Levels of Evidence - Empirically Supported Treatment (EST)

the word EVIDENCE.

Our workshops, certificate programs and other course descriptions provide information about the Empirically Supported Treatment (research supported) that the training content includes. Some trainings may focus on a single treatment model. Others may draw upon several models with varying levels of ESTs or reference content based on the best research available at this time.  When there are reputable websites that describe the research or level of EST for the training content, the description of the training will provide a link to that web page. In instances where this is not available or the content includes more than one level of research as described on this page, the describe will reference the level or levels you see below. Our goal is to be transparent in assisting you to make informed decisions as you select training that best meets your needs. For trainings that do not involve treatment content, there may be related research and the training description will reflect the level(s) of this research.

Evidence-based Practice (EBP) is  “…the framework that is used to promote adoption of best practices informed by research”- ASWB. It is a decision process completed by looking at the best research available including Empirically Supported Treatment; existing resources including practitioner expertise; environment and organizational context; and the client’s characteristics, needs, values and preferences. The intersection of these components is Evidence-Based Practice (EBP).  EBP prefers stronger evidence  and encourages clinicians to critically appraise research information. Originally, EBP came from the medical profession and has expanded to child welfare, psychology, nursing, and other disciplines. The social work profession has not yet created its own definition. 

American Psychological Association Levels of EST

After reviewing several ways of describing levels of Empirically Supported Treatment (EST), we selected the following levels to incorporate into descriptions for our training content. Please be aware that not all treatments are ethically appropriate for randomized controlled trial research, funding may not be available for the needed level of research, research may be difficult to locate or not rigorous and relevant, etc. Therefore, some treatments may never be able to rise to the highest level of research. Research outcomes can also change over time as new research occurs. In addition, reputable sites that identify levels of evidence do not always agree on the level. A link to website resources about empirically supported treatment or evidence-based treatment is at the bottom of this page

The levels we are using are adopted from an Empirically Supported Treatment system developed by Chamblee’s et al. (1998) for the American Psychological Association Division 12 Task Force on Psychological Interventions. This system was later articulated in more detail in the Journal of Clinical Child and Adolescent Psychology (Southam-Gerow & Prinstein, 2013). Use the link below to open the details on the levels.

Levels of Empirically Supported Treatment (Southam-Gerow & Prinstein, 2013)

Level 1: Well Established Treatments

These have the strongest research support currently available and achieve this by satisfying a number of criteria. Efficacy is demonstrated for the treatment by showing the treatment to be either:

  • Statistically significantly superior to pill or psychological placebo or another active treatment.
  • Equivalent (or not significantly different) to an already well-established treatment in experiments.
  • At least two independent research settings and by two independent investigatory teams demonstrating efficacy.
  • Meets all five of the Methods Criteria noted below.

Level 2: Probably Efficacious Treatments

  • There must be at least two good experiments showing the treatment is superior (statistically significantly so) to a wait-list control group
  • One (or more) experiments meeting the Level 1 Well-Established Treatment except for the criterion needing at least two independent investigatory teams.
  • Meets all five of the Methods Criteria noted below.

Level 3: Possible Efficacious Treatments

(Note: may be the most current promising practices or treatments.)

  • At least one good randomized controlled trial showing the treatment to be superior to a wait-list or no-treatment control group,
  • Meets all five of the Methods Criteria noted below.
  • Two or more clinical studies showing the treatment to be efficacious, with two or more meeting the last four (of five) Methods Criteria, but none being randomized controlled trials.

Level 4: Experimental Treatments

(Note: not sufficiently tested and/or being used but without study to meet the above levels.)

  • Not yet tested in a randomized controlled trial.
  • Tested in one or more clinical studies but not sufficient to meet level 3 criteria.

Level 5: Treatments of Questionable Efficacy

  • Tested in good group-design experiments and found to be inferior to the treatment group and/or wait-list control group; i.e., only evidence available from experimental studies suggests the treatment produces no beneficial effect.

Methods Criteria

M.1. Group design: Study involved a randomized controlled design.

M.2. Independent variable defined: Treatment manuals or logical equivalent were used for the treatment.

M.3. Population clarified: Conducted with a population, treated for specified problems, for whom inclusion criteria have been clearly delineated.

M.4. Outcomes assessed: Reliable and valid outcome assessment measures gauging the problems targeted (at a minimum) were used.

M.5. Analysis adequacy: Appropriate data analyses were used and sample size was sufficient to detect expected effects.

Website Resources

Agency for Healthcare Research and Quality - produces evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

APA (Division 12) Society of Clinical Psychology - list of treatments and the APA level of research.

APA (Division 12) Society of Clinical Psychology - Frequently Asked Questions (FAQs)

Association for Behavioral and Cognitive Therapies - a multidisciplinary organization committed to the advancement of scientific approaches to the understanding and improvement of human functioning through the investigation and application of behavioral, cognitive, and other evidence-based principles to the assessment, prevention, treatment of human problems, and the enhancement of health and well-being.

California Evidence-Based Clearinghouse for Child Welfare - provides guidance and resources about the implementation of Evidence-Based Practices (EBPs).

Campbell Collaboration - systematic reviews follow structured guidelines and standards for summarizing the international research evidence on the effects of interventions in crime and justice, education, international development, and social welfare.

Center for Effective Collaboration and Practice - promising practices in children’s mental health.

Cochrane Collaboration - gathers and summarize the best evidence from research to assist with informed choices about treatment.

Evidence-based Behavioral Practice - aims of the EBP project are to create tools to improve research and practice training for psychosocial interventions, build the evidence base for behavioral treatments, and upgrade evidence-based behavioral practice.

National Institute for Health and Care Excellence (NICE) - guidance, advice, quality standards and information services for health, public health and social care; also contains resources to help maximize use of evidence and guidance.

Promising Practices Network (PPN) - a unique resource that offers credible, research-based information on what works to improve the lives of children and families. 

SAMHSA Evidence-Based Practices Resource Center

World Wide Web Resources for Social Workers (WWWRSW) and Information for Practice (IP) - helps social service professionals throughout the world conveniently maintain an awareness of news regarding the profession and emerging scholarship.