In recent years, social work has moved in parallel with medicine and the health sciences to use evidence-based criteria to determine the actions of practitioners (Institute of Medicine, 2001; Parker-Oliver & Demiris, 2006). Consequently, social workers employed in health and mental health settings are compelled to use evidence-based practices in their work. For many practitioners, evidence-based practice means the application of empirically based service models and a trend toward interventions demonstrated to be effective in changing behavior and ameliorating clients' problems. However, social workers, including those in medical and mental health services, are often not involved in the research that informs these practices, and their ability to shape promoted practices is virtually nonexistent.
Health and mental health social workers increasingly view evidence-based practice as prescriptive, with researchers in centers of scholarship developing research for practitioners. This situation has exacerbated the rift between researchers and social workers who are expected to carry out empirically supported practices, although they are not involved in the production of research or even in the synthesis of evidence that supports particular practices and rejects others. People with research expertise and the resources to conduct empirical inquiry are generally located in academic institutions and do not necessarily call on practitioners themselves to critically examine evidence-based practice models. When these prescribed practices move from the rarified conditions under which randomized controlled trials are conducted into agency settings, they confront real-world organizational realities, Real-world "intrusions" may limit fidelity to the model produced by this "gold standard" of research. As a result, technology transfer, or reliability for replication of evidence-based practices, may be compromised. Perhaps most disheartening is how this situation encourages passivity among people in the field to engage in research or remain fluent with current research. Continuing knowledge development is a shared responsibility at all levels of the social work profession (Lewis, 2003), and current education and practice structures are not encouraging practitioners to be partners in this process. We assert that people closest to direct services are best positioned to point out practice realities that distort programs. Although practices may be supported by high-level empirical evidence, they may not prove effective or even feasible under real-world conditions.
Originally, evidence-based practice was proposed for physicians to make use of the convergence of an explosion of information and technology, so that clinicians could use the growing body of research available through online databases. Ultimately, other health professionals were supposed to formulate clinical questions, critically assess empirical studies, and decide on the best approaches to bring to a dialogue with clients. The clients were meant to be active partners in decision making about their own care.
The institution of the Cochrane Collaboration (http://www:cochrane.org./index.htm) and the Campbell Collaboration (http://www. campbellcollaboration.org/) formalized this process, and both apply rigorous, transparent standards to their reviews of research studies. Although they are meant to serve policymakers, health workers, and people who use services, the extent to which medical social workers consult their readily available Web sites is unclear. Unlike nursing, speech therapy or rehabilitation therapy, or other health professions that have produced a burgeoning literature on information literacy skills as a central concern for educators (Jacobs, Rosenfeld, & Haber, 2003; Nail-Chiwetalu & Bernstein Ratner, 2007), the social work literature is for the most part silent in this area. With the exception of two recent texts that promote a bottom-up approach to evidence-based practice (Courneyer, 2004; Gibbs, 2003) and Gary Holden's remarkable informatics Web site for social workers (http://www:nyu. …