Journal of School Psychology
Volume 43, Issue 2 , March-April 2005, Pages 99-115

doi:10.1016/j.jsp.2005.01.001      
Copyright © 2005 Society for the Study of School Psychology Published by Elsevier Ltd.

Jennifer L. White ^, and Thomas R. Kratochwill

University of Wisconsin–Madison, United States

Received 2 April 2004;  revised 25 January 2005;  accepted 31 January 2005.  Available online 7 April 2005.

Practice Guidelines have become increasingly popular at the national and international level. Practice Guidelines are a natural extension of the “evidence-based intervention” movement, and could be a mechanism to promote the use of evidence-based interventions within the field of school psychology practice and training. In this paper we review the use of Practice Guidelines in other fields and the promise and potential pitfalls associated with the development and application of Practice Guidelines within the field of school psychology. Recommendations for how to avert some of the difficulties faced by other disciplines in the development and application of Practice Guidelines are discussed. Suggestions for next steps in the profession and future research are noted.

Keywords: Practice Guidelines; Evidence-based intervention; School Psychology

The development and implementation of evidence-based interventions (EBIs) is well underway in psychology and education. This initiative towards an empirical basis for the use of interventions is an extension of the scientist–practitioner model¹ (Kratochwill & Shernoff, 2003, Kratochwill & Stoiber, 2000, Kratochwill & Stoiber, 2002, Stoiber & Kratochwill, 2000 and Stoiber & Kratochwill, 2002). The development of Practice Guidelines is a natural extension of the international movement towards “evidence-based” practice (Rowland & Gross, 2000) and has been recommended as a “next step” in the use of EBIs in practice (see Kratochwill & Shernoff, 2003 and Kratochwill & Stoiber, 2002). Practice Guidelines have a long history of application in medicine and psychiatry but, have received less attention in the field of psychology and education. The application of Practice Guidelines is an important innovation in that it has implications for how EBIs are implemented in schools and other applied settings. The purpose of this paper is to review the development of Practice Guidelines among related disciplines of professional practice, with a special emphasis on the issues surrounding the development and application of Practice Guidelines for the profession of school psychology.

Within the EBI initiative, a number of different terms have been used to refer to overlapping constructs and phenomena. In this section we briefly outline the meaning of relevant terms to assist the reader in understanding the context for references to Practice Guidelines in this paper and in the professional literature.

EVT was an early term used by the Task Force on Promotion and Dissemination of Psychological Procedures (1995) to refer to a treatment validated by experimental research (see Chambless & Ollendick, 2001). The term has fallen out of favor because it is increasingly recognized that a treatment is never completely validated. Therefore, the term evidence-based or scientifically supported in research has been used more recently in psychology and education (see below).

The term EBI is current and used in both the clinical and school psychology literatures to refer to an intervention that meets criteria of a task force for support on a wide range of methodological and statistical features (e.g., Kratochwill & Stoiber, 2002 and Weisz & Hawley, 2002). Typically, experimental (group and single-participant) methodologies are the corner-stone of this approach to designation of an intervention as evidence-based. The major feature of this designation is that a program or procedure has experimental research support.

To understand Practice Guidelines, it is useful to understand current definitions offered about the term “evidence-based practice.” Generally, EBP is referred to as integration of the best research with clinical expertise and preferences of the client for treatment (see Institute of Medicine, 2001 and Sackett et al., 2000). Hoagwood and Johnson (2003) define EBP as:

“a body of scientific knowledge, defined usually by reference to research methods or designs, about a range of service practices (e.g., referral, assessment, case management, therapies, or support services). The knowledge base is usually generated through application of particular inclusions criteria (e.g., type of design, types of outcome assessments) and it generally describes the impact of particular service practices on child, adolescent, or family outcomes. ‘Evidence-based practice' or EBP is a shorthand term denoting the quality, robustness, or validity of scientific evidence as it is brought to bear on these issues.”(p. 5)

Cournoyer and Powers (2002) offer the following definition:

“Evidence-based practice… dictates that professional judgments and behavior should be guided by two distinct but interdependent principles. First, whenever possible, practice should be grounded on prior findings that demonstrate empirically that certain actions performed with a particular type of client or client system are likely to produce predictable, beneficial, and effective results… Secondly, every client system, over time, should be individually evaluated to determine the extent to which the predicted results have been attained as a direct consequence of the practitioner's actions.” (p. 15)

Generally, EBP designates the application of a psychological intervention that has previously been documented to have empirical support and be designated as an EBI. We embrace the proposal that the terms “psychological treatments” or interventions is the language of choice for these procedures (see Barlow, 2004) but would also include academic and social/emotional treatments in this category. An extension of the concept is also that EBP involves an evaluation of an intervention in a practice context to determine if the intervention is effective in its application.

Documenting intervention decision-making parameters can be an important first step in promoting the use of EBIs among practitioners. Traditionally, the field of school psychology has primarily relied on four sources to support claims that a given intervention or strategy is “evidence-based”: (a) basic intervention research literature published in professional journals, (b) consensus or expert panel recommendations in which identified experts in a given profession review and reach agreement on the nature of what is the best practice in treatment; (c) reviews of single interventions or programs undertaken by professional groups (e.g., Task Force on Evidence-Based Interventions in School Psychology) or government funded agencies (e.g., What Works Clearinghouse), and, (d) literature reviews and synthesis documents such as the Best Practices in School Psychology Series (Thomas & Grimes, 2002), with topical chapters by single or multiple authors. Given the increasingly diverse and broad literature base relevant to the field of school psychology, the primary reliance on these four mechanisms for information dissemination may become unsustainable over time.

Indeed, few school-based practitioners have sufficient time available to keep up with the burgeoning literature relevant to the practice of school psychology, yet synthesis documents and book publications are often difficult to update and correct in a timely fashion. Although expert panel and independent intervention reviews may provide more up-to-date and user friendly ratings of various interventions, the utilization of different intervention rating criteria and failure to integrate multiple intervention options in a comprehensive way can create a system of fragmented (sometimes contradictory) clinical and applied recommendations.

A variety of alternate strategies to document and disseminate intervention decision-making parameters have been developed by other health care professions to promote the use of EBIs within their respective fields. The main purpose of these strategies and techniques has been to encourage the use of EBIs by synthesizing an intervention literature into a useable form. In the following section, we review the most commonly used strategies to document intervention decision-making parameters, and highlight some of the most commonly cited pros and cons associated with their use.

As EBIs become more widely used, the development and use of intervention manuals has increased greatly. Today, most EBIs are accompanied by an intervention manual that provides specific guidelines for how to implement and monitor the effectiveness of the intervention in question. As an illustration, in the area of childhood anxiety disorders, several manualized treatment protocols have been developed to guide the administration of individual cognitive-behavioral therapies (e.g., Giebenhain & O'Dell, 1984, Kendall et al., 1992 and March & Mulle, 1996), family-based therapies (e.g., Howard & Kendall, 1996), and group therapies (e.g., Albano et al., 1991 and Flannery-Schroeder & Kendall, 1996). Intervention manuals such as these typically spell out in great detail the materials needed, steps in implementation of the intervention, as well as special considerations in implementation of the intervention (see Kratochwill & Stoiber, 2000 for a brief review of some issues surrounding manualized interventions).

Kendall and Flannery-Schroeder (1995) cite a number of potential advantages associated with intervention manualization including enhanced internal validity, treatment integrity, and the ability for intervention providers to compare differences in the number of sessions, training requirements, and time commitments of various interventions prior to intervention selection. The use of intervention manuals has also been found to help facilitate practitioner training and the replication of intervention outcome studies (Dobson & Shaw, 1988).

Although intervention manuals have been criticized on the basis of their potential to limit practitioner creativity (Davidson & Lazarus, 1995) or restrict practitioners' ability to adapt interventions to fit specific clinical circumstances (Wilson, 1995 and Wilson, 1996), it is important to note that intervention manuals are typically intended to facilitate the implementation of a single intervention or treatment program. As such, intervention manuals do not necessarily provide practitioners with a “big picture” overview of clinically-relevant variables that should be accounted for during intervention selection or what interventions practitioners should consider if no response to intervention was observed. To be considered a useful tool in guiding practitioners' intervention decision-making parameters, this information is vitally important—but often missing from—manualized interventions.

Treatment Guidelines² refer to specific procedural protocols and related materials that assist therapists, mediators, or other professionals in implementation of a particular EBI (Hatcher, Butler, & Oakley-Browne, 2005). Treatment guidelines are often accompanied by Treatment Algorithms which provide a step-by-step protocol for making clinical decisions. In this respect, Treatment Algorithms can be thought of as a means of operationalizing Treatment Guidelines by providing a suggested course of action to treat a particular problem under various clinically-relevant circumstances.

Treatment Guidelines and Algorithms have been used extensively in the field of medicine to guide clinical decision-making in the treatment of cancer, asthma, arthritis, diabetes and a variety of other chronic medical conditions where first and second-line treatments are clearly defined. More recently, Treatment Algorithms have been developed within the field of psychiatry in an effort to codify recommended treatment sequences for the use of medication in treating mental illnesses such as Depression (Crismon et al., 1999), Bipolar Disorder (Dantzler & Osser, 1999), Schizophrenia (Buscema, Abbasi, Barry, & Lauve, 2000), Panic Disorder (Coplan & Gorman, 1999), Social Anxiety Disorder (Marshall & Schneier, 1996), Obsessive–Compulsive Disorder (Greist & Jefferson, 1998), Posttraumatic Stress Disorder (Alarcon, Glover, Boyer, & Balon, 2000), Personality Disorders (Soloff, 1998), and in the treatment of behavioral disorders among adults with Developmental Disabilities (Mikkelsen & McKenna, 1999).

Treatment Algorithms for the use of psychopharmacological interventions with children and adolescents have been developed as well. Specific examples include Algorithms for the treatment of childhood Depression (Hughes et al., 1999), Attention-Deficit Hyperactivity Disorder (Pliszka et al., 2000), and problem behaviors among children with Autism (Stigler, Posey, McDougle, & Whitcomb, 2003).

Although the clarity of Treatment Guidelines and Algorithms' step-by-step approach to clinical decision-making is attractive to some, recommending a single “if-then” course of action to guide intervention decision-making may oversimplify the multitude of considerations influence the intervention selection process. Indeed, many stand alone Treatment Algorithms assume a common knowledge base, level of training, philosophical orientation, and professional context (e.g., office practice) that may be inappropriate for the field of school psychology at this time.

Expert Consensus Guidelines are intervention recommendations based on the results of surveying a broad range of experts on a given topic, form of treatment, or disorder area (Atezaz-Saeed, 2004). Expert Consensus Guidelines are typically commissioned by professional organizations, and often focus on developing best practice recommendations for topics or intervention issues not well covered (or clear) from the research literature alone. For example, some Expert Consensus Guidelines have focused on recommended practices in the treatment of behavioral emergencies (Allen, Currier, Hughes, Reyes-Harde, & Docherty, 2001), psychiatric and behavioral problems among individuals with Mental Retardation (Rush & Frances, 2000), and the treatment of depression in women (Altshuler et al., 2001). A variety of other Expert Consensus Guidelines has been developed to guide the treatment of specific psychiatric disorders, and most can be downloaded from the Internet at no cost (http://www.psychguides.com).

The methodology used to develop Expert Consensus Guidelines was originally designed by the Rand Corporation to aid decision-making in the defense industry (Linstone & Turnoff, 1975). Originally called the “Delphi method” it involves a systematic process for engaging a panel of experts in building scientifically-based consensus around important and possibly controversial questions. A modified version of this method has been used by the American Psychological Association to develop their Expert Consensus Guidelines (American Psychological Association, APA, 2001) for the treatment of various psychological disorders.

Advocates of Expert Consensus Guidelines have argued that this form of intervention decision-making parameter can play an important role in guiding practice when existing research is insufficient to support the development of formal treatment or Practice Guidelines. Indeed, advocates of this approach argue that the current intervention research literature often fails to address critical issues practitioners face when making intervention decisions (Frances et al., 1998a and Frances et al., 1998b). For example, although randomized-clinical trials are considered the “gold standard” for most EBI research, generalizing from clinical trial research to practice may be difficult because these studies often include homogeneous samples free from common co-morbid disorders, or may not include diverse representation among clinically-relevant demographic groups. It is in these “grey areas” of practice where Expert Consensus Guideline recommendations can be most useful in bridging the gap between research and practice (Atezaz-Saeed, 2004).

Although a very practical method for documenting expert consensus on a diverse array of topics within a given field or intervention area, Expert Consensus Guidelines suffer from a number of limitations that should be noted. First, Expert Consensus Guideline recommendations are not necessarily based on empirical data or systematic literature review. Therefore, the quality of recommendations produced is intimately tied to the quality of knowledge and experience of expert panel members. Second, since these guidelines are based on a synthesis of opinions derived from a large group of experts, some individual experts may differ with the consensus view. How these dissenting viewpoints are handled is a matter of methodology, and may vary from guideline to guideline. Third, sponsorship and selection of expert panel members is far from an exact science. Few guidelines exist for how expert panel members should be selected, and what constitutes a representative expert panel. Fourth, because of the nature of the method used to develop Expert Consensus Guidelines, some important topics and intervention issues may be omitted from the expert panel query (e.g., issues of acceptability or diversity). And finally, as the developers of the Expert Consensus Guidelines astutely note, because these guidelines are generated to provide direction on issues and questions not well answered by the existing scientific literature base “expert opinion at any given time can be very wrong” (http://www.psychguides.com/methodology.htm. Accessed November 1, 2004).

Although Expert Consensus Guidelines can be an important first step in providing practitioners with guidance on providing interventions to special populations or under circumstances in which empirical evidence is limited or unclear, these guidelines can suffer from many methodological limitations that make them a less than ideal intervention decision-making parameter among professions with a mature intervention literature base.

Practice Guidelines are documents that provide applied and clinical practice recommendations based on comprehensive literature reviews undertaken by content experts (Atezaz-Saeed, 2004). These reviews typically evaluate treatment efficacy, known mechanisms of action, required training, safety, and intensity or dosage of various treatment options. The reviews and recommendations of content experts are then evaluated by an independent panel of experts, and submitted to a sponsoring professional organization for final approval.

Practice Guidelines have been used in medicine for more than 50 years (Woolf, Grol, Hutinson, Eccles, & Grimshaw, 1990), and their application in other fields has increased exponentially. To date, more than 40 professional organizations have developed Practice Guidelines (Stuart, Rush, & Morris, 2002). Examples of sponsoring organizations include the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the Veterans Health Administration, the Department of Defense, the U.S. Substance Abuse and Mental Health Services Administration, the Institute for Clinical Systems Improvement, the National Institutes of Health, and the American Society of Addiction Medicine, just to name a few.

Unlike Manualized Interventions or Treatment Guidelines with Algorithms, Practice Guidelines provide practitioners with a wide range of criteria for decisions and services for a particular problem or disorder. Typically, these guidelines include information on critical issues related to diagnosis, assessment, intervention integrity, and outcome evaluation. Therefore, they are typically more comprehensive than most Treatment Guidelines or Algorithms, and the identification of first or second-line interventions is typically made on a case-by-case basis. Although the development of Practice Guidelines does rely on the expertise of content experts, unlike Expert Consensus Guidelines, final recommendations must be solidly supported by a systematic literature review and subject to evaluation by external reviewers and sponsoring professional organizations.

In their review of the validity of guidelines, Grimshaw and Hutchinson (1995) found that those guidelines with the highest degree of validity used a formal meta-analysis or graded systematic review to synthesize evidence, had multidisciplinary development panels, and explicitly linked guidelines to evidence. Guidelines of low validity were those that relied on expert opinion to synthesize evidence, included representatives of only one discipline, and relied on informal consensus development procedures. More detailed information on the issues surrounding the application of Practice Guidelines is presented later in this paper.

Ultimately, the ability to conduct evidence-based practice requires the school psychologist and other professionals to locate and appraise the scientific evidence in the context of a particular academic and/or social/emotional need (Rosenberg & Donald, 1995). Estimates of the number of Practice Guidelines ranges from 1200 to 20,000 (Grimshaw & Hutchinson, 1995 and Hayward & Laupacis, 1993) and these numbers continue to grow. Given the diversity in the quality and content among the thousands of practice parameters currently available, the search for reliable, valid Practice Guidelines can be a time consuming and confusing process.

To help facilitate the location of guidelines, a number of private and federal agencies have developed electronic databases that catalog established and emerging guidelines and expert consensus recommendations in a variety of domains. For example, the National Guideline Clearinghouse (NGC) (http://www.guideline.gov) is an on-line database of clinical Practice Guidelines, which can be used to locate and compare guidelines. The database is sponsored by the Agency for Healthcare Research and Quality (AHRQ), the American Medical Association, and the American Association of Health Plans. To be indexed in the database, a set of guidelines or recommendations must have been authorized by approved organizations, associations, agencies, or societies and the organization sponsoring the development of the guideline must be able to provide documentation demonstrating that a systematic search and review of empirical evidence was performed during guideline development. Moreover, all indexed guidelines must have been developed, reviewed, or revised recently.

The NGC database allows practitioners to search for Practice Guidelines by disorder, treatment/intervention, or sponsoring organization. However, the NGC is only one, of many on-line resources cataloguing reviews of Practice Guidelines. Table 1 outlines some of the many electronic sources of Practice Guideline information. To date, more than 487 Practice Guidelines relevant to children's educational and mental health needs have been officially registered with the National Guideline Clearinghouse. The extent to which school psychologists are aware of existing Practice Guidelines, are able to find these guidelines, judge the relative quality of information presented, and apply guideline recommendations to their practice is largely unknown. Preliminary studies have found that school psychologists have a generally low level of familiarity with Practice Guidelines relevant to the practice of school psychology, and rarely apply guideline recommendations to actual cases (White & Kratochwill, submitted for publication). Given the absence of professionally sanctioned school psychology-specific Practice Guidelines, this finding is not all that surprising. However, it does raise the question of how school-based practitioners can (or should) use Practice Guidelines developed by non-school psychology related professions? As the number and diversity of Practice Guidelines increase, and practitioners' exposure to competing guideline recommendations grows, guidance on this issue from professional bodies within the field of school psychology or development of a process for guideline endorsement may become necessary and is discussed later in the paper.

Table 1.

On-line resources for practice guidelines

There is an increasing awareness that not all Practice Guidelines are created equal. In fact, Practice Guidelines developed by different organizations, to remediate the same problem or disorder, can be dramatically different. Some guidelines may be heavily evidence-based, quantitative, and derivative, whereas another guideline may only summarize the risks and benefits associated with alternative treatments and offer context specific caveats regarding implementation. Given the wide diversity in the nature of Practice Guidelines, some organizations have developed guidelines whose sole purpose is to guide the development of future Practice Guidelines.

The most widely cited “guidelines for guidelines” are those developed by the Institute of Medicine, 1990 and Institute of Medicine, 1992. The Institute of Medicine (IOM) identified eight important attributes of Practice Guidelines: validity, reproducibility/reliability, clinical applicability, clinical flexibility, clarity, multidisciplinary process, scheduled review, and documentation (Institute of Medicine, 1992). The IOM also suggested that developers should consider the following additional criteria in developing guidelines: (a) From whose perspective are the outcomes considered—patients, practitioners, administrators, society, or a combination of these? (b) How are competing values arbitrated? (c) How have costs been conceptualized and quantified (Indeed, only until more rigorous economic evaluations of school-based interventions are developed will the inclusion of costs or cost-effectiveness be appropriate to include in most Practice Guidelines).

In this final section of the paper we address the issue of whether the profession of school psychology should use and/or develop Practice Guidelines. Currently, intervention-relevant research findings are widely scattered throughout a poorly organized and ever-burgeoning literature base in school psychology and related psychological treatment specialties. Given the sheer bulk of the professionally-relevant literature, many practitioners and trainers may feel overwhelmed in their efforts to find an authoritative source of practice-relevant intervention information. The movement toward identification of EBIs such as through school and clinical psychology task forces as well as the What Works Clearinghouse will be helpful to the school psychology field in identifying these programs and procedures but may not be enough to promote their adoption, use, and sustainability in school practice. The utilization of Practice Guidelines is an alternate, arguably more practical, strategy practitioners could use to integrate evidence-based information into their assessment and intervention decisions for several reasons which can be advanced at the conceptual level and can ultimately in some areas be addressed at the empirical level.

First, Practice Guidelines may promote adoption, use, and sustainability of a package of strategies relevant to solving or addressing a problem or disorder. Practice Guidelines represent tools that involve the full spectrum of issues surrounding intervention strategies such as diagnosis, assessment, treatment, and outcome evaluation. Few sources in our profession provide the detail needed to implement a treatment in the way that Practice Guidelines accomplish this process. Nevertheless, several studies have found that the publication and distribution of Practice Guidelines alone is not enough to change clinical practice (Cabana et al., 1999, Kosecoff et al., 1987 and Lomas, 1991). For change to be sustained, Practice Guidelines must be combined with the necessary professional development, and environmental context information (e.g., school climate, school leadership, other programs in place, cultural issues) to facilitate implementation (Fishbein, 1995). Other professional discipline level variables, such as the establishment of administrative rules and regulations governing the use of EBIs, the provision of ongoing supervision and feedback, and increasing consumer awareness and demand for evidence-based services may also be necessary for changes in practice to be maintained (Davis et al., 1995 and Greco & Eisenberg, 1993).

Second, unlike efforts to promote empirical practice that require practitioners to evaluate their own practices and procedures, Practice Guidelines could be used to support scientifically based decision-making in a timely and cost-efficient manner. Traditionally, evidence-based practice wherein practitioners are urged to use, for example, single-participant research methods to evaluate interventions and increase their knowledge of effective treatments (e.g., Barlow, Hayes, & Nelson, 1984) has contributed little to improving the integration of research and practice for most school-based practitioners. In contrast, Practice Guidelines often and can include reference to tailor-made evaluation tools to determine whether an intervention is effective (e.g., problem or disorder specific scales and checklists). These customized tools can help focus practice on specific dimensions of problems that need to be considered and implemented in outcome evaluation. In this regard the development of Practice Guidelines may also be a more practical and attractive option for documenting school-based intervention parameters. The development of Practice Guidelines for school-based interventions could provide practitioners with clear documentation of intervention effects, in addition to important information about diagnostic, assessment, integrity, and outcome evaluation issues that must also be considered during the problem-solving process. If constructed properly, Practice Guidelines could provide practitioners with a more reliable and comprehensive level of information than Manualized Interventions, Treatment Guidelines/Algorithms, or Expert Consensus Guidelines can provide. The empirical literature base is growing to support such an endeavor, and the development of Practice Guidelines for school-based interventions should be considered.

Third, although little is known regarding the potential effects of Practice Guidelines on the processes or outcomes of school psychology interventions, effectiveness data emerging from the medical literature suggests there may be reason to be optimistic about the potential positive benefits of Practice Guidelines on intervention outcomes. Indeed, Practice Guidelines have been demonstrated to increase the utilization of EBI information among practitioners in related professional fields, and may be a means to promote the use of EBIs among school-based practitioners. Ultimately, this issue can be addressed empirically by designing studies that measure the treatment utility of Practice Guidelines as compared to more conventional practice formats (see Braden & Kratoch, will, 1997 and Kratochwill & McGivern, 1996 for further discussion of the merits of using a treatment utility model to evaluate assessment–treatment links). In terms of effects on client outcomes in other areas of health care practice, Grimshaw and Russell (1993) found that of the 50 investigations reviewed, only 4 failed to find any statistically significant improvement in the process of case, and 9 of 11 investigations examining the impact of guidelines on clients' outcomes reported statistically significant findings. On the basis of their synthesis of the available evidence, Grimshaw and Russel (1993) concluded that “explicit guidelines do improve clinical practice (p.1321).”

Fourth, Practice Guidelines may have profession-wide benefits that extend beyond changes in practitioner behavior and improving student outcomes to their effect on professional preservice and inservice training. Published guidelines could be potentially beneficial teaching tools, and be used for practicum and internship education by guiding students to use strategies consistent with the best evidence available. Adoption of Practice Guidelines also allow us to embrace a competency-based model of intervention training because specific practice criteria can be established ranging from diagnosis to outcome evaluation. The process of guideline development and subsequent training (preservice and inservice) may also help uncover areas of practice uncertainty, which could help direct research activities.

Readers may well ask by whom and how will Practice Guidelines be developed and used in the profession of school psychology. Although a number of options are available for this agenda to be enacted, it may be cost and time efficient to link these efforts to the Task Force on Evidence-Based Interventions in School Psychology as it is already considering the research-to-practice agenda supported by our three major professional organizations.

First, a careful review of current Practice Guidelines relevant to school psychology practice needs to be initiated. As noted in this paper, there are numerous guidelines already developed and these guidelines should be reviewed for consideration for adoption. In addition to the necessary attention to duplication of effort, some specific templates for review need to be considered for the review process. It is possible, for example, to review the Practice Guidelines with consideration of school contextual variables in mind. This template could be based on existing efforts of the Task Force on Evidence-Based Interventions in School Psychology. Unfortunately, because few Practice Guidelines (that meet NGC criteria) currently exist for the treatment of school-based problems most practitioners commonly see, the NGC database and other resources like it may currently be of limited relevance for many practicing school psychologists. However, should the field of school psychology decide to pursue the development of Practice Guidelines, we may be able to take advantage of an emerging infrastructure and technology to support evidence-based practice where development is already well underway. Funding of this process could be provided through either federal or foundational sources. This funding would support the review and development process and allow summaries to be created and ultimately shared with the profession.

Second, a structure to guide the development of Practice Guidelines in school psychology should be developed. The IOM framework may provide a useful starting point, however, additional criteria may be advantageous to consider during the development process. For example, although taking client preferences into account is considered an important component of evidence-based practice (Sackett et al., 2000), in their review of guideline content, Shaneyfelt, Mayo-Smith, and Rothwangl (1999) found that only 21.5% of guidelines reviewed discussed the role of client preferences in choosing among available options. The important role teacher, student, and parental treatment acceptability plays in the success of school-based interventions has also been widely cited within the school psychology literature (e.g., Elliott, 1988). Therefore, it may be appropriate for school psychology-based Practice Guidelines to clearly delineate issues of acceptability, and specify the extent to which deviation is tolerated when (a) teacher, (b) parent, and/or (c) student treatment acceptability is low.

Third, a system for state, regional, and national dissemination of guideline information needs to be developed. This system should take into account issues of dissemination for both school psychologists in practice, faculty in graduate training programs, and student trainees. Technological solutions such as cross program web-based course options and creation of university partnerships (called the Virtual University) could be helpful in the process of sharing information on Practice Guidelines (see Kratochwill, Steele-Shernoff, & Sanetti, 2004).

Practice Guidelines are no panacea for improving the quality of mental health and educational services to our schools. Yet, they hold promise for improving the quality of services provided to our children and schools in that they can convey critical information about a full range of issues in problem solving and implementing prevention and intervention programs. They will be especially useful to trainers and practitioners if they include contextual information necessary to effectively implement prevention and intervention programs and services. Still, important research issues surrounding their effectiveness in improving services needs to be addressed in our profession for guidelines adopted and/or developed. Moreover, ethical issues will need to be addressed as Practice Guidelines could become a new standard for the quality of mental health and education services provided by school psychologists in schools. Ultimately, our ability to disseminate, adopt, use, and sustain Practice Guidelines is up to our profession and those who are willing to take leadership in this area.