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.     

Evidence-based practice in group care: the effects of policy, research, and organizational practices

This article describes the effect of a province-wide vision of evidence-based and outcome-based services for children and youth and the challenges of implementing evidence-based practice (EBP) and evidence-based treatment (EBT) approaches within group care settings. The paper is based on the results of a survey of group care settings in the province of Ontario, Canada, which was designed to understand the factors affecting the use of EBP and EBT. The critical roles of policy, access to research, and organizational structure as they affect the frontline workforce were explored. The results identified key differences between programs who implemented an evidence-based approach and those who are struggling to do so. Differences in case management practices as well as organizational factors affect the program's ability to use an evidence-based approach.     

Research evidence utilization in policy development by child welfare administrators

An exploratory qualitative study was conducted to explore how child welfare administrators use research evidence in decision-making. Content analysis revealed that a cultural shift toward evidence-based practice (EBP) is occurring in Canadian child welfare organizations and multiple types of evidence inform policy decisions. Barriers to using evidence include individual, organizational, and environmental factors. Facilitating factors include the development of internal champions and organizational cultures that value EBP. Integrating research into practice and policy decisions requires a multifaceted approach of creating organizational cultures that support research utilization and supporting senior bureaucrats to use research evidence in policy development.     

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.     

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.     

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.     

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.     

Social Work Field Instructors’ Views and Implementation of Evidence-Based Practice

This article presents the results of a cross-sectional study of social work field instructors’ views of and implementation of the evidence-based practice (EBP) process and compares their responses with non-field instructors. A total of 688 National Association of Social Workers/Texas members (107 of which were field instructors) anonymously responded to an online administration of the Evidence-Based Practice Process Assessment Scale–Short. The results suggest generally positive attitudes among field instructors and high levels of familiarity but lower levels of perceived feasibility and engagement in the EBP process. In addition, field instructors and non-field instructors did not differ significantly across the 4 subscales or overall orientation toward the EBP process. Implications and future steps for social work education are discussed.     

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.     

Availability and accessibility of public health services for adolescents and young people in South Africa

Against the background of increasing international calls for the development and implementation of age-appropriate programmes that address both quality and access issues to improve adolescent and youth health, this paper explores the extent to which public health facilities are available and accessible to adolescents and youth in South Africa. The impetus for the study was the current evidence that there was generally poor utilisation of services offered at public health facilities by young people in the country. The overall findings are that despite the country's comprehensive legal and policy framework and commitment to improve the health of young people, there continues to be some structural and systemic factors that hamper effective provision and programming of adolescent and youth friendly services. The paper concludes with recommendations for policy and practice.     

Recent Social Work Practitioners’ Understanding and Use of Evidence-Based Practice and Empirically Supported Treatments

The aim of this study was to evaluate how CSWE’s 2008 shift placing more emphasis on research have affected newly trained social workers’ use of evidence-based practice (EBP). This qualitative study examined the educational and practice experiences of newly trained social workers and how those experiences influence the use of EBP and empirically supported interventions/treatments in the field. Thirteen newly graduated social workers were interviewed using a semi-structured interview. Twenty-three codes emerged from the interviews, with the most prominent theme being a sense of overall confusion about EBP. Other themes included lack of educational preparation, lack of agency resources, and prohibitive agency culture. Implications for social work education and practice are discussed.     

Can study tours help promote evidence-based practice in children's services?

Interest in evidence-based programmes and the science underpinning them has mushroomed in the UK and Ireland in recent years as policy-makers and senior managers seek tried-and-tested methods of improving child well-being. This article examines whether study tours, a form of experiential learning, can help to promote evidence-based policy and practice in children's services. Participants on two study tours to the United States in 2005 to visit evidence-based programmes and their developers were interviewed by telephone 30–36 months later. Results are presented in terms of: (1) what participants felt they were exposed to on the study tours; (2) how the tours had changed their thinking; (3) what impact the tours had in terms of actions; (4) the factors that affected the impact of the study tours; and (5) the value added by the study tours over and above other means of learning about evidence and evidence-based services.     

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.     

Use of evidence-based interventions in child welfare: Do attitudes matter?

Implementation of evidence-based programs in child welfare has progressed slowly, with the majority of services in child welfare settings lacking empirical evidence for effectiveness. In other settings, research has identified providers' attitudes about evidence-based practices (EBPs) as a potential barrier to adoption of EBPs. As little research has focused on the role of attitudes in influencing use after training in an EBP in child welfare, the potential for attitudes to impede implementation efforts in child welfare is unclear. This study addressed this question in a sample of 55 caseworkers and therapists randomly assigned to enhanced support to use an EBP following training or a training-only condition. Information on providers' use of the intervention after training and their attitudes about EBPs were measured for up to five time points. Results indicate that attitudes did not predict providers' use of the EBP, and attitudes did not change overall or in the enhanced condition that provided greater exposure to the intervention. Providers perceived of requirements to use a practice as more influential in their use than their openness to EBPs. However, those who were more open to EBPs were more likely to participate in implementation support after the training, suggesting that openness facilitates participation in activities that support use of a new intervention.     

An evaluation paradox in social work? An empirical study of evaluation use in connection with temporary programmes in Swedish social work

This article contributes to the debate on evaluation use by analysing temporary national programmes in Swedish social work. Previous empirical research shows a gloomy picture of evaluation use, thus supporting an evaluation paradox: evaluations are not used for learning and development, but are continually prioritised. The aim of this article is to study, through interviews and document analysis, how evaluations of temporary programmes in social work are designed and used. The results support the paradox and we found that it has two dimensions. First, evaluations are prioritised, but they function as a ritual, characterised by routine and unclear intentions, with limited relevance for professional learning and improvement. The second dimension is about limited use by those commissioning the evaluations, but the evaluators are using data for new purposes and in new contexts. This is, at best, a form of conceptual use, hopefully contributing indirectly to social work practice. The article ends in a discussion on how evaluations could be designed for learning and improvement by focusing on three normative models: utilisation-focused evaluation, responsive evaluation and evidence-based practice approach (EBP).     

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.     

A confirmatory factor analysis of the evidence-based practice attitudes scale in child welfare

Despite the emphasis on evidence-based practice (EBP) in child welfare services (CWS) as an emerging and inevitable trend, implementation factors such as child welfare worker attitudes towards implementing EBP have received little attention in CWS. Aaron's (2004) Evidence Based Practice Attitudes Scale (EBPAS) has been used in multiple studies across mental health and healthcare settings. However, it has rarely been used in CWS. A-Mid Atlantic State implemented the EBPAS in all child welfare jurisdictions to measure workers' performance. The purpose of this study is to examine the EBPAS applied in a large urban child welfare services setting using a confirmatory factor analysis. Based on prior literature, three models were tested: a four factor model, a five factor model, and a second order four factor model. The second order model provided the best fit to the data, suggesting the EBPAS can measure workers' global attitudes, as well as four attitude types, towards EBP in a CWS setting. This study validates the use of the EBPAS with child welfare workers. Implications for effective evidence based practice in child welfare are discussed.     

Concept mapping as a method to enhance evidence-based public health

In this paper we explore the suitability of concept mapping as a method for integrating knowledge from science, practice, and policy. In earlier research we described and analysed five cases of concept mapping procedures in the Netherlands, serving different purposes and fields in public health. In the current paper, seven new concept mapping studies of co-produced work are added to extend this analysis.For each of these twelve studies we analysed: (1) how the method was able to integrate knowledge from practice with scientific knowledge by facilitating dialogue and collaboration between different stakeholders in the field of public health, such as academic researchers, practitioners, policy-makers and the public; (2) how the method was able to bring theory development a step further (scientific relevance); and (3) how the method was able to act as a sound basis for practical decision-making (practical relevance).Based on the answers to these research questions, all but one study was considered useful for building more evidence-based public health, even though the extent to which they underpinned actual decision-making varied. The chance of actually being implemented in practice seems strongly related to the extent to which the responsible decision-makers are involved in the way the concept map is prepared and executed.     

Reconsidering the ‘idea’ of evidence in evidence-based policy and practice

Evidence-based policy and practice (EBP) has become an important social work conceptual framework. Yet, the core EBP concept, the concept of evidence, remains ill-defined. I propose a modification of the concept of evidence as applied to EBP effectiveness questions. As a basis for this reformulation ideas about evidence are examined from cross-disciplinary and multidisciplinary perspectives including epistemology, philosophy of science, evidence-science, and law. I propose that for EBP effectiveness questions: (1) to be considered ‘relevant evidence’ an explanatory connection between an intervention and an outcome must be established rather than a mere association; (2) the EBP definition of ‘best available evidence’ should include total available evidence (rather than a subset) about effectiveness, causal roles (i.e., mechanisms), and support factors and be inclusive of high-quality experimental and observational studies as well as high-quality mechanistic reasoning; (3) the familiar five-step EBP process should be expanded to include formulation of warranted, evidence-based arguments and that evidence appraisal be guided by three high level criteria of relevance, credibility, and strength rather than rigid evidence hierarchies; (4) comparative effectiveness research strategies, especially pragmatic controlled studies, hold promise for providing relevant and actionable evidence needed for policy and practice decision-making and successful implementation.     

‘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.