Evidence Based Practices

Using Research to Inform Practice

Evidence Based Practice was first defined by Dr. David Sackett  in 1996 as, “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.” This practical methodology is enthusiastically promoted and adopted by professionals in many fields including social services, education, and the criminal justice system. Used originally in the health care and social science fields, evidence-based practice focuses on approaches demonstrated to be effective through empirical research rather than through anecdote or professional experience alone.

Evidence Based Practices Database Websites

The following table was developed by the Research to Practice Project Coordinator, Kim Keffeler, MPH. It contains a list of websites that can help you find Evidence Based Practices and Programs. These websites curate evidence based practices and programs that could be of interest to your program. Each website listed in the table contains a number of different evidence based practices or programs that have been reviewed, tested, and researched by the experts at each organization. Some websites are better than others, some review processes are more rigorous: find the one that seems best for your organization!

Link to PDF Version of Table: Evidence based practices table

*Links within the table were last checked on 11/22/2017

Seminal Evidence Based Practices

Sexual Assault Nurse Examiners for Forensic Examinations

Sexual Assault Nurse Examiners (SANEs) are qualified nurses who are trained to gather forensic evidence in cases of rape and sexual assault (of both adults and children). In SANE interventions, nurses conduct forensic evidence examinations (i.e., rape kits) of victims of rape or sexual assault, in lieu of forensic doctors. The goal is to provide safe and privacy-conscious treatment that coordinates health care with counseling services, forensic collection, law enforcement, and prosecution.

A meta-analysis by Toon and Gurusamy examined six studies, which produced an overall sample size of 2,700 victims (1,223 were examined by a SANE and 1,477 were examined by a non-SANE health professional). The outcomes of interest included provision of sexually transmitted infection (STI) and pregnancy prophylaxis, and proportion of complainants who had a rape kit collected. Risk ratios or mean differences were calculated using both random-effects and fixed-effects models.

STI Treatment Results: Sexual assault/rape victims cared for by SANEs were significantly more likely to be offered treatment for an STI, compared with those cared for by non-SANE health professionals.

Pregnancy Prophylaxis Results: Sexual assault/rape victims cared for by SANEs were significantly more likely to be offered emergency contraception, compared with those cared for by non-SANE health professionals.

Citation

Toon, C., Gurusamy, K. 2014. “Forensic Nurse Examiners versus Doctors for the Forensic Examination of Rape and Sexual Assault Complainants: A Systematic Review.” Campbell Systematic Reviews 5.

Psychotherapies for Victims of Sexual Assault

Psychotherapeutic interventions for adult sexual assault victims are designed to reduce psychological distress, symptoms of post-traumatic stress disorder (PTSD), and rape trauma through counseling, structured or unstructured interaction, training programs, or predetermined treatment plans. Most treatments include individual cognitive behavioral approaches, such as cognitive-behavioral therapy or insight/experiential therapy. The goals of psychological therapy for victims of sexual assault include (1) preventing and reducing PTSD/trauma symptoms, anxiety, depression, and other psychopathologies; and (2) improving social adjustment and self-esteem.

Psychotherapeutic interventions can be provided to victims of sexual abuse and assault who are experiencing rape trauma or PTSD. Symptoms of PTSD can be categorized into three groups: (1) re-experiencing intrusive thoughts, emotions, or physiological distress upon exposure to cues of the event; (2) avoidance of thoughts or stimuli that are reminiscent of the event; and (3) biological, emotional, or cognitive arousal (Regehr et al. 2013). Sexual assault victims also report high rates of depression, difficulty concentrating, uncontrollable grief, low self-esteem, self-destructive behavior, suicidal thoughts, addictive behavior, impaired social and occupational functioning, sexual avoidance, and psychological disorders such as panic attacks (Chard 1995).

Therapy models that focus on helping victims recover from trauma can be categorized into three frameworks:

  • The cognitive-behavioral model assumes that a person is both the producer and product of her environment; therefore, treatment is aimed at changing a person’s behaviors within her environment. The model incorporates cognitive, behavioral, and social learning theory components. Examples of specific cognitive-behavioral approaches include exposure therapy or prolonged exposure, stress inoculation training, eye movement desensitization reprocessing, cognitive processing therapy, and assertiveness training.
  • Psychodynamic psychotherapy focuses on several aspects, such as expression of emotions, exploration of avoidance of distressing emotions, examining past experiences, identification of defense mechanisms, and working through interpersonal relationships. An important part of psychodynamic psychotherapy is bringing the person’s conflict and psychic tensions from the unconscious into the conscious to encourage healthier functioning.
  • Supportive psychotherapy or supportive counseling may be provided in individual or group settings, and allows an individual to share her traumatic experience and the symptoms that resulted from the event. Supportive approaches aim to normalize experience, instill hope, increase interpersonal learning, and decrease an individual’s sense of isolation.

Results

Taylor and Harvey (2009) found that psychotherapeutic approaches had a significant, large effect  with regards to the treatment of trauma and PTSD of sexual assault victims. The review by Regehr and colleagues (2013) estimated the effect of psychotherapeutic treatment using a different methodology, although the results were similar. These results suggest that psychotherapeutic interventions can be associated with decreased symptoms of trauma and PTSD in victims of sexual assault and rape.

Citations

Taylor, Joanne E., and Shane T. Harvey. 2009. “Effects of Psychotherapies With People Who Have Been Sexually Assaulted: A Meta-Analysis.” Aggression and Violent Behavior 14:273–85.

Regehr, Cheryl, Ramon Alaggia, Jane Dennis, Annabel Pitts, and Michael Saini. 2013. “Interventions to Reduce Distress in Adult Victims of Sexual Violence and Rape: A Systematic Review.” Campbell Systematic Reviews 3.

School-Based Interventions to Reduce Dating and Sexual Violence

There are a number of violent behaviors that can constitute teen dating violence, including verbal or emotional abuse, physical abuse, sexual assault, and threats of rape and murder (Fellmeth et al. 2014). School-Based Interventions to Reduce Dating and Sexual Violence include a range of universal-level programs aimed at increasing students’ knowledge about teen dating violence; changing attitudes or beliefs supportive of teen dating violence; improving conflict-management skills; and encouraging peer support and bystander involvement. The goal of the programs is to prevent or reduce incidences of teen dating violence perpetration and victimization and incidences of sexual violence in intimate adolescent relationships, in students in grades 4-12.

School-based interventions that aim to reduce dating and sexual violence include primary programs (targeted at students who have never perpetrated or been victimized by dating violence) and secondary programs (intended for students who have committed or are victims of dating violence). Many programs are at the universal level; that is, all students in a school or classroom are targeted by the intervention. For example, programs may include lessons that are provided to all students and educational posters that are placed on school walls and hallways for all to see.

There are a variety of activities or components that may be implemented in teen dating and sexual violence prevention programs. For younger students, programs may focus on changing the school culture or climate, in an effort to decrease aggression and promote respect among students. These programs generally work on encouraging students to be sympathetic and helpful to victims of dating violence and rejecting dating violence behaviors perpetrated by their peers.

For older students, such as those in middle and high school, programs generally focus on trying to change dating attitudes and behaviors. Programs include more activities to teach students skills that will foster healthy dating relationships, including skills to communicate effectively; deal constructively with stress, disappointment, or rejection; and resolve conflicts constructively. Students may also learn skills to protect themselves from the risk of violent victimization in a relationship.

De La Rue and colleagues (2014) conducted a meta-analysis to examine the effectiveness of school-based interventions designed to reduce or prevent dating and sexual violence perpetration and victimization in intimate relationships. Studies were included if they had a well-defined control group (randomized control trials, quasi-randomized control trials, and quasi-experimental designs); had examined programs implemented in (public and private) middle and high schools (studies of programs that were not conducted in schools were excluded); had a primary goal of reducing or preventing teen dating violence or sexual violence; and had measured the impact of the program on attitude change, frequency of intimate partner violence perpetration or victimization, teen dating violence knowledge, or the ability to recognize safe and unsafe behaviors in intimate partner disputes.  A total of 23 unique studies were found, producing a study population size of 20,500 participants.

Perpetration of Violence Results: Interventions had a significant effect on the perpetration of dating violence among teens (average effect size = -0.11). This means that the students who participated in the programs reported initiating dating violence less often than students who did not participate in the programs.

Teen Dating Violence Knowledge Results: Interventions were effective at improving knowledge of teen dating violence (average effect size = 0.36). Students who participated in teen dating and sexual violence interventions had greater knowledge about teen dating violence than students who did not participate in the programs.

Teen Dating Violence Attitude Results: Interventions significantly improved teen dating violence attitudes of student participants (average effect size = 0.11).

Results from three studies showed that interventions had no effect on teen dating violence victimization.

Citation

De La Rue Lisa, Joshua R. Polanin, Dorothy L. Espelage, and Terri D. Piggot. 2014. “School-Based Interventions to Reduce Dating and Sexual Violence: A Systematic Review.” Campbell Systematic Reviews 2014:7.

Interventions for Domestic Violence Offenders: Duluth Model

There are a number of interventions that are common in the treatment of domestic violence offenders. One prominent clinical intervention employs a feminist psychoeducational approach and is widely known as the Duluth Model. Originating in 1981 from the Duluth Domestic Abuse Intervention Project in Duluth, Minnesota, this intervention proposes that the principal cause of domestic violence is a social and cultural patriarchal ideology that historically has allowed men to control women through power and violence. Violence perpetrated on women and children originates from their relative positions of weakness and vulnerability socially, politically, economically, and culturally. As such, the model does not assume that domestic violence is caused by mental or behavioral health problems, substance use, anger, stress, or dysfunctional relationships. The program concentrates on providing group facilitated exercises that challenge a male’s perception of entitlement to control and dominate his partner. The Duluth Model is considered less of a therapy and more of a psychoeducational program for domestic violence perpetrators.

The Duluth Model focuses on male domestic violence perpetrators and female victims. Its theory is based upon an understanding of male power, control, and dominance as culturally and historically pervasive, and which allowed, if not encouraged, men to control women, sometimes through the use of violence.

Babcock and colleagues (2004) performed a meta-analytic review of 22 studies evaluating the effects of domestic violence interventions for male perpetrators. The outcomes of interest to this review were recidivism and victimization. For the recidivism outcomes, the meta-analysis reports an effect size for five experimental and seven quasi-experimental Duluth Model interventions. For the victimization outcome with victim report data, the meta-analysis reports an effect size for three experimental and five quasi-experimental Duluth Model interventions.

Recidivism Results: Babcock and colleagues (2004) found that the Duluth intervention demonstrated a significant positive effect on recidivism. They report the effect sizes for recidivism using police report data separately for five experimental and seven quasi-experimental Duluth interventions (note that the outcome rating only considered the effect size of the experimental studies). The five experimental studies showed a small, but statistically significant effect size favoring the treatment group (d = 0.19). Additionally, the authors also found a small to medium statistically significant effect size favoring the Duluth intervention offenders in the seven quasi-experimental studies (d = 0.32).

Citation

Babcock, Julia C., Charles E. Green, and Chet Robie (2004) “Does Batterers’ Treatment Work? A Meta-Analytic Review of Domestic Violence Treatment.” Clinical Psychology Review, 23, 1023-1053.

It should be noted that the widespread popularity of the Duluth Model has in many instances been translated into local laws that require all domestic violence interventions to be grounded in similar psychoeducational feminist theory. Other alternative models of interventions can thus be discouraged or unfunded.

A Roadmap to Selecting an Evidence Based Practice

The success and sustainability of an evidence based practice starts with selecting the right one… RoadmapToSelectingAnEBP

Use this resource from the California Evidence-Based Clearinghouse for Child Welfare to help your organization on the journey to implementing a new evidence based practice!