Reducing Low-Value Practices a Functional-Contextual Consideration to Aid in De-Implementation Efforts

Abstract

Through innovation in research and self-correction, it is inevitable that some practices will be replaced or be discredited for one reason or another. De-implementation of discredited and low-value practices is a necessary step for school psychologists’ maintenance of evidence-based practices and to reduce unnecessary costs and risk. However, efforts to clarify de-implementation frameworks and strategies are ongoing. The scope of this paper follows McKay et al. in considering the potential for de-implementation strategies to be informed by applied behavior analysis and operant learning theory. We conceptualize low-value practice as sets of behaviors evoked by their context and maintained by their consequences, and thus de-implementation as behavior reduction. We discuss the need for future research given this perspective.

Management strategies to de-implement low-value care—an applied behavior analysis

“…The center-specific strategies mainly focused on making it more difficult to provide a given LVC (i.e., increasing the response effort for ordering a lab test or an examination) or removing the situation entirely by scheduling patients with other professions. Thus, we found no strategies focused on providing support or encouragement for behaviors related to not using an LVC (i.e., differential reinforcement [ 14 ]). Examples of behaviors related to not using LVC could be to make the decision to not use a practice, to communicate to a patient the lack of benefit of a practice, or to recommend self-care strategies to patients who do not need any medical treatment.…”

“…Few behavior change theories distinguish between increasing and decreasing behaviors [ 13 ]. However, the operant learning theory explicitly distinguishes between strategies for increasing and decreasing behaviors [ 13 , 14 ]. The contemporary application of the operant learning theory is applied behavior analysis, which has been used in health care for a variety of purposes (e.g., increased staff attendance [ 15 ], improved compliance with safety routines [ 16 ], increased emergency department efficiency [ 17 ], improved compliance to routines [ 18 , 19 ]).…”

A Psychometric Network Analysis of CHC Intelligence Measures: Implications for Research, Theory, and Interpretation of Broad CHC Scores “Beyond g”

“…A group of prolific scholars has repeatedly demonstrated that although the general factor of intelligence can be measured reliably in individuals and has predictive validity for significant outcomes, they believe they have shown that the smaller broad CHC scores cannot be measured reliably in individuals and provide only negligible amounts of helpful information ( Beaujean et al 2018 ; Canivez 2013a , 2013b ; Canivez et al 2016 ; Canivez and McGill 2016 ; Dombrowski et al 2017 ; Dombrowski et al 2019b ; McGill and Busse 2017 ; McGill 2018 ; Nelson et al 2013 ). This group’s research has resulted in calls for the de-implementation of many popular intelligence testing interpretation practices ( Dombrowski et al 2021 ; Farmer et al 2021a , 2021b ). In particular, the interpretation of broad CHC scores is considered a low-value practice.…”

Reducing low value care: opportunities and challenges for Choosing Wisely campaigns

“…Patey et al undertook a critical interpretative synthesis exploring whether theories of behaviour change distinguish between starting and stopping behaviours and whether they suggest different strategies for starting and stopping behaviours 6. She observed that only operant learning theory principles7 suggest different strategies for stopping behaviours (in particular principles of ‘punishment’ could inform strategies for stopping behaviours), but how best to use these principles remains unclear 8–10. She also explored whether different behaviour change techniques (BCTs) have been used in studies focussing on implementation or de-implementation.…”