Recommendations

Based on the foregoing analysis, we believe that CPA and other Canadian organizations representing professional psychology must formulate coordinated responses to the empirically supported treatment and practice guideline initiatives. From our perspective, these initiatives are not just a "flash in the pan." They are serious efforts to enhance the accountability of psychological services, and, as such, will have an enormous impact on the future nature of professional psychology. Based on the recent experience of Canadian health care system restructuring, it is clear that Canadian professional psychology risks being marginalized unless professional psychology organizations make a concerted effort to play a central role in the development of practice guidelines and related evidence-based procedures for all behavioral health services.

To orient Canadian professional psychology organizations to the implications of these initiatives, we offer a number of specific recommendations. These recommendations touch on issues of training, credentialing, practice, and research. Whenever possible, we have also offered our suggestions regarding the Canadian organizations that might be considered for involvement. We would encourage broad circulation and discussion of this document and our recommendations, both within the Clinical Section and CPA. CPA, in particular, has an important role to play in this context because of its ability, in coordination with other national psychological organizations, to consult, inform, and educate professional psychologists.

1. The Section on Clinical Psychology of CPA should explicitly endorse the work of the APA on empirically supported treatments.

2. The Section on Clinical Psychology of CPA should encourage CPA to explicitly endorse the work of the APA on empirically supported treatments and to seek representation on future Task Force committees on empirically supported treatments. CPA should also examine the possibility of sponsoring with APA future Task Force committees.

3. The Section on Clinical Psychology of CPA should encourage CPA to seek to participate in the summit meetings on practice guidelines already taking place in the United States. Alternatively, CPA could be encouraged to work with other groups (such as the Canadian Register of Health Service Providers in Psychology and the Canadian Council of Professional Psychology Programs) to actively develop such guidelines in Canada with other psychological and behavioral health professions.

4. The Section on Clinical Psychology of CPA should encourage the CPA Accreditation Panel to require training in empirically supported treatments as a mandatory criterion for the accreditation of doctoral programs and internships in clinical psychology. For internships, there should be explicit recognition that the extent of such training may be limited due to the limited availability of supported treatments for some practice domains and client populations served by the internship. Additionally, the Section should encourage the CPA Accreditation Panel to survey training programs and internships on the extent to which training in empirically supported treatments is currently available.

5. The Section on Clinical Psychology of CPA should encourage CPA to work with other national and provincial psychological organizations (such as the Canadian Register of Health Services Providers in Psychology and the Council of Provincial Associations of Psychology) to develop and promote continuing education and training in empirically supported treatment approaches.

6. The Section on Clinical Psychology of CPA should encourage CPA to work with provincial regulatory bodies and the Canadian Register of Health Service Providers in Psychology to require knowledge of and training in empirically supported treatments as part of the assessment of suitability to independently provide health services to the public.

7. With regard to public policy in Canada, the Section on Clinical Psychology of CPA should encourage CPA to (i) inform federal and provincial ministries of health about the use of empirically supported treatments (ii) lobby these ministries to direct funding toward those programs that promote empirically supported approaches to specific patient problems. Efforts to inform the ministries should emphasize the complexity of treatment planning and the limitations inherent in the classification of treatments as empirically supported, but should also indicate where there are clearly preferable treatment options based on scientific data.

8. Similarly, the Section on Clinical Psychology of CPA should encourage CPA, in conjunction with all interested organizations, to lobby health insurance companies regarding the use of empirically supported treatments. Efforts to inform these companies should emphasize the complexity of treatment planning and the limitations inherent in the classification of treatments as empirically supported, but should also indicate where there are clearly preferable treatment options based on scientific data.

9. In conjunction with all interested organizations, the Section on Clinical Psychology of CPA should develop a clear statement, for the public and other stakeholders in the health care system, on the scientific context of psychological services. This statement should discuss the importance of using an evidence-based approach to service provision and should explicitly discuss the fact that scientific validation inevitably lags behind routine practice. Accordingly, there should be a statement that a treatment may be beneficial for an individual even if it is not listed as being empirically supported (i.e., the difference between a treatment being untested and being ineffective).

10. To ensure that psychological practitioners are cognizant of methods for enhancing practice accountability, the Section on Clinical Psychology of CPA should encourage CPA to: (i) implement an accreditation criterion requiring training in outcome evaluation for clinical training programs and (ii) sponsor continuing education workshops on outcome evaluation and other approaches to enhancing accountability

11. The Section on Clinical Psychology of CPA should encourage CPA to coordinate a national data base (perhaps in association with the Canadian Institute for Health Information) on treatment outcome from large treatment sites (e.g., teaching hospitals and university based clinics) in order to obtain data on actual practice effectiveness. This would augment the information gathered in efficacy research and could be used in the development of practice guidelines.

12. The Section on Clinical Psychology of CPA should encourage CPA to lobby the major national granting agencies regarding the importance of including psychological treatment efficacy and effectiveness research in their purview of fundable health and social science research. For those granting agencies that currently fund health service research, CPA should encourage the agencies to include, as possible research domains, research on (i) the effectiveness of training and supervision for dissemination of empirically supported treatments, (ii) the utilization of treatment manuals in the delivery of services, and (iii) measures of competence/proficiency in the delivery of services.

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