Evidence Based Practice Introduction and Overview Module One Evidence Based Practice Introduction and Overview In this module we will begin by providing a general overview of Evidence Based Practice (EBP), as defined in this training and the motivations for using EBP in Social Work.

Definition A Process Involving: Posing specific questions Searching for current best evidence Evaluating the evidence objectively and… Taking action based on evidence HANDOUT 1: EVIDENCE BASED PRACTICE: A GENERAL OVERVIEW Evidenced Based Practice, or EBP, has been defined in different ways. You may have heard about specific evidence based practices, such as Cognitive Behavioral Therapy (CBT) or Psychoeducation. These individual interventions are related to the topics covered herein, but for the remainder of this training we would like you to think of EBP as a process or an approach to practice and policy decision making. This process involves specific steps that are ultimately aimed at strengthening the linkage between research knowledge and practice. Ultimately we hope that you will find this training helpful in supporting your own professional development and ultimately improving outcomes for the clients and communities that you serve. The specific components of this process involves posing specific, and well-structured questions, searching effectively and efficiently for the best evidence, evaluating any evidence that you identify by research standards and your own agency and professional judgment, and finally taking action based on your assessment. This process will become more clear as we walk through some more specific examples.

Brief History Out of Evidence Based Medicine Evidence not authority ideas have been around for a long time Consolidated as a framework 1992 Took off in the late 90s and early 00s Like many trends in social work, EBP is a multi-disciplinary phenomenon. The roots of EBP lie in medicine. Oftentimes, in many helping and other professions, decisions have been made based on “authority” rather than objective evidence. One person in particular, Dr. David Sackett, is often associated with the evidence based medicine (EBM) movement and the development of specific methodologies to determine the best evidence. He defined EBM as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett D, 1996) EBM is a relatively recent movement, and its application in social work is newer still; although ideas concerning testing and incorporating knowledge gained from testing the efficacy of interventions has been around for quite a while. Many leaders in social work have been proponents of EBP and have written a great deal about the ethics, methodologies, challenges in, and frameworks for application of EBP in this field including Eileen Gambrill, Aron Rosen, Enola Proctor, Edward Mullen, and Leonard Gibbs to name a few.

Motivations Framework to integrate research into practice Common ground/language across professions Funding and policy friendly Ultimately more effective and efficient practice Consistent with professional goals and ethics There are several reasons why EBP is appealing to social work professionals. First, it provides a specific and concrete framework to integrate research into practice, a perennial challenge to many fields. Second, it provides a common ground or language among different disciplines. Social work is constantly influenced by, and likewise has an influence on other professions. This broader intellectual discourse is strengthened when diverse fields can incorporate similar frameworks in order to more effectively and efficiently exchange, assess, and build research knowledge. Moreover, accountability is increasingly a mainstay in the social service world. Funders and policy makers want to see that their resources are being routed to support the best work possible. EBP offers a method to continually identify effective treatments and other research knowledge in order to improve services and ensure best possible outcomes. Ultimately more effective and efficient practice ideally translates into better use of resources, including agencies’ and professional’s time and hard work, as well as improved services for clients and communities. Finally, it is consistent with the goals and ethics of the social work profession.

NASW Code of Ethics Promote the well being of clients Respect for self-determination Practice in areas of competence Advance expertise (professional development) Examine and keep current with emerging knowledge, research, and evaluation Many of the tenets and principles outlined in the National Association of Social Workers Code of Ethics are consistent with the EBP process. In EBP, as in the code of ethics, clients should receive cutting edge services, be well-informed about interventions and service options, and helped to make mindful choices about their participation in those services. Further, social work professionals should be competent in their field of practice. Part of that competence means remaining current and informed about research findings and having the skills to appropriately apply that knowledge and share it with clients.

What is “Evidence” Research evidence: quantitative and qualitative analyses, evaluations, efficacy studies, etc. But not alone…in conjunction with: Practitioner’s individual expertise Client values and expectation When we refer to evidence in this training we are talking about research evidence, including both individual quantitative and qualitative studies, as well as syntheses of multiple study findings into things like meta-analyses and systematic reviews- which we’ll explain more about later. However, evidence cannot be used alone to make important practice decisions. Evidence does not dictate, but rather provides important information that the professional practitioner must apply, along with his or her own individual expertise, as well as clients’ values and expectations. Evidence is a piece of the intervention process, but it is not the sum total of EBP.

Other decision making factors: Graphic from Davies, P. (Downloaded 7/18/05) “Policy Evaluation in the United Kingdom” (http://www.policyhub.gov.uk/docs/Korea%20%5BRead-Only%5D.pdf) Many factors are at play in any given intervention. This graphic, drawn from the work of Philip Davies, Deputy Director of the Government Social Research Unit in the UK, depicts some of the many influences that practitioners and social service agencies must consider in decision making. Dr. Davies developed this slide to show the many influences, other than research evaluation evidence, policy makers must contend with. The same is true of practitioners and agencies. As you can see, evidence is a key component, but many other important factors will come into play depending on everything from the cultural values of clients to the resources available to an agency or practitioner.

Evidence may confirm or disconfirm assumptions Keeping an Open Mind Evidence may confirm or disconfirm assumptions Research evidence does not mandate decision making, but guides it Despite the varied factors and influences social workers must consider, one of the most important messages inherent to EBP is keeping an open mind. Most of us operate in our day to day lives based on assumptions. We may not be accustomed to questioning whether or not the way we do things is the best way, the most effective way, the most efficient way, or even consider other ways of doing them all together. EBP, on the other hand, encourages us to do just that. Even when certain interventions have been successful, better options may come available. Research evidence is continually growing and what is the best evidence today, may not be the best evidence tomorrow. Moreover, having more choices about how to intervene means that clients will benefit from having more options. One type of intervention is unlikely to be successful for all people. It takes some effort to consider change in the service of continual improvement and growth, but ultimately it is about providing the best possible services to clients. This being said, research evidence does not automatically reveal the right treatment, assessment, or program. Through this training we hope to provide you with some of the tools that you can use to benefit from research evidence, and mindfully incorporate it into your practice.