity
and discuss openly the risks and benefits of medication with the knowledge that there is empirical support
for psychosocial interventions as a first line approach. Recommendations are offered to engage clients as
central partners in developing solutions—medical or non-medical—that fit each child and each situation.
This article, "Casting a Wider Net in Behavioral Health Screening in Primary Care" found that the ORS identified more clients for behavioral healthcare consultation than the PHQ-9. A first step toward the upcoming RCT with PCOMS in an integrated setting.
Duncan & Sparks Ch 5 of Cooper & DrydenBarry Duncan
THIS CHAPTER DISCUSSES
•
Systematic feedback and the Partners for Change Outcome Management System (PCOMS)
•
PCOMS as a way to truly privilege clients, include them as full partners in decision-making and operationalize social justice and a pluralistic approach
Feedback condition achieved nearly four times the amount of clients reaching reliable or clinically significant change. Nearly a 50% less separation/divorce at rate at follow up.
This is the validation study of the Group Session Rating Scale (GSRS). In a nutshell, this study found more than acceptable reliability and validity with not only an alliance measure but also with group climate and cohesiveness scales. The GSRS was also predictive of last session outcomes. An RCT comparing PCOMS to TAU in group therapy has been submitted.
PCOMS: A Viable Quality Improvement Strategy for Public Behavioral HealthBarry Duncan
This is the latest from the research team of the Heart and Soul of Change Project, published in the Journal of Consulting and Clinical Psychology. This study demonstrated that PCOMS is not only a viable quality improvement strategy but also that services to the poor and disenfranchised provided in a public behavioral setting, contrary to earlier research, can be as effective as those delivered in randomized clinical trials.
PCOMS as an Alternative to Psychiatric Diagnosis (Duncan, Sparks, & Timimi, 2...Barry Duncan
Part of an incredible series about diagnostic alternatives by the Journal of Humanistic Psychology edited by Sarah Kamens, Brent Dean Robbins, & Elizabeth Flanagan
This is the 6 month follow up study of the Norway Feedback Trial of couple's impressions of couple therapy. Found that feedback couples had less complaints about service delivery (a component of the alliance) and most clients found feedback helpful.
This 2 page article, which appeared in The Iowa Psychologist, provides an ultra brief summary of what makes therapy effective (the common factors) and how we can get better at what do: namely, add PCOMS, harvest client existing resources, and rely on that neglected old friend, the therapeutic alliance.
Slone, N. C., Reese, R. J., Mathews-Duvall, S., & Kodet, J. (2015). Evaluating the Efficacy of client feedback in group psychotherapy. Group Dynamics: Theory, Research, and Practice, 19, 122-136. doi:10.1037/gdn0000026
The first quasiexperiemental study of the ORS/SRS in a telephonic EAP company. Doubled outcomes and improved retension. Set the stage for the RCTs that followed
Article just out in Psychotherapy in Australia. Incorporating the latest research about what works in therapy to address what makes a "master" therapist.
PCOMS works with kids too!
Cooper, M., Stewart, D., Sparks, J., Bunting, L. (2013). School-based counseling using systematic feedback: A cohort study evaluating outcomes and predictors of change. Psychotherapy Research, 23, 474-488.
When children and teens present with behaviour and emotional problems the lure of a quick fix is
understandable and drugs present a ready-made solution. Therapists are often hesitant to talk about
medication and defer to medical professionals. In this paper DUNCAN, SPARKS, MURPHY and MILLER
highlight the explosion in the use of psychotropic medications for children and teens. This trend flies in the
face of the American Psychological Association’s recommendation of the use of psychosocial interventions
as the first intervention of choice with children and teens. The reliability and validity of psychiatric diagnoses is
questioned, in particular against a background of fluctuations in child development and social adaptations,
and a compelling critique is provided of the current research findings on the effectiveness of psychotropic
medications including antidepressants and ADHD medications. Therapists are urged to shed their timidity
and discuss openly the risks and benefits of medication with the knowledge that there is empirical support
for psychosocial interventions as a first line approach. Recommendations are offered to engage clients as
central partners in developing solutions—medical or non-medical—that fit each child and each situation.
This article, "Casting a Wider Net in Behavioral Health Screening in Primary Care" found that the ORS identified more clients for behavioral healthcare consultation than the PHQ-9. A first step toward the upcoming RCT with PCOMS in an integrated setting.
This article tracks the history and development of the notion of using the client's ideas, preferences, and sensabilities about change to select model and technique. It argues for exploring and incorporating client ideas about change.
Here is a recent chapter I did making the case for a relational perspective in therapeutic services (Duncan, B. (2014). The person of the therapist: One therapist’s journey to relationship. In K. J. Schneider, J. F. Pierson, & J. F.T. Bugental (Eds.). The Handbook of Humanistic Psychology: Leading Edges in Theory, Practice, and Research (2nd ed.) (pp. 457-472). New York: Sage Publications.
The outcome of psychotherapy yesterday, today and tomorrow (psychotherapy in ...Daryl Chow
In 1963, the first issue of the journal Psychotherapy appeared. Responding to findings reported in a previous publication by Eysenck (1952), Strupp wrote of the ‘staggering research problems’ confronting the field and the necessity of conducting ‘properly planned and executed studies’ to resolve questions about the process and outcome of psychotherapy. Today, both the efficacy and effectiveness of psychotherapy has been well established. Despite the consistent findings substantiating the field’s worth, a significant question remains the subject of debate: How does psychotherapy work? On this subject, debate continues to divide the profession. In this paper, a ‘way out’ is proposed informed by research on the therapist’s contribution to treatment outcome and findings from studies on the acquisition of expertise.
THIS CHAPTER DISCUSSES
•The empirical evidence supporting a strengths-based approach
•Specific practice guidelines for recruiting client resources to promote change
•The link between pluralistic counselling and a focus on client strengths
Reply DB5 w9 research
Reply discussion boards
1-jauregui
Discuss how the quantitative and qualitative data would complement one another and add strength to the study.
Evidently, the use of EBP in healthcare mostly relies on the available qualitative and quantitative data which is supported by scientific or clinical research. In studying the EBP, quantitative data is used to enhance qualitative information and vice versa, because one method complements the other one (Tappen, 2015, p.88). For example, in the selected article the EBP about beliefs and behaviors of nurses showed that the number of the nurses who were certified vs. nurses who were not certified explained why some of the nurses have higher perceived EBP implementation than others (Eaton, Meins, Mitchell, Voss, & Doorenbos, 2015, “Evidence-Based Practice Beliefs and Behaviors”). Quantitative data would improve the study by providing evidence in the form of numbers or amounts such as the scores which show the proficiency of nurses in different areas (Eaton, Meins, Mitchell, Voss, & Doorenbos, 2015, “Evidence-Based Practice Beliefs and Behaviors”). Quantitative data could strengthen the study by providing more detailed information about EBP implementation which will explain certain trends and occurrences as found in the research.
2- rosquete
The qualitative research is exploratory/ descriptive and emphasizes the importance of subjects frame to be referenced and the context of the study. The research will be more concerned with the truth perceived by informants and less concerned with the truth of the objectives. The information from this research will be important in understanding the informants’ behaviors in details. The description of this approach will be used to get the picture and the opinion of nursing caregivers on the use of CNS depressants by the elderly (Susan, Nancy, & Jennifer, 2013).
The method that is used is explorative/descriptive. The strengths of the descriptive method are: effective to analyze non-quantified subjects and issues, the possibility to observe the phenomenon in a natural environment, the opportunity to use qualitative and quantitative method together, and less time consuming than quantitative studies. In the case of exploratory studies, the principal advantage is the flexibility and adaptability to change and it is effective in laying the groundwork that guides to future research. We can find disadvantages in this kind of studies. For example, descriptive studies cannot test or verify the research problem statically, the majority of descriptive studies are not repeatable due to their observational nature, and they are not helpful in identifying cause behind the described phenomenon. Another weak point, that includes exploratory research, is the interpretation of information is subject to bias. These type of studies make use a modest number of samples that may not represent the target population and they are not usually helpful in decision ma.
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Evidence Translation and ChangeWeek 7What are the common.docxturveycharlyn
Evidence Translation and Change
Week 7
What are the common barriers to evidence translation in addressing this problem?
There are many barriers when it comes to translating evidence into practice. In regards to obesity, the most common barrier to translate evidence-based changes locally, nationally, and globally are the stakeholders. According to Chamberlain College of Nursing, (2020, translating research into practice relies on the clinician knowing who the stakeholders are and getting them involved in the planning stage and in every aspect of the practice change. Some stakeholders may not be conducive to change. In order to adopt and launch a practice change, the change leader has to be able to sell the project to key stakeholders. For a project leader to get others to go along with a practice change, the leader has to be knowledgeable, motivated, and believe in the research he or she is presenting to the stakeholders.
Additional barriers in translating research evidence into this practice problem would cost, available resources, and timing. For instance, it is less likely for individuals living in a low socioeconomic community to prioritize a 30 minutes time slot five days a week for exercising activities. Barriers like work schedules, family commitment, and financial obligations may impede these practices. The lack of motivation may also be a factor. Most individuals may not have a membership to the local gym, and rain and cold weather may prevent walking in the local park. The lack of appropriate lighting in the parks may fend off participation in outdoor activities in the fall and winter months. According to Tucker, the individuals, the location, and the practice itself and have a huge role in influencing evidence-based practice (2017). For an evidence-based practice to be adapted effectively it must be realistic in all public health settings.
What strategies might you adopt to be aware of new evidence?
I would create an interprofessional group to include clinical and research practitioners to discuss new and upcoming research evidence appropriate to the practice problem. Focus groups both locally and nationally as well as globally are great outlets to discover what is working in different areas of healthcare. Small focus group outlets in which to gather people with the same interest to discuss and present new research (Chamberlain College of Nursing 2020). I would sign up for alerts on new research, evidence-based practice interventions, and quality improvement publications on obesity throughout the country and globally. Tucker indicated that research experts are great resources to look into and introduce the latest pieces of evidence (2017). I also believe an expert Ph.D. colleague would be a great mentor to help guide me in this practice problem intervention. Dang and Dearholt indicated that a team approach between DNP and Ph.D. scholars influenced the best clinical outcome.
How will you det.
No evidence for demand characteristics or social desirability with the Session Rating Scale.
Reese, R. J., Gillaspy, J. A., Owen, J. J., Flora, K. L., Cunningham, L. E., Archie, D., & Marsden, T. (2013). The influence of demand characteristics and social desirability on clients’ ratings of the therapeutic alliance. Journal of Clinical Psychology, 69, 696-709.
Article in Division 29's journal, psychotherapy that reviews the research on routine outcome monitoring, arguing that current efforts are at risk for repeating the history of failed efforts to improve the outcome of psychotherapy.
Notes for question please no plag use references to cite wk 2 .docxcherishwinsland
Notes for question please no plag use references to cite
wk 2 1. Briefly summary of the comparison of the reliability and validity of responses on attitude scales
Washtenaw Community College, Ann Arbor MI, Retrieved from http://www4.wccnet.edu/departments/curriculum/assessment.php?levelone=tools
Strong words or moderate words: A comparison of the reliability and validity of responses on attitude scales
A common assumption in attitude measurement is that items should be composed of strongly worded statements. The presumed benefit of strongly worded statements is that they produce more reliable and valid scores than statements with moderate or weak wording. This study tested this assumption using commonly accepted criteria for reliability and validity. Two forms of attitude scales were created—a strongly worded form and a moderately worded form—measuring two attitude objects—attitude towards animal experimentation and attitude towards going to the movies. Different formats were randomly administered to samples of graduate students. There was no superiority found for strongly worded statements over moderately worded statements. The only statistically significant difference was found between one pair of validity coefficients ( r = 0.69; r = 0.15; Z = 2.60, p ≤ 0.01) and that was in the direction opposite from expected, favoring moderately worded items over strongly worded items (total scores correlated with a general behavioral item). (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
wk 2 2. What are Effective ways to understand and organize data using descriptive statistics?
Organizing Quantitative Data
Organizing quantitative data [Video file]. (2005). Retrieved January 20, 2017, from http://fod.infobase.com/PortalPlaylists.aspx?wID=18566&xtid=36200
http://fod.infobase.com/p_ViewVideo.aspx?xtid=36200
Effective ways to understand and organize data using descriptive statistics. Analyzing data collected from studies of young music students, the video helps viewers sort through basic data-interpretation concepts: measures of central tendency, levels of measurement, measures of dispersion, and graphs. A wide range of organization principles are covered, including mode, median, and mean; discrete and continuous data; nominal, ordinal, interval, and ratio data; standard deviation; and normal distribution. Animation and graphics clarify and reinforce each concept. The video concludes with a quick quiz to assess understanding and focus on key areas. A viewable/printable instructor’s guide is available online. WE DISCUSSED HOW TO DESIGN AN EXPERIMENT AND CONTROL VARIABLES IN OUR FIRST VIDEO. AND NOW WE'RE GOING TO LOOK AT WHAT TO DO WITH ALL THE DATA THAT HAS BEEN COLLECTED. AN EXPERIMENT IS ONE OF THE MOST POWERFUL WAYS TO SHOW THE CAUSE OF AN EVENT AND ITS EFFECT ON OTHER THINGS. BUT REMEMBER THAT AN INVESTIGATION CAN ONLY BE A SCIENTIFIC EXPERIMENT IF IT HAS AN INDEPENDENT VARIABLE WHICH IS MANIPULATED .
DEBATE Open AccessComparative effectiveness research what.docxedwardmarivel
DEBATE Open Access
Comparative effectiveness research: what
to do when experts disagree about risks
Reidar K. Lie1* , Francis K.L. Chan2, Christine Grady3, Vincent H. Ng4 and David Wendler3
Abstract
Background: Ethical issues related to comparative effectiveness research, or research that compares existing standards
of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees
(ERCs) should evaluate the risks of comparative effectiveness research.
Main text: We discuss what has been a prominent focus in the debate about comparative effectiveness research,
namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives.
We argue that this focus may be misleading. Rather, we should focus on the fact that some experts believe that
the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the
alternative(s). We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should
deal with such cases of expert disagreement.
Conclusion: We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment
arrive at a risk judgment about the study under consideration. We also argue that assessment of expert
disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions,
how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible
increased risk of clinical trial participation.
Keywords: Standard of care, Research ethics, Risk judgments, Research ethics review, Equipoise
Background
Ethical issues related to comparative effectiveness research,
that is, research that compares existing standards of care,
have recently received considerable attention. Such research
is warranted when the evidence is insufficient to decide be-
tween alternate interventions that different clinicians may
reasonably offer their patients. Comparative effectiveness
research is done with the hope that additional research will
shed light on whether one option is superior or causes
fewer adverse effects.
In this paper we focus on how Ethics Review Committees
(ERCs) should evaluate the risks of comparative effective-
ness research. In cases of insufficient evidence to make a
definite judgment, reasonable physicians and patients may
prefer a particular intervention, at the same time as they
recognize that other patients and physicians prefer alterna-
tive interventions. The reason for the disagreement is not,
in these cases, because the two alternative interventions are
known to have different risk or benefit profiles, but, in the
absence of a universally agreed upon standard for evaluat-
ing evidence, experts disagree about what the probabilities
of the risks and benefits of the alternative interventions are.
The challenge for ERCs in these cases is how they .
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
2. mentary, in many ways, provides a ready explanation for the
divide. They suggest:
. . .we think that where it is possible to use more reliable measures that
give us normative information, we should attempt to use them. . .The
more reliable measures are better at detecting early improvement and
more importantly early deterioration and allow us to track change in
a scientifically meaningful manner. (p. 84)
Although “more reliable” is not defined, “where it is possible”
represents the crux of the issue, and it is where the division
between research and practice occurs. Or in other words, can the
science of measurement be feasible for everyday clinical use? The
brevity of the ORS, with its attending lower reliability and validity
(although we contend are far from unacceptable), makes a differ-
ence, because, as is news to no one on the front lines, and
especially in the public sector, the number of forms and other
oversight procedures has exploded. Few have the time to devote to
the repeated administration, scoring, and interpretation of lengthy
measures—feasibility is critical.
Low compliance rates are the most frequent result of longer
measures. For example, comparison of two similar sites, one
implementing the ORS and the other the OQ revealed a compli-
ance rate for the ORS of 86% at the end of one year, and despite
ongoing encouragement, the use of the OQ was just 25% (Miller,
Duncan, Brown, Sparks, & Claud, 2003). Furthermore, longer
measures often wind up being used as periodic or prepost mea-
sures, which result in poor data integrity, not representative of
actual practice. For example, a benchmarking study conducted in
a managed care setting requiring the 30-item OQ at the first, third,
fifth, and every fifth session thereafter lost over 55% of the data for
lack of two data points (Minami et al., 2008). Similarly, a study of
the CORE 34 resulted in only 9,703 clients with pre- and post
information from a database of over 33,000 (Stiles, Barkham,
Connell, & Mellor-Clark, 2008).
Measures that are perceived as too long by psychotherapists pre-
vent many from even considering monitoring outcome. For example,
in reaction to a managed care company’s introduction of a 30-item
outcome questionnaire, the New England Psychologist (Hanlon,
2005) reported that providers complained about its length and fre-
quent administration. The response by clinicians was so severe that
the State Psychological Association president said, “I have never seen
such negative reaction from providers” (Hanlon, 2005, p. 11).
Intimately related to feasibility is the issue of the utility of the
feedback—whether the measure has an intended clinical use to
improve the effectiveness of rendered services. Most outcome
measures are used primarily as prepost and/or periodic assessment
devices. Such instruments measure program effectiveness but are
not feasible to administer frequently, and therefore, they do not
provide real-time feedback for immediate treatment modification
before clients drop out or suffer a negative outcome—in short, they
are not clinical tools as much as they are management or oversight
tools. The ORS was designed as a clinical and outcome tool to
provide real-time feedback to improve the effectiveness of services
and as a way to measure outcomes.
Perhaps this speaks to the normative versus communicative
distinction made by Halstead et al. The communicative aspects of
the ORS are critical to enhancing outcomes, but the normative
aspects provide the credibility for the discussion. There are now
over 400,000 administrations of the ORS resulting in algorithms
for expected treatment response. It is not surprising that the tra-
jectories are not unlike those reported by other outcome measures.
There is an unfortunate lack of data from where most mental
health services are provided—in public behavioural health set-
tings. In many ways, the lack of available data in the real world
speaks to the very heart of the divide between research and
practice. Wolfe (2012), in a clever dialogue between his researcher
and practitioner selves, suggested that practical outcome tools for
everyday clinical practice, like the ORS, can serve to build the
bridge between research and practice.
There is no doubt that 45 items, 30 items, or even 19 items is
better than 4 items, and that the increased reliability and validity of
longer measures likely result in better detection, prediction, and
ultimate measurement of outcome. But how much better is the
reliability and validity and more important, how much better is the
detection, prediction, and ultimate measurement of outcome? Are
these differences clinically meaningful, and do they offset the low
compliance rates and resulting data integrity issues? These are the
questions that require empirical investigation to determine how
brief is too brief.
But when is a measure too long? The answer is simple: When
clinicians won’t use it.
Résumé
Dans leur réaction a` Duncan (2012), Halstead, Youn et Armijo
(2013) posent la question d’ordre psychométrique suivante :
qu’est-ce qui constitue une mesure trop courte pour l’évaluation du
progrès? Ils suggèrent que les mesures doivent être suffisamment
longues pour assurer fiabilité et validité, sans toutefois offrir de
définition de ce qui constitue une fiabilité ou une validité suff-
isante. En outre, Halstead et al. passent sous silence l’importante
question dans le domaine clinique qu’est la faisabilité, a` savoir si
la mesure sera couramment utilisée par les cliniciens de première
ligne. Nous affirmons qu’il ne fait aucun doute que la fiabilité et
la validité accrues de mesures plus longues donneront probable-
ment lieu a` de meilleurs résultats en ce qui a trait a` la détection, a`
la prédiction et a` l’évaluation finale des résultats, mais nous
suggérons qu’il faut avoir recours a` l’enquête empirique pour
déterminer si ces différences sont significatives sur le plan clinique
et si elles compensent les faibles taux de conformité. Nous affir-
mons de plus que s’il faut recourir a` l’enquête empirique pour
déterminer ce qui constitue une mesure trop brève, la réponse a` la
question « Quand une mesure est-elle trop longue? » est simple :
lorsque les cliniciens ne veulent pas l’utiliser.
Mots-clés : PCOMS, fiabilité, validité, faisabilité, ORS.
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Received February 14, 2013
Accepted February 21, 2013 Ⅲ
137CONSIDERATIONS IN PROGRESS MONITORING