Integrating Evidence-Based Practice and Social Work Field Education
Edmond, Tonya, Megivern, Deborah, Williams, Cynthia, Rochman, Estelle, Howard, Matthew, Journal of Social Work Education
RECENTLY, the social work academic community has been considering and critiquing the idea of evidence-based practice (EBP), an important paradigm shift designed to promote the consistent use of scientifically validated information and effective interventions in social work practice (Cournoyer & Powers, 2002; Gambrill, 2003; Gilgun, 2005; McNeece & Thyer, 2004; Mullen & Streiner, 2004; Rosen, 2003; Thyer, 2002). Evidence-based practice may be thought of as a process undertaken by professionals wherein the scientific status of potential interventions is investigated and a thorough explication of the results is shared with clients, so that practitioner and client together can select the most appropriate steps for addressing a specific problem (Franklin & Hopson, 2004; Gambrill, 1999; Kessler, Gira, & Poertner, 2005).
First introduced in medicine and allied health professions, EBP has been advocated in social work as an alternative to "authority-based practice," or practice based solely on the expertise and experience of practitioners (Gambrill, 1999, 2003; Gibbs & Gambrill, 2002; Upshur & Tracy, 2004). Preliminary research suggests that EBP-trained medical professionals provide higher-quality and more effective services than those who rely on traditional, expertise-based methods (Choudry, Fletcher, & Soumerai, 2005; Norman & Eva, 2005). For example, research has shown that practitioners do not automatically learn from experience and may be prone to relying on obsolete or ineffective interventions without the introduction of strategies to advance professional knowledge and skill development (Batalden, 2001; Bickman, 1999, 2002; Norman & Eva, 2005; Wakefield & Stuart, 1996). Training that emphasizes EBP offers practitioners a set of skills that supports lifelong knowledge development, while more traditional training (e.g., case consultation with supervisors, colleagues, or faculty) is more likely to teach theory and skills that become outdated in time (Batalden, 2001; Coomarasamy & Khan, 2004; Eddy, 2005; Gibbs & Gambrill, 2002; Zlotnik & Galambos, 2004).
The push toward scientifically supported interventions, and away from practices based primarily on practitioners' ideology or preferences, has been driven by internal professional/ ethical concerns about the effectiveness of social workpractice (Gilgun, 2005; Perez, 1999; Powell, 2003), external pressures such as demands for service accountability from government (Goldman & Azrin, 2003; Petrosino, Boruch, Soydan, Duggan, & Sanchez-Meca, 2001; Raines, 2004), and funding sources (e.g., requiring that treatments have a demonstrated evidence base for reimbursement) (Fox, 2005; Steinberg & Luce, 2005). Numerous observers have concluded that EBP has become institutionalized throughout health, education, and social services as ever-stronger infrastructure is developed to support it (Kessler et al., 2005; Petrosino et al., 2001; Steinberg & Luce, 2005).
Barriers to EBP
The movement to inform social work practice using scientific research and evaluation is not new (Fischer, 1973; Rosen, 1996). Prior to the development of EBP within social work, many proclaimed the need for practitioners to use scientific methods to evaluate their practice, while keeping current with the latest innovations from research (Kirk, 1999; Thyer, 1996; Whittaker, 2002). Some have suggested that EBP is the natural evolution of thinking about the scientific practitioner (Steinberg & Luce, 2005; Thyer, 2002). However, while few social workers would discount the importance of research innovations, the actual utilization of scientific research in everyday practice faces many barriers (see Mullen, Shlonsky, Bledsoe, & Bellamy, 2005, for a full review of barriers to the implementation of EBP). Just a few examples of such barriers include lack of available evidence, uneven access to research, practitioner resistance, and constraints on providers' time (Gibbs & Gambrill, 2002; Gira, Kessler, & Poertner, 2004; Raines, 2004; Rosen, 2003; Wambach, Haynes, & White, 1999). …