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EvidenceBasedPracticeACommonDefinitionMatters.pdf

EvidenceBasedPracticeACommonDefinitionMatters.pdf

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Journal of Social Work Education

ISSN: 1043-7797 (Print) 2163-5811 (Online) Journal homepage: https://www.tandfonline.com/loi/uswe20

Evidence-Based Practice: A Common DefinitionMatters

Danielle E. Parrish

To cite this article: Danielle E. Parrish (2018) Evidence-Based Practice: A Common DefinitionMatters, Journal of Social Work Education, 54:3, 407-411, DOI: 10.1080/10437797.2018.1498691

To link to this article: https://doi.org/10.1080/10437797.2018.1498691

Published online: 05 Nov 2018.

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GUEST EDITORIAL

Evidence-Based Practice: A Common Definition Matters

More than a decade ago, a national survey of social work faculty suggested that although the majority(73%) were favorable toward the evidence-based practice (EBP) movement, a collective definitionand understanding of EBP was lacking (Rubin & Parrish, 2007). Despite multiple efforts since thattime to disseminate the EBP process model as originally defined by Sackett Richardson, Rosenberg,and Haynes (1997) and Sackett, Straus, Richardson, Rosenberg, and Haynes (2000) in field education(Edmond, Megivern, Williams, Rochman, & Howard, 2006; Matthieu, Carter, Casner, & Edmond,2016; Parrish & Oxhandler, 2015; Tennille, Solomon, Brusilovskiy, & Mandell, 2016), social workeducational programs (Bender, Altschul, Yoder, Parrish, & Nickels, 2013; Howard, McMillan, &Pollio, 2003), and the broader social work community (Bellamy, Bledsoe, Mullen, Lin, & Manuel,2008; Mullen, Shlonsky, Bledsoe, & Bellamy, 2005; Parrish & Rubin, 2011), a broad sampling of thesocial work literature continues to reflect confusion with the term.

Much of this confusion has resulted from misconceptions about EBP based on inaccuratedepictions in the literature, which discount key aspects of the EBP process, fail to cite or integratethe original EBP sources, or propose new models of EBP that share the same key elements as theoriginal proposed model (Gambrill, 2016; Gibbs & Gambrill, 2002; Thyer, 2013). What is unfortu-nate about this discourse is that self-identified proponents and skeptics often seem to agree about theimportant elements of research-practice integration. The hang-up tends to lie in misunderstandingsof how the EBP process model was originally defined and operationalized almost 2 decades ago. Infact, one may need to consume the original sources in medicine (Straus, Richardson, Glasziou, &Haynes, 2010) or in social work (Gibbs, 2003) to truly understand the entire model and how andwhy each step is implemented.

EBP was originally defined in the late 1990s as the “conscientious, explicit and judicious use ofcurrent best evidence in making decisions about the care of individuals [clients]” (Sackett,Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71) and “the integration of best research evidencewith clinical expertise and [client] values” (Sackett et al., 2000, p. 1). As such, it is a decision-makingprocess for practice that includes the following five steps: formulating an answerable practicequestion; searching for the best research evidence; critically appraising the research evidence forits validity and applicability; implementing a practice decision after integrating the research evidencewith client characteristics, preferences, and values; and evaluating the outcome (Mullen, 2004;Shlonsky & Gibbs, 2004; Thyer, 2006). It is also notable that the original EBP process sources(Gibbs, 2003; Straus et al., 2010) clearly describe the application of this process to all kinds ofpractice questions including background questions on general knowledge about a condition, prac-tice-related issue, or population (e.g., etiology, assessment, client experience and meaning) andforeground questions, which ask for specific knowledge to inform practice-related decisions (oreffectiveness questions, also described as population, intervention, comparison, outcome questions).

The EBP process definition and decision-making approach differs greatly from the EBP definition,which refers to interventions, programs, or policies that certain entities (e.g., Society of ClinicalPsychology, Division 12 of the American Psychiatric Association [APA]; Substance Abuse andMental Health Services Administration; National Registry of Evidence-Based Programs andPractices) have deemed to have a desired level of research support regarding effectiveness. To helpmitigate the confusion this term has had in the field, Division 12 of the APA stopped using the termevidence-based practices in 2006, noting these guidelines were not intended to support the dictationof specific forms of treatment (APA Presidential Task Force on EBP, 2006). The APA PresidentialTask Force on EBP (2006) also shared its support of the original EBP definition: “Evidence-based

JOURNAL OF SOCIAL WORK EDUCATION2018, VOL. 54, NO. 3, 407–411https://doi.org/10.1080/10437797.2018.1498691

© 2018 Council on Social Work Education

practice in psychology (EBPP) is the integration of the best available research with clinical expertise inthe context of patient characteristics, culture and preferences” (p. 272). Those in the fields ofpsychology and social work have noted the confusion and controversy the EBP definition hascreated, much of which can likely be traced to the way it was adopted and implemented by state,federal, and health care funding entities to mandate and restrict service delivery to those approachesdeemed evidence based. Unfortunately, these parallel efforts to disseminate two very differentdefinitions of EBP have led to great misperceptions regarding the kinds of research and practice-related expertise, skills, or interventions that are valued by the EBP process model. To clarify, thismodel: 1) values all forms of high quality inquiry (qualitative and quantitative) depending on theEBP question posed, 2) prioritizes the selection of interventions or programs based on researchvalidity, applicability to the client and clinical/practice expertise, and 3) defines clinical expertise asthe ability to think critically about these multiple sources of information (research, practice contextand client characteristics) and then select and deliver the intervention using essential therapeuticrelationship skills (e.g., common factors) (Gambrill, 2016; Straus et al., 2010). This model alsoemphasizes the evaluation of the EBP process and client outcomes (Gambrill, 2016).

Major efforts have been undertaken in social work and psychology over the past decade to correctsuch misconceptions of the EBP process by distinguishing the evidence-based process from the EBPdefinition and by referring to these practices as research supported or empirically supported (APAPresidential Task Force on EBP, 2006; Gibbs & Gambrill, 2002; Thyer & Myers, 2010). Given the lackof clarity about EBP terminology, many proponents of the EBP process (e.g., Gambrill, 2010) haveadopted the term evidence-informed practice as a synonym of the EBP process, in part because theterm evidence-based has taken on the connotation, by some, to imply that nonresearch factors arenot important in the EBP process. Others have suggested the use of new labels (and new models thatdo not differ from the EBP process model) such as evidence-driven practice or evidence-guidedpractice. However, the continued proposal of additional terms is problematic as it serves to muddythe waters and adds to the lack of clarity and misunderstandings about the original EBP model.

Why does a common definition of the EBP process matter?

A common definition matters given the potential of the EBP process framework to teach students toengage in critical and reflective thinking, ethical practice rooted in client empowerment, and practicedecisions that have the most promise for helping the clients they serve. Teaching the EBP processconsistently across the curriculum can equip students with the following valuable skills: criticalthinking and questioning of the status quo or authority; consideration of the best available researchin the context of client preferences, values, and culture, as well as the larger environment; criticalappraisal of different kinds of high-quality research to answer all kinds of EBP questions (e.g.,effectiveness, general knowledge of a client population, effective assessment) related to practice;collaborative decision making, cultural sensitivity, empowerment, and informed consent with theclient; and skills to evaluate practice decisions and improve the course of intervention as needed.

It emphasizes critical thinking and evaluation of practice

In an era of alternative facts and propaganda (Gambrill, 2010, 2016), as well as a proliferation ofcredible and noncredible sources on the Internet, there is no more important skill for social workstudents than to be critical consumers of information. EBP offers a framework for teaching criticalthinking as a key element of practice decision making given its focus on questioning, curiosity, open-mindedness, analysis of multiple information sources, reflection, unbiased evaluation of outcomes,and thinking beyond agency protocol and practice wisdom (O’Neill, 2015; Profetto-McGrath, 2005).A bonus of the EBP approach, consistent with critical thinking, is teaching students to objectivelyevaluate their practice decisions, often using single-system designs, and to use that information to

408 GUEST EDITORIAL

make ongoing decisions about practice. The integration of such evaluations—an important aspect ofethical social work practice—can also serve as a tool to collaboratively assess client progress andexplore reasons for improvement or lack thereof.

It teaches social workers to be critical consumers of practice-related research

The most challenging part of teaching the EBP process is helping students understand how to poseuseful EBP practice questions and critique the research they have identified. However, if research istaught from a consumer’s perspective (Rubin & Bellamy, 2012; Straus et al., 2010) in which studentsare taught to use rather than produce research, it can greatly influence their interest in research andtheir perceived efficacy with the process (Parrish & Rubin, 2011). Undergraduate and graduate socialwork students rarely get opportunities to do research during their programs, but if the EBP model istaught across courses, they will have several opportunities to practice and build their skills by askingvaried kinds of EBP questions and critiquing the literature for its validity and applicability. Such anunderstanding of research is critical, as underscored by the National Association of Social Workers’(2017) ethical mandate to keep current with emerging knowledge relevant to social work. If socialworkers continue to fear research or are unable to critically evaluate the literature, this may haveserious consequences for their practice, including doing harm in the process of helping (Gambrill,2001, 2006, 2007). Likewise, clients increasingly have access to reliable and dubious sources ofinformation online and may present such findings to the practitioner. In these cases, social workersmust be informed enough to answer or correct misconceptions or disinformation. Finally, theconsistent critical analysis and integration of the most valid and applicable research for all popula-tions can help achieve social justice and health equity by providing the very best services (McMillin,2014; O’Neill, 2015).

Students learn to consider and respect client differences and self-determination andengage in informed consent

The EBP process emphasizes informed consent, or a shared decision-making process whereby theclient is fully informed about the evidence supporting different approaches (including when there arenone), potential risks and benefits, and what is involved with the interventions and any associatedfeasibility issues (Straus et al., 2010). Such an approach empowers clients and attends to thedynamics of power that may preclude a client from questioning practitioner-driven decisions(O’Neill, 2015). In addition, the client’s acceptance of an agreed-on approach in which the client’sunique preferences and characteristics are an equally important aspect of the decision is more likelyto increase that client’s engagement and goal collaboration, which are potent common factorscontributing to positive outcomes identified in psychotherapy research (Wampold, 2015). Finally,the EBP process emphasizes integrating the client’s unique background (e.g., culture, spirituality,age, gender) and preferences as key sources of information when making practice decisions.Specifically, a key aspect of the EBP process is to integrate these characteristics and relevantsynonyms (e.g., youth, adolescent, teen) as literature search terms (Rubin & Parrish, 2015). Thisensures the identification of the best available research for a specific client or population.

Conclusion

We need a common definition of EBP so that our profession can move past this circular debate thatconflates the EBP process and EBP definitions. Moving forward with clarity will allow our professionto focus more energy on using the EBP process model to better prepare our students to thinkcritically about the world and their practice, and purposely apply social work values, ethics, practice,and research in an integrated manner. Given the potential of the EBP process model as a truly

JOURNAL OF SOCIAL WORK EDUCATION 409

integrated social work practice model, it is my sincere hope that it does not become a passing fad.After a decade of confusion, it is time for a consistent definition and understanding of the EBPprocess.

Danielle E. ParrishAssociate Professor

Diana R. Garland School of Social WorkBaylor University

http://orcid.org/0000-0002-2448-5343

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JOURNAL OF SOCIAL WORK EDUCATION 411

  • Guest Editorial
  • Why does a common definition of the EBP process matter?
    • It emphasizes critical thinking and evaluation of practice
    • It teaches social workers to be critical consumers of practice-related research
    • Students learn to consider and respect client differences and self-determination and engage in informed consent
  • Conclusion
  • References

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