Evidence-Based Practice in the Past Thesis

  • Length: 15 pages
  • Sources: 20
  • Subject: Psychology
  • Type: Thesis
  • Paper: #81673277

Excerpt from Thesis :

In fact the inabilty of the sociall work profession to adequaelty and discretely define EBP, specifically the main goal of this work, may in part be to blame for scholalry blunders, such as the use of evidence-based practice in a title of a work that is highly qualitative, anecdotal or even based on a single or small set of case studies.

Just as Weed lists the various levels of evidence, The American Psychological Association (APA) went a step further by establishing a task force to judge good evidence for a range of psychological disorders. According to Rosen and Proctor (2003), as taken from the APA, the most basic criterion used by this task force is that well established and empirically validated data requires a design that involves two or more rigorous studies that support the proposed intervention.

History of EBP

Newly gained interest in EBP makes it appear as a fairly new phenomenon to the social work and social services field. In fact, EBP was derived from medicine in general. Some in fact argue that the application of a standard that is derived as a tool for something such as a drug trial may not be a reasonable fit for social work, as the outcomes and answers are rarely as discrete as say, the drug removed the pain, or lowered blood pressure, or the trial surgical procedure healed faster and had less risk of failure than an older procedure. Relapse is far less common in such discrete issues than it is in fields associated with the human mind driven to action or inaction, based on thoughts and feelings.

Rosen (2003) states that EBP has been advocated in a number of human services professions, first in medicine, and more recently in psychiatry, clinical psychiatry and now social work. Early scholars in the field of social work education such as Edith Abbott, Sophonisba Breckinridge, Porter Lee, and Gordon Hamilton have long advocated for research based on practice (Shoemaker, 1998). Conversely, the implied assumption is that such research would then be used to improve practice at a later date, or even in the present research group. Yet, it is also clear that for the most part the rigors of science and data set searches were not likely at the forefront of their minds. As early as the late 1800's, social welfare advocates Anna Dawes and Mary Richmond, began moving toward an organized method of training new social workers, when they did so they also implied that there was a way to train, that involved experience and application, again a simplified support for EBP, in its most rigorous form, and mostly a simple goal of attaining professionalism through at least some standardization of practice. In this quest schools were where applied philanthropy was taught (Shoemaker, 1998). Yet, it is likely that in these classrooms and clinical settings a great deal of "you will get a feel for it," was espoused by these "applied philanthropists."

Bridging health and human services with scientific research inquiry, emerged as a trend toward the end of the 20th century and spread world wide within the 21st century throughout major universities, treatment facilities and medical and mental health centers throughout the world (Roberts and Yeager, 2004). In today's world of technology, the research industry plays a major role in the perceptions that consumers have for products being advertised and delivered and accountability is the key to consumer driven thought. This holds true for the field of social work and supports the emergence of EBP and its importance to the field of social work and other community service fields. Yet, it also makes sense that such a system as EBP, as it applies to social work would emerge in a climate of "accountability" as in the development of a culture that sees only "raw" data as a real gage of success and/or failure of a system, individual or organization. This is certainly not to say the EBP is essentially in error, as this would be another invalid certainty, as it is clear that evidence and knowledge must be utilized to the best degree possible when developing client interventions and that to do so requires rigor, it is also fair to say that many practitioners would like to see a bit of converse flexibility.

Per Yunong and Fengzhi (2009), observe that many scholars in the field of social work utilize the five steps of EBP originally formulated by a seminal work by Satchell et al. In 2000. The five steps include; 1 Converting one's need for information into an answerable question. 2. Searching for the best evidence to answer that question. 3. Critically evaluating the evidence. 4. Integrating the critical expertise and with the patient's unique biology, values, and circumstances, and finally 5 Evaluating one's own effectiveness and efficiency in undertaking the previous steps and to strive for self-improvement. The core of these principles, themselves certainly do not seem to denote judgment, as they provide a clear sense that the "best" evidence can in some cases be dependant upon the individual, the case and the practitioner and that this flexibility is inherent within reason.

The five step process is said to be designed to engage practitioners in a continual process of evidence identification, evaluation, and application in partnership with clients to improve practice outcomes (Bellamy et. Al, 2008). Yet, you could also argue that any paradigm that invokes inquiry would be of greater assistance to the practitioner than none. In short, using EBP can be viewed as a learning what treatments and techniques work based on research, while integrating client views into determining what will work best for them. Thoughout this work have been hints at the various contentions of both advocates and opponents of evidence-based practice. The following section will further stress this trend as it applies to education and application.

Multiple Perspectives on EBP

EBP has several potential benefits to social work. First, social work has been obsessed with professional status for almost its entire existence and advocating and applying a system that stands up to scientific rigors would aide in the quest for professionalism and professionalization of the field. (Bellamy et. Al, 2008). In other words the emphasis of research and strict evidence in EBP social work could potentially enhance the credibility of the social work profession. Second, it has been argued that social workers seldom use research evidence in practice, which many find a disheartening reality of the field (Rosen, 2003). The emphasis of research evidence in EBP social work could promote the integration of research evidence into social work practice, helping even the most ardent opponent see how even reading a single well documented research article might give them insight and promote thinking about solutions for clients. The fear is that if practitioners fail to consider the effectiveness of their interventions, then it is possible that clients will leave agencies without getting adequate and helpful treatment for their concerns and when they do this the profession is degraded.

With new advancements in technology, the invention of and the wide spread usage of the internet, research studies and findings are more readily available and easier to access than in the past, though again the ability, time and learning curve for such research must be considered. There are many researchers who are passionate about the effectiveness and the need for EBP in the social services and medical fields. For example; Roberts and Yeager have produced a document: Evidence-Based Practice Manual: Research and Outcome Measures in the Health and Human Services; (2004) that offers evidence-based knowledge so that graduate students and practitioners in the medical and human services professions can have the latest research and evaluation guidelines and evidence-based protocols in a comprehensive manual. Such a document, though exceedingly helpful may need to be the type of document that gains annual status, i.e. producing a yearly digest with new and emerging EBP evidence scholarship. Other scholars and textbook authors in the social work field have begun to add EBP to educational materials in relatively comprehensive manner. (Grinell & Unrau 2008)

Indeed many practitioners are excited about EBP and devoted advocates for continuing research and even teaching courses pertaining to EBP to college students; however, as has been pointed out not all practitioners are in favor of EBP. Social work educators must include thoughtful discussion of multiple aspects of evidence-based practice in the curriculum, including both the opportunities evidence-based practices hold for social work as well as the potential limitations. This is needed in order to ensure that students do not oversimplify the process of identifying and using evidence- based practices, and to ensure that students remain vigilant to potential evidence-based practice misuses and inappropriate practices under the guise of evidence-based practice (Bellamy et. Al, 2008). Yet, probably most importantly EBP must be adequately and appropriately defined in some sort of standardized manner.

Teaching clinical skills is of course an important element in existing social work education and if social workers…

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