From science to practice: The flexible use of evidence-based treatments in clinical settings.

Psychosocial treatment options are nearly as broad as the behavioral problems that they address. With literally hundreds of treatment approaches available, how should clinicians select the most appropriate and effective intervention? One way is to consider using only those treatments with evidence of therapeutic efficacy. Indeed, funding agencies have invested substantial sums to evaluate the efficacy of many treatments, and the result is a growing list of evidence-based treatments (EBTs) for children and adolescents (e.g., Kazdin and Weisz, 2003). The accumulated data for these treatments support their consideration as first-line intervention options. Despite the documentation of the efficacy of these EBTs, they have not been widely incorporated by training programs or practicing clinicians (Addis and Krasnow, 2000). The arguments most often made against the clinical use of EBTs are that they are developed and tested in well-controlled research settings and therefore may not be effective with “real patients” treated by “real therapists” in “real clinical settings” (see Persons and Silberschatz, 1998; Wilson, 1998). Some aspects of these arguments are valid. There is much that we do not know about existing EBTs, such as which components are necessary and sufficient, how they work, and under what conditions they are most effective (Kazdin and Nock, 2003; Nock, 2003). Rather than waiting for the answers to these questions; however, in this paper we describe how clinicians can use EBTs currently, flexibly, and effectively in clinical settings.