Evidence Based Practice — Is it good for you?

This article is the first in a series which aim at ‘unpacking’ some of the concepts and controversies involved in ‘evidence based practice’ (EBP). It is critically important for clinicians to be able to understand EBP, because there is a growing likelihood that the politics of EBP will be used to construct the ways in which we are expected to provide services in our workplaces. Although EBP looks relatively benign, the whole area reveals some very disturbing aspects. I invite readers of the Journal to begin a dialogue with me and with each other about EBP and whether it is possible, or even desirable, to embrace this practice within a systemic framework.     

A Framework for Enabling Evidence-based Practice in Allied Health

Evidence-based practice (EBP) is upheld as best practice in health and human services but there is a need for more research on how this approach can be enabled in day-to-day practice. This qualitative study examined EBP with allied health managers and practitioners in a health service network (n = 17). The findings highlight the systemic nature of EBP and the extent to which it involves both individual and environmental attributes. Individual attributes include clear understanding of EBP, relevant knowledge and skills, and motivation and passion. Environmental attributes are the presence of an organisational culture that values and prioritises EBP and an integrated mix of research support services, professional development activities, supervision and mentorship, and university partnerships. Theoretical frameworks can be useful for making sense of complex processes, planning, and evaluating change. Therefore, the findings are presented as a framework incorporating reflective questions relating to the elements identified as enabling EBP.     

Overrating or Dismissing the Value of Evidence-Based Practice: Consequences for Clinical Practice

Current implementation of the evidence based practice (EBP) model in social work has focused on empirical evidence from efficacy studies, with far less attention to practitioner judgment and client values. Among many clinical social workers the opposite is often true: clinical judgment supersedes the use of scientifically tested techniques. Clinicians may reject EBP as coming out of narrowly focused, possibly irrelevant research, and adherents of EBP run the risk of discounting psychotherapy techniques derived from practice experience or the vast diversity of client situations—both positions threaten our effectiveness. Reasserting clinical judgment and the centrality of clients’ experience into EBP, while enhancing traditional psychotherapy with strong treatment-effectiveness evidence, will improve clinical social work practice, especially in addressing the wide array of human problems and suffering that clients present, especially in the context of globalization and cultural diversity.     

Applying Critical Consciousness and Evidence-Based Practice Decision-Making: A Framework for Clinical Social Work Practice

Social work education is increasingly driven by the established movement of evidence-based practice (EBP) that drives the delivery of mental health care with the promise of providing treatments that work and greater efficiency. This emphasis on EBP coexists with the profession’s expressed commitment to social justice. Social work literature rarely addresses the complexities of EBP decision-making in relation to social justice. Rather, separate conversations either explore the commitment to social justice through a reflective approach to practice decision-making or take a positivist approach to scientific inquiry. This article offers a framework to apply critical consciousness and EBP decision-making that integrates reflective and positivist approaches to facilitate processes and outcomes that amplify social justice aims in social work practice.     

Evidence-Based Practice in Social Work: Challenges and Opportunities for Clinicians and Organizations

Evidence-based practice (EBP) is increasingly emphasized in social work, yet effective approaches for translating research evidence into social work practice remain elusive. Despite a growing body of evidence describing effective interventions with a variety of populations, social workers continue to encounter substantial challenges with incorporating knowledge gained from these intervention studies into their routine practice with clients. This paper presents the current research outlining the known barriers and promoters to using EBP in social work clinical practice. Because social workers practice within the context of organizations, we consider the barriers that exist at both the individual and organizational levels that affect clinical social work practice. In addition to addressing the various challenges to incorporating research evidence into practice, we will also discuss a variety of emergent opportunities accompanying the move toward EBP that can be leveraged by clinicians in their social work practice with clients.     

Field Instructors' Perceptions of Evidence-Based Practice in BSW Field Placement Sites

This exploratory study surveyed 17 BSW-level field instructors on their experience, beliefs, and perceived self-efficacy regarding evidence-based practice (EBP). The authors conducted focus groups concerning EBP in participants’ agencies and with BSW students under their supervision. Results indicate that although they felt positive toward EBP and reported moderate levels of perceived self-efficacy regarding EBP, implementation occurred in a piecemeal fashion, if at all. Factors identified to enhance EBP in the agencies include training, resources, supervision, matching EBP to client populations, and trust between administrators and staff members. According to our study, students’ experience with EBP in field settings could probably be facilitated by students' research readiness, collaboration between field instructors and faculty, access to university resources, and training.     

Evaluating a Teaching Module on Ethically Responsible Evidence-Based Practice Decision Making in an Advanced Micro Practice Course

ABSTRACT

This article adds to the growing body of literature on the use of evidence-based practice (EBP) in social work. Specifically, it examines a 9-hour EBP educational model designed to prepare MSW students for appropriate decision-making strategies in working with multicultural client populations. The model places emphasis on identification and application of critical thinking skills for micro- and mezzo-level practice in urban social work systems. It moves beyond traditional research approaches and emphasizes community-based and emic approaches for generating evidence appropriate for ethnic minority populations. Students’ written assignments (N = 80) demonstrated the model’s pedagogical value as a learning strategy for applying EBP. Students’ evaluations demonstrated the model’s value in sensitizing students to the importance of becoming ethically responsible research consumers.     

Creating Synergy in Practice: Promoting Complementarity Between Evidence-Based and Postmodern Approaches

Postmodern and evidence-based practice (EBP) are compared and contrasted with the primary aim of adapting evidence-based practice with a more flexible epistemological lens. We begin by reviewing the epistemological underpinnings of postmodern and EBP within the field of marriage and family therapy (MFT). We next discuss how these contrasting philosophies inform therapists’ traits and practice in the context of translational research and practice-based evidence. Finally, we point toward some promising directions for a flexible adaptation of evidence-based practice in which both modern and postmodern clinicians can practice, and ways to incorporate some of these more flexible principles into the clinical training of MFT students.     

Youth care workers' perspectives on and adoption of evidence-based practice

Despite increased emphasis on evidence-based practice (EBP), the limited implementation of EBP is a well-known reality. This research examines youth care practitioners' knowledge of, attitudes toward and adoption of EBP (N = 74). Additionally, the difference between EBP and empirically supported treatments (ESTs) is made. Findings show that some practitioner background variables are related to their knowledge of and attitudes toward EBP, but not to ESTs. Findings also provide evidence for current dissemination and implementation models that strongly emphasize the importance of good knowledge of and favorable attitudes toward EBP and EST by practitioners. Expanding the knowledge base of practitioners and positively influencing their attitudes toward EBP are two of the tracks for closing the gap between research and practice.     

From the Editor—In This Issue

This article critically analyzes challenges that may influence whether evidence-based practice (EBP) enjoys more success than previous efforts to improve the integration of practice and research in social work education. Key challenges include: (1) alleviating disparities in how EBP is being defined by social work educators; (2) maximizing the feasibility of implementing the EBP process appropriately after graduation, while at the same time preparing students not to over-rely on authoritative publications that designate certain interventions as evidence-based; and (3) preventing evidentiary standards from getting softened to the point that EBP becomes a meaningless term, as any study, regardless of its methodological rigor, can be cited to justify deeming an intervention to be evidence based.     

The fusion of culture and science: Challenges and controversies of cultural competency and evidence-based practice with an African American family advocacy network

This paper identifies interrelationships between evidence-based practice (EBP), radical structuralism, and culture, arguing that culturally-specific beliefs and norms should be integrated into evidence-based, cross-cultural partnerships within child and family service systems. A single case study of family advocate training in evidence-based practice is provided as an illustration of, and impetus for, the development of a format for use with community-based and ethnically-diverse parent/family advocates. The lessons learned from teaching evidence-based practice to a parent advocate in a particular child welfare service system are highlighted. The use of enhanced roles for social workers and indigenous social capital and resources, such as family advocates as allies, is recommended to help achieve a greater degree of accountability, cooperation, and core understanding in the use of EBP. By training racially-diverse foster parents as mental health advocates to work collaboratively with policymakers, community groups, and family participants, proponents of EBP will reach and benefit more diverse populations.     

Newly Educated MSW Social Workers’ Use of Evidence-Based Practice and Evidence-Supported Interventions: Results From an Online Survey

ABSTRACT

Social work programs have increased evidence-based practice (EBP)-related curricular content; yet, it is unclear whether newer practitioners are successful in incorporating it into their practice. This study examines factors that influence the use of EBP among newly graduated social workers. We developed and implemented a Web-based survey that assessed individual, school, and agency factors that predict implementation of EBP among a sample of master’s of social work practitioners post-graduation. Multiple regression analysis resulted in five factors that were significantly associated with use of EBP: confidence with EBP; feeling that EBP is essential to practice; organizational culture emphasizes EBP; field placement/internship emphasizes EBP; and faculty emphasizes EBP. Findings suggest that individual and organizational factors may be more important in determining use of EBP than educational program factors alone.     

‘So I Feel Like I'm Getting It and Then Sometimes I Think OK,No I'm Not’: Couple and Family Therapists Learning an Evidence‐Based Practice

This research concerns itself with the experiences of couple and family therapists (CFTs) learning about and using an evidence‐based practice (EBP). The engagement with EBP is growing across many aspects of the mental health and health care systems. The EBP model is now being applied in a broad range of health and human service systems, including mental and behavioural health care, social work, education, and criminal justice (Hunsley, 2007). The dialogue about the role of evidence‐based approaches in the practice of CFT and research literature is also evolving (Sexton et al., 2011; Sprenkle 2012 ). Interestingly, while the research delves into what are the best approaches with different populations and presenting issues, little research has explored the experience of CFTs themselves, particularly while learning an EBP. Using a phenomenological approach called interpretive phenomenological analysis (Smith, Flowers & Larkin, 2009), this research explores the experiences of CFTs learning and using an EBP. The paper reports on key issues, challenges, and areas for CFTs, educators, and supervisors. As researchers, educators, administrators, policy makers, and CFTs struggle with what works best with which populations and how best to allocate resources, this research contributes to dialogues about how best to educate and support CFTs, and the complexity of doing research in real‐life settings.     

Social Workers’ Knowledge and Attitudes About Evidence-Based Practice: Differences Between Graduate Students,Educators, and Practitioners

Clinical Social Work Journal - The implementation of evidence-based practice (EBP) is increasingly being stressed as a responsibility of social work practitioners and social work educators....     

Evidence-based practice in social work: perceptions and attitudes among Norwegian social workers

Although the concept of evidence-based practice (EBP) eludes precise definition, it is used as a trademark label to ensure that practice is based on science and thereby effective and of high quality. Proponents of EBP have proposed that both education and practice in social work should be transformed according to the principle of EBP. They attribute critical opposition to EBP to a lack of knowledge of what EBP is. In this article, we endeavour to clarify the concept and present results from a survey among social workers (N?=?2060) from Norway. The survey results show that although many have heard of the concept, few have precise knowledge about it. However, the more educated social workers are (master’s level), the clearer their opinions, both critical and non-critical. The results are discussed in relation to neo-liberal governance and development of social work.     

ADOPTING AND TEACHING EVIDENCE-BASED PRACTICE IN MASTER'S-LEVEL SOCIAL WORK PROGRAMS

This article makes specific suggestions for teaching evidence-based practice (EBP) in the master's-in-social-work (MSW) curriculum. The authors use the model of EBP as it was originally conceived: a process for posing empirically answerable questions, finding and evaluating the best available evidence, and applying that evidence in conjunction with client characteristics and practitioner judgment. The authors suggest that EBP, in its original form, is both sufficiently well operationalized and flexible to serve as a primary paradigmatic component of social work education. Furthermore, EBP carries a series of distinct advantages for MSW education that have not been widely recognized to date. These include the provision of a structure for more explicitly recognizing client factors, bridging the micro–macro and researcher–clinician divides, and emphasizing the professionalism of MSW-level practice. Specific curricular components are proposed and discussed.     

Evidence-Based <Emphasis Type="Italic">Practices</Emphasis> Do Not Exist

The original process model of evidence-based practice (EBP) is described, and contrasted with the empirically supported treatments (EST) initiative which designated selected interventions as meeting some evidentiary benchmark (e.g., supported by two-well-designed randomized controlled trials). EBP does not utilize lists of ESTs, and designating a given psychotherapy as empirically supported is actually antithetical to the EBP decision-making process. Much of the resistance to EBP within social work may be attributable to confusion between EBP as it was originally conceived as a mutual decision-making process occurring between the clinician and the client, and the promulgation of lists of EST and the subsequent urging that social workers select their psychotherapies from such lists. The latter is not scientifically justifiable, nor does it taken into account other variables crucial to EBP, such as professional values, clinical expertise, client preferences and values, and available resources. EBP as it was originally conceived has much to add to the practice of clinical social work.     

Evidence-based practice in real-world services for young people with complex needs: New opportunities suggested by recent implementation science

There is growing agreement that child and youth services have been slow to implement evidence-based practice (EBP). A variety of interrelated barriers and facilitators of EBP implementation have been recognized and investigated. Key categories include the attitudes of providers, the characteristics of client populations, the characteristics of usual practice, organizational factors, and resource availability. Implementation scientists are investigating these factors, seeking to bridge the gap between clinical science and practice. Much of this work has been conducted in the context of behavioral health services for children and young people. This paper provides a purposeful review of this research from the perspective of decision-makers in agencies serving young people with multiple and complex psychosocial needs. It is argued that major barriers to EBP may be mitigated if ways can be found to transcend the oppositional construction that has characterized the discourses of EBP versus practice wisdom. A conceptual approach to such integration is offered. New lines of implementation research are offering opportunities for practical action by decision-makers consistent with this integrative approach.     

Multiple-Family Groups: Practice Implications for the 21st Century

ABSTRACT

Multiple-Family Groups have been utilized in a variety of settings for almost fifty years in this country. This unique practice approach has undergone many changes and refinements during this period of development. The primary purpose of this chapter is to provide readers with a delineation of the current practice implications of this treatment modality. The history of Multiple-Family Groups (MFG) will be reviewed to provide a historical framework for an increased understanding of its current usages. In addition, new directions for research and further refinement of this practice model will be outlined for clinical practitioners.     

Evidence-based practice in occupational health: description and application of an implementation effectiveness model

Work-related muscuoloskeletal disorders (WMSDs) continue to represent the most costly category of occupational diseases. There is a growing body of literature regarding the causal nature of these injuries and effective intervention strategies. In this context, the consistent utilization of evidence-based practice (EBP) to address these problems can be viewed as one indicator of occupational health effectiveness. However, the routine integration of EBP remains elusive in occupational and physical therapy practice, including the occupational health arena. This article describes an implementation effectiveness model from the field of organizational management and applies it to the implementation of EBP within the occupational health practice arena. As a predictive or evaluative tool regarding implementation success, the model can assist clinic managers and clinicians in developing targeted approaches to EBP initiatives within any health care facility.