Views of Evidence-Based Practice: Social Workers' Code of Ethics and Accreditation Standards as Guides for Choice
Gambrill, Eileen, Journal of Social Work Education
THERE HAS BEEN CONSIDERABLE interest in evidence-based practice (EBP) over the past years, including discussion of its role in social work (Briggs & Rzepnicki, 2003; Gambrill, 2006; Gibbs, 2003; Howard, McMillen, & Pollio, 2003; Mullen, Shlonsky, Bledsoe, & Bellamy, 2005; Thyer & Kazi, 2004). The realities of EBP and the difficulties in dealing with these realities depend on the view of EBP. Descriptions of EBP differ in their breadth and attention to ethical issues, ranging from the broad, systemic philosophy and related evolving process and technology envisioned by its originators (e.g., Gray, 1997; Sackett, Richardson, Rosenberg, & Haynes, 1997) to narrow views (using practice guidelines) and total distortions (Gambrill, 2003). Rosen and Proctor (2002) used the term EBP "primarily to denote that practitioners will select interventions on the basis of their empirically-demonstrated links to the desired outcomes" (p. 743). Reid (2001) stated that EBP "consists of requiring practitioners to use empirically-based treatments" (p. 278). As described by its originators, EBP involves much more, including considering client values and expectations as well as local constraints (see Table 1).
Social workers' Code of Ethics (National Association of Social Workers, 1999) and the Educational Policy and Accreditation Standards of the Council on Social Work Education (2001) can be used as guides to select among different views of EBP as well as to negotiate application obstacles that arise in all related venues including professional education. These guides describe obligations, such as drawing on practice- and policy-related research, critical thinking, competence, accountability, service to clients, informed consent, respect and integrity, promotion of social justice, and lifelong learning.
Such obligations provide a guide for responding ethically to controversies regarding questions such as, "What is evidence?" and "When do we have enough to recommend a policy or practice?" Social workers' Code of Ethics (National Association of Social Workers, 1999) stresses beneficence (helping), avoidance of harm, informed consent, autonomy (self-determination), and social justice. I suggest that only if evidentiary criteria are considered, can these interrelated obligations be honored. Only when specific, real-life examples are examined can trade offs be determined.
Evidence-Based Practice: A Process and Philosophy
Given the many different views of EBP, it is important to review the vision of EBP and policy presented in original sources (Gray, 1997; Sackett et al., 1997). EBP describes a philosophy and process designed to forward effective use of professional judgment in integrating information regarding each client's unique characteristics, circumstances, preferences, actions, and external research findings: "It is a guide for thinking about how decisions should be made" (Haynes, Devereaux, & Guyatt, 2002, p. 2). EBP involves the "conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual [clients]" (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 2). Sackett et al. (1997) described a process for EBP and a professional educational format (problem-based learning) designed to help practitioners link evidentiary, ethical, and application issues (see also Straus, Richardson, Glasziou, & Haynes, 2005). This process entails "the integration of best research evidence with clinical expertise and [client] values" (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000, p. 1). It encourages us to ask, "How good is the evidence?" and "Could I be wrong?" Such questions illustrate the close connection between critical thinking and evidence-informed practice. Recently, more attention has been given to client preferences and actions because what clients do often differs from their stated preferences, and estimates of preferences are often wrong (Haynes, Devereaux, & Guyatt, 2002). …