Evidence-Based Practice:
Introduction and Overview
Joanne Yaffe, PhD, ACSW
University of Utah
College of Social Work
What is “Evidence-Based Practice”
(EBP)?
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Originated with “Evidence-Based Medicine”
Now “the buzz” in helping professional
education
Model is commonly misunderstood and
misinterpreted within helping professions.
There is still much disagreement even among
proponents as to what the term means.
What is EBP not?
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The “Scientist/Practitioner Model”
“Empirical Clinical Practice”
“Best Practice”
“Evidence-Based Practices”
“Eminence-Based Practice”
What is“The Scientist/Practitioner Model?”
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Boulder Conference on Graduate Education in Clinical
Psychology (1949).
Practitioners adhere to scientific methods, procedures, and
research in day-to-day practice.
Core tenets:
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scientifically-based protocols for assessment and intervention;
integration of scientific findings;
hypothesis testing in practice;
contributing to practice-based R&D to improve practice.
Criticisms:
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Is it possible to expect practitioners to adhere to the ideals and
tenets of the Scientist-Practitioner model?
Clinicians find it difficult to complete their practical duties let alone
conduct research or to remain up-to-date with cutting edge
science.
What is “Empirical Clinical Practice?”
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Technology transfer from psychology to social work
in early 1970s.
Grew out of joint program at University of Michigan.
Jayaratne, S. & Levy, R. (1979). Empirical Clinical
Practice. NY: Columbia University Press.
Involved incorporation of scientific methods,
including behavioral assessment and single-case
design to document outcomes of practice.
Resisted by many who saw the model as “too
behavioral for social work.”
What is “Best Practice?”
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Assumption: There is a clinical technique or menu of techniques
that is more effective at delivering a particular outcome than
other techniques.
Has evolved to lists of acceptable practices, e.g., Oregon.
Considered by some as a buzzword used to describe the
process of developing and following a standard way of doing
things that multiple organizations can use for management,
policy, and reimbursement.
Criticisms:
 No one intervention has been shown to be effective in every
case.
 We aren’t all trained the same way.
 Systematic reviews challenge accepted efficacy.
 Reification??
What are“Evidence-Based Practices?”
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More formally known as “Empirically Supported
Treatments.”
Division 12 (Clinical Psychology of the APA) “Task
Force on Promotion and Dissemination of
Psychological Procedures” in the early 1990s.
Purpose: “publish information for both the
practitioner and the general public on the random
assignment, controlled outcome study literature of
psychotherapy and of psychoactive medications.”
What was the mandate for the Task Force?
The Task Force had 2 sequential tasks:
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2.
To develop evidentiary standards to be used to
designate given treatment/assessment methods
as “empirically validated” (later changed to
“empirically supported”).
To review the literature and publish lists of
treatments that met or did not meet these
evidentiary standards.
What evidentiary standards did they
develop?
Two sets of standards or evidence
benchmarks:
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1.
2.
one to designate an intervention as “empirically
supported” (hence ESTs) or “well-supported”,
and
another, less stringent one, used to designate an
intervention as “promising” or “probably
efficacious.”
Where are these lists of ‘approved’
treatments?
Two major publication pathways emerged
from the Task Force’s efforts: :
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2.
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Book: Nathan, P. E. & Gorman, J. M. (Eds.)
(2007). A Guide to Treatments That Work (third
edition). New York: Oxford University Press
Series of articles:
http://www.apa.org/divisions/div12/journals.html#
ESTs
Nothing has been added to this list since
1998.
Is there anything else?
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New Division 12 developed, edited and
supported book series titled “Keeping up
with the Advances in Psychotherapy:
Evidence-based Practice”, published by
Hogrefe & Huber.
http://www.hhpub.com/books/series/apt_flye
r_may_2007_e.pdf
Note the crucial terminology change from
‘empirically supported’ to ‘evidence-based’
What is “Eminence-Based Practice?”
What is Evidence-Based Practice then?
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Evidence-based practice (EBP) began in
medicine in the early 1990s.
Its primary source document is: Sackett et al.
(1997). Evidence-based medicine: How to
practice and teach EBM. New York:
Churchill Livingstone.
EBP “…requires the integration of the best
research evidence with our clinical expertise
and our patient’s unique values and
circumstance” (Straus et al., 2005, p. 1).
What is EBP as commonly
conceptualized?
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Converting information needs into well-formulated
answerable questions.
Tracking down with maximum efficiency the best
evidence with which to answer the questions.
Critically appraising the evidence for validity and
applicability.
Applying the results of this evidence appraisal to
policy/practice.
Evaluating performance.
From: Gibbs, L. E. (2003). Evidence-based practice for the helping
professions: A practical guide with integrated multimedia.
Pacific Grove, CA: Thomson/Brooks/Cole. Pp. 8-9.
“Evidence-based Practice” is really
“Evidence-informed Practice.”
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Professional ethics and the EBP model call
for shared decision-making with client, taking
into account their wishes, preferences, and
values.
Intervention is constrained by agency and
social policy.
Professionals must practice within their
competencies.
Evidence-Informed Practice Model
Client and Context
Variables
Client Preferences
and Values
Best Evidence
Intersection
is EBP
Clinical Expertise
Deconstructing EBP:
Asking well-formed questions
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“converting information needs related to
practice decisions into well-structured
answerable questions;
Practitioners bring questions from the field
and learn to develop well-formed questions
from which they can derive keywords for their
evidence searches (PICO)
Deconstructing EBP:
Finding the evidence
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tracking down with maximum efficiency, the best
evidence with which to answer them,
Practitioners select keywords based on their
questions, make use of methodological locators to
find the best evidence available
Can use university library indexes and databases,
as well as other resources, to quickly locate
evidence relevant to their questions.
Gibb’s website provides helpful suggestions:
(http://www.evidence.brookscole.com/)
Deconstructing EBP:
Selecting the best evidence available
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critically appraising that evidence for its
validity, impact (size of effect) and
applicability (usefulness in practice)
Practitioners utilize basic criteria of sound
science to appraise the articles that they find.
Some tools are publicly available from
Bandolier
(http://www.medicine.ox.ac.uk/bandolier/learnzone.html )
Deconstructing EBP: Applying the
evidence to practice and policy decisions
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applying the results of this appraisal to practicepolicy decisions. This involves deciding whether
evidence found (if any) applies to the decision at
hand (e. g., is a client similar to those studied? Is
there access to services described?) and
considering client values and preferences in
making decisions as well as other application
concerns
Practitioners utilize the results of their evidence
search and together with clients select the most
appropriate interventions.
Deconstructing EBP: Evaluating the
effectiveness of evidence-informed interventions
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evaluating our effectiveness and efficiency in
carrying out steps 1-4 and seeking ways to
improve them in the future (Sackett, et al., 2000, pp. 34, cited in Gambrill, 2006).
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Practitioners evaluate the effectiveness of
their interventions using both clinical and
program evaluation tools.