EvidenceBased Practice in Social Work

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Evidence-Based Practicein Social Work
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The EBP Model
Sackett et al., 1997
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Newest EBP Model
Haynes, Devereaux, and Guyatt, 2002
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Steps of EBP

• Become Motivated to Apply EBP
• Step 1Convert information need (prevention,
  assessment, treatment, risk) into an answerable
  question.
• Step 2Track down current best evidence.
• Step 3Critically appraise the evidence.
• Step 4Integrate critical appraisal with practice
  experience, clients strengths, values, and
  circumstances.
• Step 5Evaluate effectiveness and efficiency in
  exercising steps 1-4 and seek ways to improve
  them next time.
• Step 6Teach others to follow the same process

Gibbs, 2003
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Sources of Evidence in EBP
Adapted from Davies, 2004
Evidence
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Arguments For Evidence-Based Social Work (EBSW)

• Enhances decision quality
• Fosters learning of assessment skills
• Incorporates client values and expectations
• Fosters evidence search and appraisal skills
• Makes best use of best evidence
• Framework for self-directed, life-long learning
• Identifies gaps in knowledge
• Common interdisciplinary language

Sackett et al, 2000
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Arguments For Evidence-Based Social Work (EBSW)

• Eschews authoritarian practices and policies
• Promotes SW ethics through
• Informed consent
• Using effective services
• Wisely allocating scarce resources
• Involving clients in practice process
• Individualizing personalizing decisions

Gambrill, 2003
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Arguments For Evidence-Based Social Work (EBSW)

• Helping clients develop critical appraisal skills
• Involving clients in design and critique of
  practice and policy related research
• Involving clients as informed participants who
  share in decision making
• Recognizing clients unique knowledge in terms of
  application concerns
• Promoting transparency and honesty
• Encouraging a systemic approach for integrating
  practical, ethical and evidentiary issues
• Maximizing the flow of knowledge and information
  about knowledge gaps

Gambrill, 2003
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Challenges Facing EBSW

• Evidence-of-effectiveness
• Authority
• Conflicting hierarchy
• Definition of evidence
• Shortage of evidence
• Variation by field of practice
• Inflation of evidence
• Small transient effects
• Assessment validity
• Nomothetic versus ideographic knowledge
• Efficacy versus effectiveness
• Diffusion, adoption and implementation
• Policy system level issues
• Training sustaining

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Authority Challenge

• As originally conceived the founders of
  evidence-based medicine envisioned that medical
  practitioners would seek out evidence appraise
  the quality of that evidence, alone or in teams
  of practitioners
• The new paradigm puts a much lower value on
  authority. The underlying belief is that
  physicians can gain the skills to make
  independent assessment of evidence and thus
  evaluate the credibility of opinions being
  offered by experts (Evidence-Based Medicine
  Working Group, 1992)

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Conflicting Hierarchy Challenge

• Hierarchy of Evidence Ranked by Quality
• N of 1 randomized trials
• Systematic reviews/Meta-analysis of randomized
  trials
• Randomized Controlled Trials
• Systematic review of observational studies
  addressing patient-important outcomes
• Physiological/Laboratory experiments
• Unsystematic clinical observation