Thesis: Evidence-Based Practices

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Evidence-Based Practice

In the past decade, evidence-based practice (EBP) has been consistently recommended for the helping professions (Proctor, 2004; Roberts & Yager, 2007). Trace the historical roots of evidenced-based practice. Evaluate the benefits and risks of its implementation in social work and community services.

Roberts, A.R., & Yaeger, K.R. (Eds.). (2007). Foundations of evidence-based social work practice. New York: Oxford University Press.

Proctor, E.K. (2004). Leverage points for the implementation of evidence-based practice. Brief Treatment and Crisis Intervention, 4(3), 227-242.

The nature of the social work profession is to assist people who are in need of services. People who chose to work in helping professions such as social work and community services are charged with the task of helping people overcome problems by providing a variety of resources. Commitment to the welfare of clients is one of the most important aspects of being a social worker and/or any other worker in a service profession. The emergence of the phenomenon that is Evidence-Based Practice (EBP) has caused a great deal of controversy in the world of social work as well as other service related professions. Therefore, it is important to exam the methods by which social workers assist clients using EBP and to more discretely define EBP and its various components. Despite these accepted facts, there is substantial evidence that across the varied settings in which many social workers are employed, including mental health, substance abuse, public health, child protection, and so on, large numbers of clients perhaps half or more who are offered treatment do not engage, and among those who begin treatment, many possibly another half or more drop out of treatment before any significant impact could be expected (Bellamy et. Al, 2008).

EBP can be applied to decisions that arise not just within clinical work with individual clients, but also in managing human service organizations, developing policy, or designing and administering educational programs to train social workers. Those who choose the route of research for the field argue that EBP is essential and must be taught and studied in order for the profession to thrive and come up with cutting edge, effective interventions for clients. However, many practitioners have no interest in research and have not been trained to seek out interventions tested by EBP. Many practitioners might even feel threatened by EBP as it requires a substantial educational investment, learning how to search and retrieve data, and then applying it to either new practice or related existing practice. To a large degree EBP is an essential marriage between the scholar and the practitioner, and though logically this marriage makes sense, as many would like to see the most current and cutting edge theory applied (without delay) to clinical practice the reality is that clinical and scholarly skills and desires are not always compatible in a single individual. Where one individual practitioner may see the value in the goal of publishing, researching and searching data sets, others are more likely to seek out more time to actually interact directly with patients, not study subjects. (Grinnell & Unrau 2008)

Gambrill (2003) as strong advocate for EBP states that practitioners and clients will not have access to effective interventions, if researchers continue to utilize inadequate rigor, while others complain that scholarly rigor may not be the needed function of an equation in each and every clinical situation. Herbert et. Al.(2001) discern that the overwhelming strength of the evidence-based approach to clinical practice is that it takes full advantage of the only potentially unbiased estimates of effects of therapy those which are derived from carefully conducted clinical research (pp. 210).

While conversely, many opponents of EBP, social work practitioners will spend more money and time accessing, reading, and analyzing a lot of social work books and journal articles, even though the information in the books and journal articles may not be relevant to their practice. Unless social workers' time constraints and heavy workload can be reduced, adopting EBP will increase social workers' stress, workload, and possibly even their personal resource allocation. This will likely force many social workers to leave the social work profession and look for other jobs (McNeill, 2006).

What is Evidence-Based Practice (EBP)

Roberts and Yeager (2006), cite Gibbs (2003) when defining EBP as a systemic approach to evaluate problems, formulate answerable questions, gather and critically evaluate evidence, applying the evidence to the present situations, and evaluating the intervention. Over the past decade, there has been an increasing recognition that social work should be evidence based. The potential contribution of evidence-based practice to the effectiveness, efficiency, and accountability of social work education and practice has been emphasized.

All clinical practice to some degree is EBP, though often a vastly oversimplified one in which a practitioner first determines a client's diagnosis or condition, then consults a diagnostic criteria and works from there to aide the client in personal development or change, to better the situation. The National Association of Social Workers (NASW) defines EBP as interventions for which scientific evidence consistently shows that they improve client outcomes (NASW, 2009). It has been argued that EBP reflects a primarily positive, epistemology and that its ontological and epistemological assumptions are too narrow to embrace human behaviors and the metaphysical world that social workers strive to understand (McNeill, 2006).

Rosen (2003), states that EBP must include the client's individual circumstances in the decision process. Consideration of the client includes informing the client of the available interventions and explaining the research and findings associated with that intervention. EBP is again thought to be a means to bridge the gap between practice and research, and can be simple, i.e. related to a case by case process of research and application, yet it can also be highly scholarly and formal. McNeill (2006) stated that evidence is much more of a relative concept than proof; it can range from clinical observations to the results of both large-scale epidemiological studies and randomized control trials (p. 150).

What is Evidence?

This paper will explore EBP based on a fusion of the definitions mentioned above. In order to develop a greater understanding of EBP a more in-depth explanation of the terms must be offered. Zlotnik and Galambos (2004) define evidence as randomized controlled trials that support an intervention. In other words, phenomenon considered as evidence must be contrived as a result of some sort of research and/or trial. According to many the most essential aspect to learning, using and even teaching EBP is that not all information produced by studies can be considered good or credible evidence.

Christopher Weed describes evidence in a level system. Below are the levels listed from highest to lowest weight in credibility, where evidence is ranked according to its validity/repeatability. In level 1 evidence is gleaned from a true experimental design such as a randomized clinical trial, and is considered the best type of evidence. Level 2 evidence is that which is gleaned from quasi-experimental research designs, such as clinical trials that do not include randomization but do include all the other elements of a true randomized clinical trial. Level 3 evidence is that which is based on expert consensus, which can be anecdotal but is based on observation and experience of supposed experts en mass. Level 4 evidence is that which comes from qualitative literature reviews, and finally level 5 evidence which is simply gleaned from anecdotal experience. (Weed, 2007)

If these levels are to be trusted, much of the tradition of social work might be challenged, though the profession would seem much more "scientific" in nature. Another credible challenge to this hierarchy of information with regard to social work, is similar in concern to any thinking science as much of the work is un- recordable and unobservable, as it occurs within the mind, rather than the action of the individual. Here in lies another controversy surrounding EBP in social work, or any helping science involved with mental processes; defining individuals then, "are we what we think or are we what we do?" Yet, it is clear that defining evidence, taken separately from the term evidence-based practice is essential to the establishment of the whole of the definition of EBP and is certainly part of the learning curve for application. Certainly, practitioners and scholars, or any marriage of the two must be clear that when retrieving evidence, that not all research is "good," yet this also implies that much of the unspoken and undercurrent of what we do as social workers is not considered "good" by these standards.

Straus and Haynes (2009) in fact, warn those who seek interventions that claim to be EBP at any of the level must ensure that evidence is reliable by being aware of the methods used to generate, synthesize, discuss and summarize it. They should know that just because a resource has references does not mean that these reosuces are evidence- based. Or just because a resource uses the terms evidence-based in its title does not mean that it was derived through appropriate research methods and could… [END OF PREVIEW]

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Evidence-Based Practices.  (2009, May 30).  Retrieved November 14, 2019, from

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"Evidence-Based Practices."  May 30, 2009.  Accessed November 14, 2019.