2. Cognitive Mapping
3. EBP Curricula
4. Problem Solving in Medicine
4.1. Heuristics and Causal Models
4.2. Causal Models and Interventions
4.3. Causal Mapping
4.4. Making Decision-Making Visible
4.5. Intervention Theory
4.6. Teaching How to Think about Interventions
Clinical Example of Intervention Analysis
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Intervention Rubric
|Clearly names intervention and provides alternative names that may be associated with the intervention, (e.g., The Listening Program and auditory integration training)|
and links to resources that provide specific, in-depth information about the intervention.
|Provides only the name of the specific intervention being described and links to resources that provide specific, in-depth information about the intervention.||Does not clearly name intervention nor provide links to resources.|
|Clearly describes the theoretical model(s) and tenets that were used to develop the intervention, including:||Identifies the theoretical model used to develop the intervention, including:||Labels the theoretical model used to develop the intervention.|
|Clearly describes what population should be considered and/or ruled out as potential candidates for this intervention||Labels and describes what clinical population would benefit and not benefit from this intervention.||Provides only minimal information on inclusion/exclusion for intervention|
|Clearly describes a “best practice” aspects of measuring outcomes of intervention, including:||Provides major indicators that should be monitored for measuring the impact of the intervention.||Does not provide any information on measuring the impact of the intervention.|
“Key elements of Intervention”
|Clearly describes a theorized or evidence of the process by which the intervention causes the change.||Based on a broad theory (e.g., dynamic systems, diffusion of innovation, etc.), and/or heavy reliance on values and beliefs.||Does not address.|
|Clearly describes important indicators that should be considered while reflecting on the client-intervention- outcome process.|
Clearly describes all of alternative interventions which should be considered and ruled out due to clinical and/or client characteristics (e.g., consistent with differential diagnosis)
|Highlights some indicators that should be considered while reflecting on client-intervention- outcome process.|
Identifies some alternatives interventions which should be considered.
|Does not provide any indicators that should be considered while reflecting on client-intervention- outcome process.|
Does not identify any alternative interventions which should be considered.
Clearly describes the strength of evidence to support using this intervention with each population
Provides clear synthesis of clinical evidence
Uses multiple person/multiple site narratives/clinical experience to describe the client change experienced when using this intervention.
Describes a systematic outcomes data collection system, including the list of data points collected, however only some clinical outcomes data provided
No peer-reviewed evidence is provided, reliance on expert opinion and personal experience
Anecdotal experience with general description of client outcomes and heavy reliance on goal achievement (unstandardized and/or lacks evidence of reliability/validity, limited interpretability of change scores)
- Name: Intervention has a clear name that allows it to be distinguished from other interventions.
- Interventions which have more resources available, such as protocols or manuals, provide deeper understanding of the assessment, application (activities which should and should not be done), and the theoretical underpinnings which provide explanation of how the intervention causes a different outcome.
- Fidelity Tools: provide criteria to assess current practice for similarities and differences and assess if application done locally is develop consistent with the intervention as theorized or in efficacy studies.
- Theory—“Why it works”Interventions are developed using treatment theory, which identifies a specific group of activities which specify the mechanism by which the active ingredients* of a treatment intervention produce change in the treatment target. In other words, it identifies the aspect of function that is directly impacted by the treatment. A well-defined treatment theory will identify active ingredients (those which cause the change) from inactive ingredients. See Figure 5 and Hart & Ehde  for a more extensive discussion of treatment theory.
- Active ingredients involve at a minimum those things that the clinician does, says, and applies to the client that influence a targeted outcome. These include both communicative processes and sequential healing, learning, and environmental processes.
- Essential ingredients are those activities which must be included in order for it to be a given intervention.
- Mechanism of Action: clearly identifies the processes by which the ingredients bring about change on the outcome target.
- Measurable/observable treatment targets: “things” that you measure or observe to know if the intervention is beginning to work in therapy, i.e., clinical process measures.
- Population: Clearly defines who is or is not a member of the population of interest, including clinical characteristics.
- Inclusion/exclusion criteria: what are clinical or client characteristics indicating that the intervention should or should not be applied.
- Measuring the Impact of Intervention: Clearly describes a “best practice” aspect for choosing and observing/measuring outcomes of the intervention including:
- Using the ICF Framework, identifying the measurement construct that are indicators of change theoretically “caused” by the intervention. See addendum a: Outcome Domains Related to Rehabilitation.
- Collecting client reported outcomes at baseline (before), during, end, and after discharge from therapy. Distal measures should include satisfaction, value of change, and functional change outside of the medical model indicators (e.g., activity, participation, or quality of life levels of the ICF). Distal measures will provide evidence that the clinical interventions translated to meaningful change in life circumstances (See do we want to add reference that limited evidence that clinical goals have real world affects)
- Identify and describe the standardized subjective and objective measures that should be used, including the psychometrics and appropriate clinical interpretations of the scores obtained
- Identification of assessment and evaluation tools which have known reliability, sensitivity, and predictive validity, when possible.
- Describe “best practice” for non-standardized data points, e.g., provides clinical data indicators which should be systematically collected locally if the intervention is provided.
- Intervention Process- “Key elements of Intervention”
- Clinical reasoning: clearly describes the important indicators (i.e. person, organizational, socio-political factors, etc.) that should be considered on the intervention process, including conditional decisions regarding strategy feasibility, applicability, and appropriateness in the specific situation.
- Evidence “What Works”:Peer-reviewed Evidence:
- Clearly describes the strength of evidence supporting the use of the intervention with each population.
- Peer-reviewed evidence would be provided when possible.
- Provides a synthesis of clinical outcomes data including: number of sites using the intervention and number of clinicians (indicators of replication)
- Provides the estimated number of clients who have received the intervention and who have pre-post outcome data
- Provides estimates of the number and characteristics of patients who did not respond to treatment in the expected time frame.
- Provides information on how they minimized bias and allocated patients to the “new” intervention (compared to standard treatment)
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|Step 1||Identify possible problem(s), concepts, etc.|
|Step 2||Reflect on your beliefs, knowledge, experiences, and place any variable which may be affecting the problem on the map|
|Step 3||Seek empirical evidence and background information |
|Step 4||Identify and link interventions to the variables they affect|
|Step 5||Assess applicability, feasibility to context and client|
|Step 6||Identify and collect outcomes data points locally which will allow assessing accuracy of decision|
|Step 7||Reflect on outcomes data:|
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