Evidence Based Practice
A Critically Reflective Approach To Evidence-Based Practice
A Sample of School Social Workers Michelle Bates Definitions of EBP
The first type of definition implies that practitioners are recipients of existing research knowledge. These definitions of evidence-based practice represent a deterministic, prescriptive approach to practice. According to these definitions, knowledge is created by researchers, and handed to practitioners to be applied in practice situations.
The second type of definition suggests that practitioners investigate practice problems, and assess research in accordance with their clinical judgment and then, thirdly, collaborate with their clients Some authors define evidence-based practice with a focus not on the research, but rather on the practitioner; on her or his professional judgment, skills, and knowledge acquisition processes.
These distinctions regarding the evidence and the role of the practitioner, are but one area of debate concerning evidence-based practice. vidence-based practice generally understood effort to direct practitioners to base their interventions upon formal research, promising benefits to both clients and practitioners.
Emergence of EBP in Social Work
During the empirical practice movement questions about the credibility, effectiveness, and efficacy of social work have been raised. EBP emphasizes science, and, by lessening reliance on professional judgment; offers a sense of certainty about social work interventions. Some authors suggest that evidence-based practice in particular is tied to neo-liberalism.
In this context, evidence-based practice ensures that social workers provide high-quality services effectively * The public’s reluctance to accept social work’s authority has forced social work, like many other professions, to adopt evidence-based practice as a new mechanism of trust Beginning in the 1990s, public cynicism concerning the welfare state and “expert systems” led many to doubt the validity of social work interventions
Government cutbacks and a demand from funding bodies for accountability and efficiency have also necessitated the adoption and implementation of evidence-based practice.
Quality and accountability have become the watchwords of health and mental health services” Governments and agencies embraced evidence-based practice as a method of ensuring quality services and demonstrating accountability in service delivery The Promises of EBP for Clients and Social Workers Promises made by proponents of evidence-based practice are numerous. Supporters of EBP claim that clients will receive better services, occupy a more egalitarian position, and are less likely to be harmed when practitioners use evidence-based practices.
For social workers themselves, protection from lawsuits, enhanced job security and service funding, increased professional confidence, and improved professional status and credibility are promises associated with evidence-based practices. Many authors argue that reliance on research evidence leads to better decision-making by social work practitioners and, results in, improved services. It is also claimed that clients, able themselves to access the ‘evidence’, will achieve greater equity with professionals. Numerous authors assert that EBP is the most ethical way to practice.
Gambrill (2003), in her support of EBP, suggests that social work practice that is not evidence-based may potentially be harmful to clients Barriers to Using Evidence For some other authors, despite an increasingly available literature concerning evidence-based practice, dissemination studies reveal that social work practitioners have been neither accessing nor implementing the available evidence, for some, EBP remains overwhelming, unclear, or irrelevant. Barriers to the implementation of evidence-based practice include social workers’ doubts about the applicability of research findings to practice settings questions about practitioners’ ability to read and interpret research findings
- practitioners’ scepticism about research specifically
- their reluctance to change generally, practitioners’ lack of time to review the literature
- ideological debates about the nature of social work and its incompatibility with positivist research
Applicability of Research Findings to Practice Settings
There is a significant disconnect between treatments established in the laboratory and the everyday use of these treatments Practitioners, keenly aware of this discrepancy, have been suspicious of evidence-based practices The Research
In the absence of literature from practicing social work practitioners, this research sought to discover and understand their opinions and experiences with evidence-based practice. School social workers are an especially appropriate focus of attention because
1- They are practicing in environments that emphasize effective service delivery with improved service outcomes.
2- Additionally, EBP is endorsed as a practice framework by many Ontario School Boards and school social work practice associations Methods qualitative research project; semi-structured interview
Social workers were asked for their definition of evidence-based practice, what they either liked or disliked about EBP, what influenced them to either use or not use EBP, and what were the challenges, risks or gains in either using or not using EBP for themselves, their department or the profession.
All participants held MSW degrees and RSW designations.
Two of the social workers were employed by Catholic school boards and the other two by public school boards.
All of the participants worked within urban school settings in cities that ranged in size from 200,000 to 500,000 people
One social worker worked within a fairly affluent and culturally homogeneous community, and the remaining three in schools that represented economically and culturally diverse communities. One participant was a manager, and the remaining three participants were front-line practitioners.
Participants ranged in their years of experience as a school social worker from 2 years to 21 years.
Participants’ experiences with evidence-based practice varied. Two participants were extremely familiar with evidence-based practice, and the other two participants knew about it, and described themselves as having a beginning understanding of what it meant.
Their employers’ organizational embrace of evidence-based practice varied as well. One board was silent, two were in the early stages of investigating it and one Board has endorsed the use of evidence-based practices wholly.
Findings
A. Benefits of using evidence-based practice as prescribed: Several benefits emerged from the participants’ experiences of using evidence-based practice “as prescribed. “
1- Every participant identified how evidence-based practices usefully informed and guided their activities with individual clients. These activities included the issues or problems that social workers explored, the questions subsequently formulated and asked, and the interventions chosen.
2- Evidence-based practices were also used to guide the selection of group models and various protocols, as noted by two of the social workers.
3- All participants indicated that using evidence-based practices provided them with a sense of certainty about their own practice.
4- Three of the four participants specifically stated their desire to know that what they did made a difference to clients. Using evidence-based practice was perceived as a means of ensuring that the interventions they were providing were effective
5- All participants indicated that using evidence-based practice improved their professional credibility.
6- The other two social workers believed that using evidence-based practices would improve the profile of their department within the school board and would also create a higher profile and better public persona for all social workers.
B. Tensions arising from the use of evidence-based practices as prescribed:
Rigidity versus flexibility :
Ensuring that their interventions fit for clients was an overriding concern for all of the participants, and was expressed as a tension between implementing rigid evidence based practices versus the need to be flexible with clients based upon the uniqueness of each individual client and his or her situation. Three of the four participants were also cognizant of the fit, or lack of it, of evidence-based practices with their organizations or settings.
Formal knowledge versus practice knowledge :
All of the participants made a distinction between formal knowledge and their practice knowledge. Each one of them revealed a tension between these two kinds of knowledge and all of them talked about valuing their own practice knowledge. Despite the benefits they identified of using formal knowledge derived from evidence-based practice, these participants continued to believe in the value of their practice knowledge.
The tension between formal knowledge and practice knowledge is reflected in this social worker’s comment: “I would hate to become so single-minded that I’m sitting in a meeting saying, ‘well, based on the evidence that…. ‘ So I use both [practice and formal knowledge], and I’m not apologetic that I use both. ” Not only did all of the participants in this study use both kinds of knowledge; they resoundingly claimed the value of their practice knowledge.3. Results versus improvement and change :
All of the participants were keenly aware of their desire to know the results of their interventions with clients, and hinted at the pressures they felt to be producing changes for their clients. In other words how clients perceive their gains is more meaningful than what would be reflected according to a particular measure or assessment instrument. Three of the four participants were steadfast in their acceptance of their clients’ definitions of improvement and change, rather than relying on pre-determined outcomes.
Method/technique versus relationship :
Every participant noted that the relationship with the client was more important than the particular technique use.
Only in the context of a meaningful relationship with clients could evidence-based practices be shared and used meaningfully. In other words, the relationship provides the context in which evidence-based information can be shared and used meaningfully.
Adapting evidence and evidence-based practice :
participants revealed how they are using evidence and evidence-based practices in adaptive and creative ways.
This has led to a redefining of evidence and the uses of evidence-based practice for school social workers. 6- Adaptations to local context: Much often evidence-based practice literature sees it as problematic that front-line practitioners alter evidence-based practices when they implement them into practice settings. Contrary to the literature, every one of these practitioners saw adaptations to the local context as not only a necessity, but also an asset.
Redefining Evidence:
Information from these participants indicates that they have a broad definition of evidence-based practice that incorporates evidence from a wide variety of sources, including their practice experience. As noted in the literature review, there are numerous definitions of evidence-based practice that reflect either a dependency upon formal research, or suggest that evidence based practice is a process of knowledge acquisition.
These social workers conceptualize evidence in its broadest sense, and as a result, their definitions, and their practice based upon those definitions, represent a de-mystifying of evidence as it is constructed in the dominant discourse on evidence based practice.
Evidence and evidence-based practice as power :
The various social, economic and political contexts that have give rise to the emergence of evidence-based practices have created a powerful paradigm, a political economy of evidence-based practice.
Interestingly, all research participants talked about their different uses of evidence and evidence-based practice within different contexts. In this way, social workers are negotiating power through their definition of evidence, and their strategic use of both evidence-based practice and the language of EBP. One of participant’ definition of evidence holds different currency with different audiences.
Within organizational structures that are determining funding and service levels, formal knowledge is seen as more reliable and valid therefore, the language of evidence-based practice is used to provide proof or support of the request for continued or additional service. From the data, social workers have indicated that they use the language and power of evidence-based practice to meet a variety of needs. all participants noted how the language of evidence-based practice was used to provide proof of the value of social work services.
Because school social work is offered within a secondary setting, participants were acutely aware of the need to prove the value of their service and how it supports the goals of the school board to retain students in school and to improve their academic achievement.
Discussion and implications
1- Much of the mainstream EBP literature suggests that social workers have been ambivalent or reluctant to adopt evidence-based practices due to limitations of their skills, time and resources, or their beliefs and attitudes. This study, however, in keeping with important critiques of EBP, confirms that social workers identify important tensions between the dominant discourse of EBP and social work practice values.
2- A key tension for social workers centred on the value placed upon formal knowledge versus practice knowledge. This is reflected in the epistemological debate concerning the definition of evidence. The discourse on evidence-based practice is situated within a narrow, prescriptive, and scientifically defined construct about what constitutes evidence and how that evidence should be used. Evidence-based practice has been criticized for minimizing practitioner knowledge. As Holloway (2001) observed, evidence-based practice, “imposes a paradigm for what counts as legitimate evidence that is external to the practices and ways of knowing of the many professionals” Within the paradigm of evidence-based practice, the definition of evidence is crucial to understanding what kinds of knowledge are accepted and valued, and what kinds of knowledge are dismissed. The evidence-based paradigm further means that certain treatments are endorsed as evidence-based, and others are not. Social workers in this study believed in, relied upon, and valued their practice knowledge, when the literature was absent on the practice issue, when they were applyingthe evidence-based literature and when their knowledge was contrary to the literature.
3- Social workers in this study also described the tension they felt between rigid adherence to manualized protocols required of evidence-based practices and the need to be flexible in response to their individual clients’ needs. This tension is reflected in the critiques of the evidence-based practice research. Many authors have been critical of the artificial results created within highly controlled laboratory settings.
4- Evidence-based practice has also been criticized for ignoring and negating the nature of social work practice. Social workers interviewed in this study consistent with critiques of EBP, the problem with the current discourse of evidence-based practice is that it reduces understanding of the complexity of human experience in the real world, ignores the realities of practice settings, and negates the practice knowledge of social workers.
Social workers also revealed how they negotiate power through their definition of evidence, and their subsequent strategic and creative use of both evidence-based practice and the language of EBP. Social workers use the language and persuasive discourse of EBP with management and funding bodies to provide accountability for services provided, proof of the value of social work services, and rationales for continued or increased service levels. With colleagues, using the language of EBP provides the practitioner with the voice of authority.
The literature on evidence-based practice often advocates either for or against EBP. Interestingly, this research shows how social work practitioners can simultaneously appreciate and benefit from EBP while also questioning and adapting it.
School social workers from this study value both formal and informal knowledge, and creatively use their different kinds of knowledge in different contexts 8- Data from this research project identifies how social workers are cultural bridges between the research and practice worlds, two vastly different kinds of evidence, and two different uses of evidence-based practice.
The divide between researchers and practitioners has a long history in social work. And while there have been pleas to respect each other in order to effectively learn from each other researchers, especially within the evidence-based discourse have enjoyed a higher status than practitioners. What this research highlights is that practitioner knowledge is highly valuable knowledge, and should be regarded as such by researchers.
This research also implies that social work practitioners can make valuable contributions to research projects by ensuring that the research is relevant to clients and practitioners by focusing on client needs/experience and insisting that the research takes place in the real world under real life practice conditions.
