THE INTRODUCTION OF EVIDENCE BASED PRACTICE (EBP) IN SOCIAL WORK
Evidence-based practice (EBP) is an educational and practice paradigm that includes a series of predetermined steps aimed at helping practitioners and agency administrators identify, select, and implement efficacious interventions for clients. Evidence-based practice (EBP) is a five-step process used to select, deliver, and evaluate individual and social interventions aimed at preventing or ameliorating client problems and social conditions. At its most basic level, EBP seeks to systematically integrate evidence about the efficacy of interventions in clinical decision-making. Adhering to EBP, however, is a complex process that requires practitioners to be skilled at posing practice-relevant questions and proficient at accessing evidence that answers these questions. Importantly, practitioners must have the requisite methodological skills to evaluate evidence about the efficacy of interventions from clinical trials, systematic reviews, and meta-analyses. Finally, to teach the process of EBP, social work educators must be competent in tasks associated with information retrieval and interpretation of evidence.
Evolution of Evidence Based Practice
EBP appeared in the medical profession in the 1990s as a process to help physicians select effective treatments for their patients. The introduction of EBP in medicine was viewed by many scholars and practitioners as an effective way to bring research findings to medical practice decisions. The rapid diffusion of EBP since then has been attributed to advances in knowledge about the prevention and treatment of medical conditions and to economic forces that emphasize the selection of efficacious treatments as a strategy to reduce health care costs. The growth of EBP in medicine has also been a product of an increasingly active and well-informed patient population. The sophistication of medical consumers has required physicians to become more skilled at evaluating and applying evidence to medical practice decisions. The introduction of EBP in medicine has created considerable interest in the process of applying evidence to medical practice decision-making. Importantly, scholars also believe that EBP has moved the medical profession away from its long-standing reliance on authority-based decision-making processes that fail to adequately consider empirical evidence.
Emergence into the Field of Social Work
When the field of medicine introduced evidence-based practice it challenged medical providers to consider three things:
1. Choose the best quality care for their clients
2. Assess how qualified the available current evidence is
3. Present quality information to clients as they make an informed decision
No longer solely applicable to the field of medicine, these three considerations are equally important when deciding on a social work intervention. In fact, evidence-based practice in social work is a process that focuses on three parts:
1. Best research evidence,
2. Social work expertise, and
3. Client expectations and desires
Not only does a social worker need to have expertise in social work but a social worker must also understand their client and use that information to find the best evidence to help address their needs. Collectively, all three parts support the fundamental importance of using this process. This is the need to evaluate information as a way to assess the most appropriate and accurate intervention for an individual or group of people.
Essential Steps of EBP
Step 1: Converting Practice Information Needs into Answerable Questions
An important first step in the process of EBP requires practitioners to define information needs about a particular client problem. This information needs to be framed in the form of answerable questions. Further, they recommend that questions identify the client population, intervention type, and anticipated outcomes. Posing answerable questions requires precision and practice. Students and practitioners must be trained to pose different types of practice-relevant questions and learn ways to retrieve evidence that is critical in answering such questions.
Step 2: Locating Evidence to Answer Questions
Step 2 requires practitioners to search for and locate evidence pertaining to the questions they pose. At least four sources are available currently to search for empirical evidence: books and journals, systematic reviews organized by client problem or treatment approach that detail the effects of interventions on specified outcomes, published “lists” of effective programs by federal entities and research centres, and practice guidelines that offer treatment protocols based on empirical evidence. Sources of information and evidence have proliferated widely in recent years. Practitioners must possess a range of information retrieval skills to identify appropriate sources of credible evidence. The appraisal of such evidence, discussed next, is a critical next step in the EBP process.
Steps 3 & 4: Appraising and Applying Evidence to Practice and Policy Decisions
EBP requires practitioners to use their knowledge of research design and methodology to evaluate and apply evidence to practice situations. These steps require familiarity with research methodology and the ability to draw conclusions about the utility of information on the basis of levels of evidence. The scientific community recognizes findings produced by randomized controlled trials as the most rigorous and acceptable level of evidence. However, results from studies using correlation, single-subject, quasi-experimental, experimental, and meta-analytic designs must also be considered and evaluated in steps 3 and 4. The flurry of activity associated with EBP is not confined to selecting and implementing well-tested programs. To develop new knowledge about the effects of interventions, a small but increasing number of social work researchers are testing the effects of interventions across different problem areas in controlled efficacy trials.
Step 5: Evaluating the Process
The steps in EBP appear deceptively simple at first glance. However, the process of EBP requires knowledge of current literature about the onset, prevention, and treatment of client or social problems, the ability to search for relevant information and data, and skills to evaluate and apply knowledge obtained in systematic searches. The complexity involved in steps one to four demands an ongoing evaluation of one's knowledge of current literature, familiarity with constantly changing electronic databases, and skills in drawing conclusions based on methodological rigor. Most scholars would agree that the social work profession is in the beginning stage of implementing the process of EBP in practice, education and research settings.
EBP and Social Work Education
Reports indicate that more than 70% of respondents from a survey of social work educators in the USA were in favour of teaching It was noted that as many as 40 social work programs in the USA have created classes that incorporate principles of EBP. Importantly, the Council on Social Work Education has identified EBP as an important principle in its educational policy and accreditation documents. These and other examples illustrate the increasing attention being paid to EBP in the social work curriculum. Significant structural and pedagogical changes in social work education are necessary to teach EBP. For example, a new generation of students must be exposed to the complexities involved in posing relevant practice and policy questions. Students must become experts in information retrieval and possess the methodological skills necessary to evaluate and apply evidence. New and innovative teaching approaches will be required to systematically teach EBP. Faculty will need to be trained, and in some cases retrained, to teach EBP. Finally, the appropriate location for teaching the actual process of EBP must be determined in undergraduate and graduate curricula.
EBP and Social Work Practice
EBP is receiving considerable attention from policy makers and funding sources. Governments and local systems of care, private foundations, and federal entities have entered the debate about the best ways to select and implement effective interventions for clients and client systems. Agency administrators and practitioners are working diligently to understand EBP in an effort to develop competitive research proposals and implement effective program components. One significant practice challenge is how to teach principles of EBP to practitioners and agency administrators. Community agencies vary widely with respect to their awareness, understanding, and acceptance of EBP. Community partnerships and collaborative research projects are needed to help practitioners apply EBP principles in a wide variety of practice settings.
Challenges and Implications
The promotion of EBP in social work was attributed initially to individual scholars and small groups of researchers. These early efforts were aimed largely at exposing social workers to definitions of EBP and to concurrent developments in evidence-based medicine. Discussion of the process of applying EBP principles to social work practice and policy soon followed. A significant number of social work researchers and educators have since acknowledged the importance of EBP. Support is evident in the exponential growth in the number of books and articles on EBP since 2003. Sessions on EBP have increased significantly at recent national social work conferences sponsored by the Society for Social Work and Research and the Council on Social Work Education. An increase in attention to EBP by social work educators is indisputable.
However, EBP is not without its critics. There have been voices of scepticism and even rejection characterized by claims that EBP offers nothing new to the field. Others point to the lack of an effective knowledge base for certain client problems and populations, which hinders the advancement of EBP in the field. EBP is at an important turning point in social work. To some, it reflects a new and revolutionary practice approach that holds great promise for building stronger bridges between science and social work. Others view EBP as a repackaged attempt to integrate research and practice that is fraught with educational and implementation problems. Regardless, the challenges of EBP to social work education, practice, and research are varied and complex.
Social workers increasingly are seeking information about evidence-based practices. Numerous resources are emerging to help connect research to practice and provide information that can be helpful to practitioners. The term evidence-based practice (EBP) is used in numerous ways; definitions that have been provided have helped expand social workers understanding of EBP. Resources, and publications needs to be identified that can be useful to inform practice and guide policymakers. Since the identification of evidence-based practices involves assessing the available body of practice-relevant research, having a robust social work research base is important.
1. Evidence Based Practice in Social Work| Policy Institute
2. Introduction to Evidence Based Practice-EBP for Social Work Practitioners
3. Evidence Based Practice. NASW
4. Evidence Based Practice. Encyclopaedia of Social Work