1. Evidence-Based Practice A Stepwise Approach Bruce D. Friedman, PhD, ACSW, CSWM University of Texas – Pan American Social Work Department friedm52@panam.edu October 27, 2006 www.socialworkmanager.org

2. Objectives Understand evidence-based practice & its relationship to the professional, client system, existing knowledge, and values & expectations. Develop an understanding on how to ask focused clinical questions. Develop search strategies that include: –Identifying appropriate search engines on the web. (Various search engines may be used depending on connectivity). Learn how to critically appraise literature for validity and applicability.

3. Problems Suspected accuracy of assessment of treatment protocols. Our textbooks are out of date. Our journals have slim pickings with too much to read and too little time. Consequently, our knowledge and performance deteriorate. Traditional instructional CE doesn’t improve our performance or client outcomes.

4. Three Solutions Clinical performance can keep up to date by: 1. Learning how to practice EBP ourselves. 2. Seek and apply evidence-based practice summaries generated by others. 3. Apply evidence-based strategies for changing our clinical behavior.

5. “Evidence-Based Users” Efficiently track and use sources of pre-appraised evidence (journals of secondary publication)  provide immediately applicable conclusions. Master a set of skills to acquire up to date information for delivering evidence-based care. More likely (than personal search and critical appraisal) to be true. Saves precious (scarce!) time. Avoids error and duplication of effort.

6. What evidence-based practice is: The practice of EBP is the integration of individual clinical expertise with the best available external clinical evidence from systematic research and client’s values and expectations.

7. Individual Clinical Expertise Best External Evidence Client Values & Expectations EBP

8. What do we mean by EBP? A conscious decision to base clinical decisions on the most objective evidence of effectiveness available. Involves a fundamental acknowledgement that our clinical convictions can be wrong.

9. Why is EBP necessary? Essential to the process of lifelong learning and keeping up to date. Frees you up to do things that you want to do. It is egalitarian. Best way of being sure that we provide effective care within the confines of our finite social service resources.

10. The EBP Process When caring for a client it creates the need for information: 1. Ask a focused clinical question. ( “answerable question”) Yogi Berra said…. "You got to be very careful if you don't know where you're going, because you might not get there."

11. The EBP Process cont.. 2. Efficiently track-down the best available evidence. 3. Critically appraise the evidence for its validity and clinical applicability. 4. Integrate the critical appraisal with your clinical expertise and the client’s unique values and expectations  Action. 5. Evaluate your performance (= Audit).

12. Tactics for efficiently tracking down the best evidence Carry out instant information searching as soon as we need to know something

13. The advantages of instant information searching n Answers found will be better remembered in the context of needing to know. n Will apply the information to similar patients in future. n Applying valid and relevant E-B information will improve outcomes in a timely fashion. n Answering questions that arise around problems we commonly see will keep us up to date with a minimum amount of work.

14. The usefulness of information equation Usefulness of information = Applicability x Validity Work

15. A stepwise approach to finding the best evidence efficiently Step 1. Ask a focused clinical question. Step 2. Devise a search strategy. Step 3. For questions with a narrow focus concentrate on information contained in Evidence Based Journals of Secondary Publication Step 4. For EBP queries use sites like TRIP or Mental Health Step 5. If previous steps fail then use broader search engines like PubMed, or Google.

16. Internet Resources for SEARCHING

17. TRIP (Turning Research Into Practice) TRIP (Turning Research Into Practice) http://www.tripdatabase.com/

18. Mental Health Resources Mental Health Resources http://www.mentalhealth.com

19. SUM Search SUM Search http://SumSearch.UTHSCSA.edu/cgi-bin/SUMSearch.exe

20. Cochrane Library Cochrane Library http://www.cochrane.org/

21. Drug Reference Site Drug Reference Site www.rxlist.com

22. NASWNASW - http://www.naswdc.org

23. Urban InstituteUrban Institute www.urbaninstitute.org

24. Netting the Evidence: ScHARR Netting the Evidence: ScHARR http://www.shef.ac.uk/~scharr/ir/netting/

25. Search Strategy Stick to “answerable questions”. Remember EBP databases will predominantly have studies that satisfy the highest levels of evidence  If an answer to your question can’t be found in these databases (e.g. TRIP) good evidence on this topic probably does not exist. Restrict yourself to a handful of high quality databases that you can implicitly trust and know them well.

26. Literature Validity & Applicability Does the literature answer your question? Is the information useful in working with your client system? How does the information relate to the client system’s value orientation?

27. Summary What is evidence-based practice & its relationship to the professional, client system, existing knowledge, and values & expectations? How do you ask focused clinical questions? Identify two search engines and how you would use them. Identify criteria for critically appraising literature for validity and applicability.