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I've mentioned #deimplementation quite a bit. But what do I mean? What are low value practices? And, most importantly, how do we go about doing that?
https://psyarxiv.com/u7kzj (preprint)
https://journals.sagepub.com/doi/10.1177/0829573520974915 (online first)
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https://psyarxiv.com/u7kzj (preprint)
https://journals.sagepub.com/doi/10.1177/0829573520974915 (online first)
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First, huge shout out to my co-authors here. This could not have come together without @ZaheerImad, Gary Duhon, and Stephanie Ghazal! @okstate_ehs. Also, huge shout out to @Shawpsych for leading this special issue.
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So what are low value practices? Typically, they're defined as practices that a-d (McKay et al, 2018; https://pubmed.ncbi.nlm.nih.gov/29971792/ )
a. They have not been shown to be effective or efficacious. This can be a lack of adequate empirical work or through negative results (e.g., DARE).
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a. They have not been shown to be effective or efficacious. This can be a lack of adequate empirical work or through negative results (e.g., DARE).
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b. they are less effective or efficacious than another available practice (e.g., abstinence-only education).
c. they cause harm (e.g., restraint & punishment procedure; disproportionate labeling)
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c. they cause harm (e.g., restraint & punishment procedure; disproportionate labeling)
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d. they're no longer needed (e.g., hopefully, wearing masks to prevent COVID-19 spread ca. 2022!).
These are tricky with assessment, but there's building evidence that some of what we do doesn't work (a), isn't as good as alt options (b), or causes harm (c).
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These are tricky with assessment, but there's building evidence that some of what we do doesn't work (a), isn't as good as alt options (b), or causes harm (c).
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Following Patey et al (2018; …https://implementationscience.biomedcentral.com/articles/10.1186/s13012-018-0826-6), we recommend taking a #functionalcontextual lens to address #deimplementation.
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First, we view low value practices as sets of complex #behavior. Some of those behaviors are #rulegovernered and others are directly maintained by consequences (e.g., completion of tasks, meeting job expectations).
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Like any #behavior, to decrease it we need to consider the context, including its #antecedents and its #consequences. This is where the #functionalcontextual lens comes in.
By assessing the variables that maintain the LVPs, we can take a strategic ( #functional) approach.
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By assessing the variables that maintain the LVPs, we can take a strategic ( #functional) approach.
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A lot of our LVPs are entrenched. Bad policy & training have embedded some LVPs in our practice culture, intuitional history, and they may be thoroughly anchored. Montini & Grahm (2015; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339245/) go into this quite a bit more.
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So what do we do? We need to identify our LVPs, which ones are causing the biggest drag on the profession & practice, and start working toward eliminating them. First evaluate the context, then act. This may be uncomfortable. But its important work. #DoWhatWorks #SP4EBP
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