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Book Forum: Mental Health Services   |    
Evidence-Based Practice Manual: Research and Outcome Measures in Health and Human Services
DONALD M. HILTY, M.D.; MALATHI SRINIVASAN, M.D.
Am J Psychiatry 2005;162:831-832. doi:10.1176/appi.ajp.162.4.831
View Author and Article Information
Sacramento, Calif.

Edited by Albert R. Roberts, Ph.D., and Kenneth R. Yeager, Ph.D. New York, Oxford University Press, 2003, 1,080 pp., $89.50.

This manual for research and outcome measures in health and human services is an important topic today for clinicians, teachers, researchers, and administrators in public health. Its main objective was "to bridge and augment health and human services with scientific research inquiry." It is intended to affect clinical practice, mainly through improving research and program evaluation, but it reaches for too many audiences—health care workers, administrators, and health services researchers. There are more than 100 chapters and 1,000 pages.

The first few chapters in section 1 provide an overview for the book (e.g., background, how to implement procedures, performance indicators). Section 2 reviews research ethics and grant applications and would be of use to administrators, junior faculty, or driven trainees embarking on a research career. Clinicians may use it for reference. Section 3 is squarely focused on the title with regard to how evidence-based issues apply to diagnosis, interventions, and outcomes. It appears more useful for researchers and administrators than clinicians. Some childhood and adult mental health disorders are covered as exemplars (e.g., attention deficit hyperactivity disorder, depression, and anxiety). For some topics, only a single evidence-based approach is addressed (e.g., cognitive behavior therapy for posttraumatic stress disorder).

Section 4 is well organized and covers epidemiology and public health research. Once again, certain populations are targeted as exemplars (e.g., Northern Plains Indians). Sections 5 and 6 focus on conceptualization and operationalization of clinical assessment, providing a brief overview of measures, mainly those used in nonmedicine sectors. The overview presented here is not as well organized, detailed, or clinically applicable for medicine and psychiatric settings as can be found in other books (1).

Section 7 is very useful for program evaluation, and section 10 complements it by addressing continued quality improvement—both are helpful for administrators and/or researchers. Sections 8 and 9 provide qualitative and quantitative research exemplars, respectively. The exemplars are generally public health populations (e.g., HIV, cancer prevention, drug courts). The sections highlight some clinical issues in the process of demonstrating how one would administratively evaluate populations and settings. Things to do are well outlined.

We have several suggestions for the next edition. First, we would group the chapters on how to conduct health services research as one section of the book, with applications of these techniques in another portion. There is, for example, a wonderful chapter on constructing validated scales that is buried after a chapter about measuring fatherhood propensities. Second, our sense is that the chapter authors were encouraged to provide a topic review and then to discuss their own research. The weakness in this technique is that it does not provide a sense of where this research falls in a continuum of research methods or link it to other related research methods. The examples override the approach, but the examples make the techniques real. Third, the chapters could benefit from an outline, learner objectives, and a standardized format. The headings are easy to see, although the print could be bigger. The tables could be more helpful. Fourth, contributions should be considered from health services researchers in pediatrics, internal medicine, and medical informatics, who have significantly contributed to advances in qualitative and quantitative health services research methods. This would include a discussion of issues in large database research, educational research techniques that affect patients, or a variety of other standard health services research techniques. However, some community-based interventions are discussed. Fifth, the authors only briefly discuss problems that they ran into during their research and common mistakes that were made. This would have been very valuable to other researchers and public policy workers. Finally, the link to applied clinical practice is not very strong, nor is the assertion of the authors that cost-savings can be achieved with these measures. Health services research and evidence-based practice are costly to conduct, but they assure accountability and allow effective programs to flourish while eliminating pet projects without evidence of benefit.

This is a reasonable reference book. The text, intended as comprehensive, is actually a compendium of interesting chapters that address research, grants, and the administrative foundation of evidence-based medicine in public health settings. In the attempt to enhance practice-based medicine, it is a good hands-on, "how-we-did-it" book for researchers, administrators, and clinicians charged with evaluating or initiating clinical programs. Academic physicians working in public health might find this useful, but most physicians and clinicians will not find it immediately applicable.

American Psychiatric Association: Handbook of Psychiatric Measures. Washington, DC, APA, 2000
 
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References

American Psychiatric Association: Handbook of Psychiatric Measures. Washington, DC, APA, 2000
 
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