Social Workers' Orientations toward the Evidence-Based Practice Process: A Comparison with Psychologists and Licensed Marriage and Family Therapists
Parrish, Danielle E., Rubin, Allen, Social Work
Social workers and other helping professionals are now being urged in the professional literature and by third-party payers to engage in evidence-based practice (EBP). Indeed, we live in an era when the term EBP is virtually ubiquitous in our literature, pervading recently published journal issues, titles of books on practice, and professional newsletters. It is not surprising that this EBP tidal wave has irked quite a few scholars and practitioners, who have criticized EBP on many grounds, including (among others) epistemological arguments, concerns about its deleterious impact on practice, and skepticism about pragmatic obstacles (Adams, LeCroy, & Matto, 2009; Bolen & Hall, 2007; Graybeal, 2007; Manuel, Mullen, Fang, Bellamy, & Bledsoe, 2009; Mullen, 2004; Mullen, Bledsoe, & Bellamy, 2008; Nelson, Steele, & Mize, 2006; Rubin & Babbie, 2010; Rubin & Parrish, 2007).
Advocates of EBP have responded to its critics, arguing that most of them misconstrue the EBP process and proposing ways to alleviate the feasibility barriers to EBP (Gibbs & Gambrill, 2002; Lilienfield, 2007; Manuel et al., 2009; Mullen, 2004; Parrish & Rubin, 2011a; Rubin & Babbie, 2010; Thyer, 2004). Some have expressed optimism about the prospects for practitioner acceptance of and engagement in EBP, citing widespread Internet access to practice resources and research (Crisp, 2004; O'Neill, 2003; Shlonsky & Gibbs, 2006), the proliferation of systematic reviews and meta-analyses on effective interventions (de Smidt & Gorey, 1997; Gorey & Thyer, 1998; Kirk & Reid, 2002; Weissman et al., 2006), and the inclusion in the NASW Code of Ethics (NASW, 2000) of a statement that social workers should base their practice on empirically based knowledge (see section 4.01c).
Nevertheless, there remain ample grounds for skepticism about the extent of social work practitioner acceptance of and engagement in the EBP process, based not only on the criticisms mentioned earlier, but also on evidence emanating from older studies indicating that social work practitioners rarely used research evidence to guide their practice (Kirk & Reid, 2002; Mullen & Bacon, 2004; Pignotti & Thyer, 2009; Sanderson, 2002) and instead tended to rely on supervisors or colleagues or their own experiences with treatment (Bilsker & Goldner, 2004; Mullen & Bacon, 2004; Nelson et al., 2006). Recognizing that the EBP process can be successfully implemented in social work only if practitioners believe it is both important and feasible, the current study assesses practitioners' views of and engagement in the EBP process.
It is important to distinguish the singular term, the EBP "process," from the plural term, "evidence-based practices" (or more correctly, empirically supported treatments). The latter have been defined as "any practice that has been established as effective through scientific research according to a clear set of explicit criteria" (Mullen & Streiner, 2004, p. 113). In contrast, the EBP process has been defined by Sackett, Rosenberg, Gray, Haynes, and Richardson (1996) as the "conscientious, explicit and judicious use of current best evidence in making decisions about the care of individuals [clients]" (p. 71) and "the integration of best research evidence with clinical expertise and [client] values" (Sacket, Straus, Richardson, Rosenberg, & Haynes, 2000, p. 1). This process involves five steps: (1) formulating an answerable practice question; (2) searching for the best research evidence; (3) critically appraising the research evidence; (4) selecting the best intervention after integrating the research evidence with client characteristics, preferences, and values; and (5) evaluating practice decisions (Mullen, 2006; Shlonsky & Gibbs, 2006; Thyer, 2004).
Although practitioners' attitudes regarding the EBP process have not yet been assessed, Mullen and Bacon (2004) compared the implementation of practice guidelines and empirically supported interventions among a sample of psychiatrists, psychologists, and social workers in a large agency that employed 500 staff engaged in the provision of clinical services. …