Limitations of Evidence-Based Practice for Social Work Education: Unpacking the Complexity

Article excerpt

EVIDENCE-BASED PRACTICE (EBP) is a term that is now widely used in social work and psychosocial disciplines. Modeled after evidence-based medicine, a state-of-the-art approach where the focus is on finding appropriate treatments (pharmaceutical, medical, and surgical) for a patient's medical conditions (Eddy, 2005; Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000), EBP within psychosocial disciplines focuses on using intervention approaches with demonstrated effectiveness for a client's particular presenting problem or condition in collaboration with the client (Gambrill, 1999, 2001). In social work, proponents of EBP link this approach to social work values, noting the ethical imperative to offer clients treatments that are known to work and to use the best evidence available (McNeece & Thyer, 2004). Reviews of EBPs have been published in such diverse social work areas as the substance abuse field (O'Hare, 2002), direct practice in aging (Cummings, Kropf, Cassie, & Bride, 2004), and school-based interventions (Franklin & Hopson, 2004), and EBP in these areas appears to be increasing rapidly. Practice guidelines are being developed (Duncan, Solovey, & Rusk, 1992; Howard, Edmond, & Vaughn, 2005; Rosen & Proctor, 2003), and manualized treatments are being published (Fraser, 2004; LeCroy, 2008) in many areas of practice. Social work textbooks with the "evidence-based" label in their titles are becoming commonplace (e.g., Corcoran, 2000; Roberts & Yeager, 2006; Thyer & Wodarski, 2007), and other textbooks also reference an increasing amount of intervention research on practice approaches. Scholars, educators, and students are affected by these trends, as Educational Policies and Accreditation Standards (EPAS) standards for social work education require schools to incorporate teaching evidence-based practices (Council on Social Work Education, 2004). Across the country, schools of social work are deciding where and how EBP will fit in their curricula.

Whereas the idea of giving preference to practices with empirical support is not new, it is being redefined in today's social work EBP with renewed fervor. As Kirk and Reid (2002) describe in Science and Social Work, beginning in the 1970s with "the effectiveness crisis" in social work, efforts to make the profession more scientific have received strong academic support, most notably with the scientific-practitioner and the empirical-clinical practice models (e.g., Jayaratne & Levy, 1979 and others). Those models, emphasizing systematic evaluation of one's own practice and use of research evidence to inform practice, although not adopted wholesale by the practice community, nevertheless have been responsible for introducing a number of innovations into typical social work practice. Behaviorally oriented and cognitive-behavioral treatments (e.g., Thomas, 1967) and time-limited, structured intervention approaches (e.g., Reid & Epstein, 1972) have become commonplace in social work service delivery (Mullen & Streiner, 2004). In the early 21st century, the generalist practice models we teach our students emphasize behavioral specificity in goal setting, skills training, or psychoeducation and regular evaluation of measurable practice outcomes (Hepworth, Rooney, Dewberry-Rooney, Strom-Gottfried, & Larson, 2006). In its latest incarnation, however, EBP focuses more exclusively on using the best available research to make practice decisions.

Two broadly defined conceptualizations of EBP, or the sometimes preferred term, evidence-informed practice, are used. First is a focus on the use of evidence-based practices (e.g., Norcross, Beutler, & Levant, 2006; Roth & Fonagy, 2006), also known as empirically supported treatments (ESTs). In this conceptualization, certain practices or Intervention programs become established as being effective through intervention outcome literature, either individual studies or systematic reviews and meta-analyses that synthesize and quantify the results of a number of studies. …