What is evidence-based practice?

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Although there is no universally accepted definition of evidence-based practice in social work and family work [1, 2], it is generally described as a decision-making process that incorporates:

1. The best research evidence
2. The best clinical experience
3. Family and client values [2-7]. (see Figure 1)

Figure 1: Evidence-based practice (Source: Walsh, Rolls & Williams [2])

(For a some suggested changes to this description of evidence-based practice, see Rethinking the roles of families and clients in evidence-based practice.)

The dominant model of evidence-based practice involves a five decision-making model originating from evidence-based medicine [6, 8-13]. According to Plath [8] the five steps are:

(1) Convert information needs regarding practice issues into specific answerable questions, to guide a literature search.

(2) Track down with maximum efficiency the best evidence with which to answer the question.

(3) Critically appraise the evidence for its validity, impact and applicability.

(4) Apply the results of this appraisal to policy/practice decisions. The appraised evidence, clinical expertise and client circumstances are integrated to inform practice decision making. This involves assessment of similarity of practice case to those studied, access to the interventions described in the literature, weighing anticipated outcomes against other demands, practical matters and client preferences.

(5) Evaluate process and client outcomes. This may entail record keeping and single case designs. (p. 910, emphasis in original)

At times two additional steps are included: Become motivated to apply evidence-based practice and teach other to follow the same process [6].

What is meant by “best evidence” varies greatly. For some authors, this involves an emphasis on “more rigorous” [4, p. 2] research methodologies (e.g., systematic review, random controlled trials and quasi experimental designs). Other authors have a much broader understanding of what constitutes relevant evidence [14, 15].

While there is little argument that evidence is important to practice, there are a number of criticisms of a narrow understanding of evidence-based practice. Criticisms include [1, 4, 14, 16]:

1. A too narrow definition of evidence
2. The limited availability of relevant research evidence
3. The gap between how evidence is used in practice and how evidence-based practice literature suggests it is used
4. Difficulties being clear about what the evidence says
5. A lack of recognition of the impact of the organisational contexts of practice
6. A risk of simple “solutions” to complex problems.

While many practitioners agree there is value in basing their practice on evidence [3, 17] there can be resistance and barriers to adopting evidence-based practice. Practitioners may have other priorities and favour “pragmatic decision making” over evidence-based practice [3]. In one study, a practitioner suggested “I would rather sacrifice the [evidence-based practice] being perfect than sacrifice the rapport that I have with my clients with their other bigger issues” [quoted in 18, p. 413]. Barriers to adopting evidence-based practice can include the lack of time or resources (e.g., access to journal databases), the lack of skills in finding and interpreting relevant research, evidence-based practice not being part of an agency’s culture, the costs involved and practitioners not feeling that their practice wisdom and experience is acknowledged [1, 3, 17, 19].

There is an increasing emphasis on evidence-based practice in social work, family work and community development [20-25] community development and there is wide agreement that practitioners need to ensure they are making a difference and that they are contributing to family and community well-being. Despite limitations, evidence-based practice is one approach that can support practitioners to take up the challenge.

In coming posts I will also discuss evidence-based programs and evidence-informed practice.

If you liked this post, you might like to follow my blog and look at:

1. Research evidence for family (and community) workers
2. Finding literature on working with families
3. What are program logic models?
4. Some good articles/links – evidence-based programs and practice
5. Blogging as an academic
6. 10 things I’ve learnt about strengths-based community engagement

References

1. Plath, D. (2013). Support for Evidence-Based Practice in a Human Service Organization. Administration in Social Work, 37(1), 25-38. doi: 10.1080/03643107.2011.638731 Available from http://dx.doi.org/10.1080/03643107.2011.638731
2. Walsh, C., Rolls Reutz, J., & Williams, R. (2015). Selecting and implementing evidence-based practices: A guide for child and family serving systems (2nd ed.). San Diego, CA: California Evidence-Based Clearinghouse for Child Welfare. Available from http://www.cebc4cw.org/files/ImplementationGuide-Apr2015-onlinelinked.pdf
3. Gray, M., Plath, D., & Webb, S. A. (2009). Evidence-based Social Work A Critical Stance. Hoboken: Taylor & Francis.
4. Centre for Community Child Health. (2011). Evidence-based practice and practice-based evidence: What does it all mean? Policy Brief: Translating early childhood research evidence to inform policy and practice(21). Available from http://ww2.rch.org.au/emplibrary/ecconnections/Policy_Brief_21_-_Evidence_based_practice_final_web.pdf
5. Austin, M. J., & Claassen, J. (2010). Implementing evidence-based practice in human service organizations: Preliminary lessons from the frontlines. In M. J. Austin (Ed.), Evidence for child welfare practice. London: Routledge.
6. Shlonsky, A., & Ballan, M. (2011). Evidence-informed practice in child welfare: Definitions, challenges and strategies. Developing Practice: The Child, Youth and Family Work Journal(29), 25-42. Available from http://search.informit.com.au/documentSummary;dn=895477260656059;res=IELAPA
7. Levant, R. F. (2005). Report of the 2005 Presidential Task Force on Evidence-Based Practice: American Psychological Association. Available from https://www.apa.org/practice/resources/evidence/evidence-based-report.pdf
8. Plath, D. (2013). Organizational Processes Supporting Evidence-Based Practice. Administration in Social Work, 37(2), 171-188. doi: 10.1080/03643107.2012.672946 Available from http://dx.doi.org/10.1080/03643107.2012.672946
9. Webber, M., & Carr, S. (2015). Applying research evidence in social work practice: Seeing beyond paradigms. In M. Webber (Ed.), Applying research evidence in social work practice. London: Palgrave.
10. Mullen, E. J., Bellamy, J. L., & Bledsoe, S. E. (2011). Evidence-based practice In R. M. Grinnell & Y. A. Unrau (Eds.), Social work research and evaluation : foundations of evidence-based practice. Oxford ; New York: Oxford University Press.
11. Sackett, D. L. (1997). Evidence-based medicine : how to practice and teach EBM. New York: Churchill Livingstone.
12. Gibbs, L., & Gambrill, E. (2002). Evidence-Based Practice: Counterarguments to Objections. Research on Social Work Practice, 12(3), 452-476. doi: 10.1177/1049731502012003007 Available from http://rsw.sagepub.com/content/12/3/452.abstract
13. Johnson, M., & Austin, M. J. (2010). Evidence-based practice in the social services: Implications for organizational change. In M. J. Austin (Ed.), Evidence for child welfare practice. London: Routledge.
14. Epstein, I. (2009). Promoting Harmony Where There Is Commonly Conflict: Evidence-Informed Practice as an Integrative Strategy. Social Work in Health Care, 48(3), 216-231. doi: 10.1080/00981380802589845 Available from http://dx.doi.org/10.1080/00981380802589845
15. Donaldson, S. I., Christie, C. A., & Mark, M. M. (Eds.). (2009). What counts as credible evidence in applied research and evaluation practice? Los Angeles: SAGE.
16. Webb, S. (2001). Some considerations on the validity of evidence-based practice in social work. British Journal of Social Work, 31, 57-79.
17. Plath, D. (2014). Implementing Evidence-Based Practice: An Organisational Perspective. British Journal of Social Work, 44, 905-923. doi: 10.1093/bjsw/bcs169 Available from http://bjsw.oxfordjournals.org/content/44/4/905
18. Aarons, G., & Palinkas, L. (2007). Implementation of Evidence-based Practice in Child Welfare: Service Provider Perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 34(4), 411-419. doi: 10.1007/s10488-007-0121-3 Available from http://dx.doi.org/10.1007/s10488-007-0121-3
19. Winter, C., & Ohmer, M. (2014). Using the Best of Research and Practice to Create an Outcome Measurement Framework: A Family Service Agency’s Experience. Families in Society: The Journal of Contemporary Social Services, 95(3), 155-162. doi: doi:10.1606/1044-3894.2014.95.20 Available from http://familiesinsocietyjournal.org/doi/abs/10.1606/1044-3894.2014.95.20
20. Gray, M., Joy, E., Plath, D., & Webb, S. A. (2015). What Supports and Impedes Evidence-Based Practice Implementation? A Survey of Australian Social Workers. British Journal of Social Work, 45, 667-684. doi: 10.1093/bjsw/bct123 Available from http://bjsw.oxfordjournals.org/content/45/2/667.full.pdf
21. Pack, M., & Cargill, J. (2015). Evidence discovery and assessment in social work practice. Hershey, USA: Information Science Reference.
22. Shonkoff, J. P., & Fisher, P. A. (2013). Rethinking evidence-based practice and two-generation programs to create the future of early childhood policy. Development and Psychopathology, 25(4), 1635-1653. doi: doi:10.1017/S0954579413000813 Available from http://dx.doi.org/10.1017/S0954579413000813
23. Family and Community Services, NSW. (2015). Targeted Earlier Intervention Programs: Sector Consultation Paper. Sydney. Available from http://www.community.nsw.gov.au/__data/assets/pdf_file/0005/335165/CS_TIER_consultation_paper.pdf
24. Family and Community Services, NSW. (2016). Targeted Earlier Intervention Programs: Reform directions – local and client centred. Sydney:  Available from https://www.fams.asn.au/sb_cache/associationnews/id/42/f/TEI%20Program%20Reform%20Directions%20-%20local%20and%20client%20centred%20%28002%29.pdf.
25. Parker, R., & Robinson, E. (2013). Evidence-based practice and service-based evaluation: Australian Institute of Family Studies. Available from https://aifs.gov.au/cfca/publications/evidence-based-practice-and-service-based-evaluation