Criteria for Practice Guideline Development and Evaluation

Introduction

1.1 Purpose

This document is a guide for the development, evaluation, and review of proposed and existing practice guidelines. It is designed to promote quality and consistency in practice guideline development and to describe the criteria by which practice guidelines are evaluated and reviewed. These criteria are designed to assist in the development of guidelines that are broadly applicable to a range of practice areas yet provide sufficient specificity to assist the practitioner in providing high quality psychological services. The intent behind these criteria is to ensure deliberation and care in the development of practice guidelines. This document is intended for practice guideline development committees composed entirely of psychologists and for multidisciplinary efforts in which psychologists are involved. The term practice guidelines refers to a document that includes a set of statements that recommend specific professional conduct for psychologists. Proposed practice guidelines are not considered American Psychological Association (APA) policy until they have been approved through the formal APA process.

Guidelines are created to educate and to inform the practice of psychologists. They are also intended to stimulate debate and research. Guidelines are not to be promulgated as a means of establishing the identity of a particular group or specialty area of psychology; likewise, they are not to be created with the purpose of excluding any psychologist from practicing in a particular area.

Guidelines must be reasonable, as described in the APA ASME Guidelines (APA, 1992). All guidelines should be well researched, aspirational in language, and appropriate in goals.

1.2 Guidelines versus standards

The term guidelines refers to statements that suggest or recommend specific professional behavior, endeavor, or conduct for psychologists. Guidelines differ from standards in that standards are mandatory and may be accompanied by an enforcement mechanism. Thus, guidelines are aspirational in intent. They are intended to facilitate the continued systematic development of the profession and to help assure a high level of professional practice by psychologists. Guidelines are not intended to be mandatory or exhaustive and may not be applicable to every professional and clinical situation. They are not definitive and they are not intended to take precedence over the judgment of psychologists.

1.3 Practice versus treatment guidelines

Although the terms practice guidelines and treatment guidelines are often used interchangeably, APA draws a distinction between the two and encourages consistent use of terminology within the association. Treatment guidelines provide specific recommendations about clinical interventions. They tend to be conditionor treatment-specific and are typically disorder based (e.g., attention-deficit/hyperactivity disorder, substance abuse, depression). For guidance in developing treatment guidelines, refer to the "Criteria for Evaluating Treatment Guidelines" (APA, 2002b).

In contrast to treatment guidelines, practice guidelines consist of recommendations to professionals concerning their conduct and the issues to be considered in particular areas of psychological practice (e.g., APA Committee on Professional Practice and Standards, 1999; APA Division 44/Committee on Lesbian, Gay, and Bisexual Concerns Task Force on Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients, 2000).

1.4 Background

These criteria are a revision of the Criteria for Guideline Development and Review originally developed by APA's Committee on Professional Practice and Standards (COPPS) and adopted by the APA Council of Representatives (APA, 1995). The reason for these criteria was set forth in the 1995 document as follows:

a. As the profession of psychology evolves and the number of areas of practice within it increases, there is a greater demand for guidelines that facilitate the continued systematic development of the profession and help to assure a high level of professional practice by psychologists.

b. As the complexity of the practice of psychology increases and the reciprocal involvement between psychologists and the public broadens, the need for guidelines to educate the profession, the public, and other interested parties regarding desirable professional practices in various areas has expanded and will probably continue to expand in the foreseeable future.

c. In spite of increased demand for guidelines, the profession lacks criteria for developing, implementing, and evaluating them. (APA, 1995, p. 2)

On the basis of continuing experience with guideline formulation, evaluation, and use, the Board of Professional Affairs (BPA) charged COPPS to undertake a revision of the 1995 document. The following needs were identified:

a. Standardization across guidelines. Guidelines have varied widely with respect to clarity, structure, and specificity.

b. Periodic review of guidelines. Lack of sunset provisions has permitted guidelines to become outdated.

c. Clear structure and instructions. Guideline developers would benefit from clear instructions and a thorough explanation of the criteria by which guidelines are evaluated.

d. Practice versus treatment guidelines. A clear distinction between practice and treatment guidelines was required.

1.5 Development process

The 1995 document (APA, 1995) was developed after a review of the relevant literature on practice guideline development. Although much of this literature focused on clinical treatment guidelines, the templates, outlines, and processes proposed in some of the major texts in this area were reviewed (e.g., Agency for Health Care Policy and Research, 1993; Field & Lohr, 1990, 1992; Woolf, 1991).

As part of the development of the current document, the 1995 document (APA, 1995) and references were reviewed. In addition, a literature search was conducted by APA staff that yielded documents focused primarily on either professional standards or treatment guidelines. COPPS reached consensus that virtually all available material addressed treatment guidelines or standards of practice. In addition to the literature used in the 1995 document, several recent articles informed the current document (e.g., Lawton & Parker, 1999; Phillips, 1998).

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