Evidence-Based Practice

NASW Practice Snapshot

Social workers increasingly are seeking information about evidence-based practices. Numerous resources are emerging to help connect research to practice and provide information that can be helpful to practitioners. Since the term evidence-based practice (EBP) is used in numerous ways, definitions will be provided that can help expand social workers understanding of EBP. resources, and publications will be identified that can be useful to inform practice and guide policymakers. Since the identification of evidence-based practices involves assessing the available body of practice-relevant research, having a robust social work research base is important.

NIHM 2007 Symposium

In 2007, the National Institute of Mental Health (NIMH) hosted an invitational symposium of social work leaders, representatives from federal agencies and national organizations, consumer and advocacy groups, and experts who were implementing model EBP efforts in states and at schools of social work. 

The report from the symposium, "Partnerships to Integrate Evidence-Based Mental Health Practices into Social Work Education and Research," was prepared by the Institute for the Advancement of Social Work Research (IASWR) under contract to NIMH. Portions of this page are adapted from a report and the briefing paper developed by IASWR in conjunction with a symposium. 

The symposium attendees identified a number of issues related to the incorporation of EBP into mental health practice including the following:

• Social workers and other mental health professionals must be skilled in assessment and diagnosis so the interventions they select appropriately match the identified problem.
• Evidence-based treatments (EBT) must be adapted and personalized for individuals based on their culture, interests, and circumstances.
• Consumers and professionals are important stakeholders in developing research agendas so research moves from effectiveness and efficacy to intervention research and takes into account real-world issues of resources, access, consumer and organizational culture, and organizational climate.
• Given the nature of mental illness, the prevalence of co-occurring conditions, and the wide array of settings in which treatment may be provided, incorporation of EBT must take these multiple disorders and multiple settings into account.
• Due to the breadth of the services that social workers provide to persons with serious mental illness, knowledge of interventions must be broader than being able to implement specific evidence-based mental health psychotherapies; however, social workers working with persons with mental health disorders should also be exposed to relevant EBT.

Definitions

Evidence-Based Practice. The term evidence-based practice (EBP) was used initially in relation to medicine, but has since been adopted by many fields including education, child welfare, mental heath, and criminal justice. The Institute of Medicine (2001) defines evidence-based medicine as the integration of best researched evidence and clinical expertise with patient values (p. 147). In social work, most agree that EBP is a process involving creating an answerable question based on a client or organizational need, locating the best available evidence to answer the question, evaluating the quality of the evidence as well as its applicability, applying the evidence, and evaluating the effectiveness and efficiency of the solution.

EBP is a process in which the practitioner combines well-researched interventions with clinical experience, ethics, client preferences, and culture to guide and inform the delivery of treatments and services.

Evidence-Based Practices, Evidence-Based Treatments, Evidence-Based Interventions, and Evidence-Informed Interventions are phrases often used interchangeably. Here, for consistency, we will use the term evidence-based treatments (EBT). Differentiating from the evidence-based practice process described above, one definition of an evidence-based treatment is any practice that has been established as effective through scientific research according to a set of explicit criteria (Drake et al., 2001). These are interventions that, when consistently applied, consistently produce improved client outcomes. Some states, government agencies, and payers have endorsed certain specific evidence-based treatments such as cognitive behavioral therapy for anxiety disorders and community assertive treatment for individuals with severe mental illness and thus expect that practitioners are prepared to provide these services.

Evaluation of Research on Practice Interventions. Randomized controlled trials (RCT) are frequently viewed as the gold standard for the evaluation of interventions. However, it is not always possible or ethical to conduct RCT in social, health, and human services, and thus there is a lack of that type of research evidence for some interventions provided by social workers. Qualitative research can enhance quantitative research and help us better understand cultural issues and contexts related to interventions. 

Some view research as falling into a hierarchy with the highest level of the strength of research being systematic reviews and meta-analyses. From this perspective, the next levels of evidence from highest to lowest are: RCT; quasi-experimental studies; case-control and cohort studies; pre-experimental group studies; surveys; and qualitative studies (McNeece & Thyer, 2004). A number of organizations have attempted to develop objective evidence grading systems to rate the strength of evidence for interventions. For example, the California Evidence-Based Clearinghouse for Child Welfare has developed a detailed six-level system. The Institute of Medicine (IOM) has convened a multidisciplinary roundtable on evidence-based medicine that is exploring multiple issues including examination of the lack of consistency in assessing the strength of evidence regarding what works. 

The Campbell Collaboration conducts systematic reviews of research and promotes systematic reviews because such rigorous analysis of research endeavors to minimize bias in the identification, assessment and synthesis of research results (Littell, 2006, p. 9). In these systematic reviews, the review process and decision-making criteria are transparent and established in advance. 

While there is no consistent agreement on the hierarchy of best available research, a common perspective on a hierarchy of evidence might be: 

• Surveillance data; 
• Systematic reviews of multiple intervention research studies; 
• Expert opinion/narrative reviews; 
• A single intervention research study; 
• Program evaluation; 
• Word of mouth/media/marketing; and Personal experience. 

For practitioners trying to identify EBT for the clients they serve, there are a growing number of Web sites and guidebooks available to provide some useful information to help guide practice. In identifying EBT, the practitioner must assess the extent to which the particular EBT is adoptable and adaptable for their client and specific situation. In particular, practitioners may have concerns that many interventions are tested on very homogenous samples and therefore may not represent the complex co-occurring conditions or cultural and community contexts of many of the clients with whom social workers work. 

Resources

Anxiety Disorders Association of America (ADAA) provides detailed information on anxiety disorders and treatment options.  

California Evidence-Based Clearinghouse for Child Welfare provides up-to-date information on evidence-based child welfare practices. It also facilitates the utilization of evidence-based practices as a method of achieving improved outcomes of safety, permanency, and well-being for children and families involved in the California public child welfare system. 

Cochrane Collaboration is an international, nonprofit organization that produces and disseminates systematic reviews of health care interventions. 

Evaluation Center at Human Services Research Institute is a national technical assistance center dedicated to adult mental health systems change. The Evaluation Center provides technical assistance in the area of evaluation to states and nonprofit public entities for improving the planning, development, and operation of adult mental health services. The toolkits give users access to some of the most current approaches and instructions on how to implement sound evaluation studies. Toolkits are available in the areas of outcomes measurement, evaluation methodology and statistics, managed care, performance measurement and quality, Internet evaluation issues, multicultural issues in evaluation, and evidence-based practices.  

Evidence-Based Behavioral Practice (EBBP) creates training resources to help bridge the gap between behavioral health research and practice. Professionals from the major health disciplines are collaborating to learn, teach, and implement evidence-based behavioral practice. 

National Alliance of Multi-Ethnic Behavioral Health Associations (NAMBHA) promotes the behavioral well-being and full potential of people of color and to eliminate disparities in behavioral health services and treatment. NAMBHA works to identify culturally appropriate best practice models.  

National Association of State Mental Health Program Directors Research Institute (NRI) offers information about defining evidence-based practices, a directory of resources that describe criteria for defining which practices are evidence-based, and important information regarding the implementation of evidence-based mental health practices.

National Initiative for the Care of the Elderly (NICE) is a Canadian national network of researchers and practitioners involved in the care of older adults through medicine, nursing social work, and other allied health professions. The overarching goal is the dissemination of research and best practices for the care of older adults. Specifically, NICE shares research about evidence-based practice within an interdisciplinary team context across the university-community continuum.  

National Institute of Mental Health (NIMH) offers information on many mental disorders, as well as information on NIMH research, publications, and activities. 

Dr. Leonard Gibbs' Evidence-Based Practice for the Helping Professions is a resource for social workers who want to learn about EBP and how to conduct a search of evidence.  

The Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence (SAMI-CCOE) is a technical-assistance organization that helps service systems, organizations, and providers implement and sustain the Integrated Dual Disorder Treatment (IDDT) model (an evidence-based practice), maintain fidelity to the model, and develop collaborations within local communities that enhance quality of life for consumers of mental health services and their families.  

Social Care Institute for Excellence (SCIE) works to disseminate knowledge-based good practice guidance; involve service users, carers, practitioners, providers, and policymakers in advancing and promoting good practice in social care; and enhance the skills and professionalism of social care workers through tailored, targeted and user-friendly resources. 

National Registry of Evidence-based Programs and Practices (NREPP) is designed to support informed decision making and to disseminate timely and reliable information about interventions that prevent and/or treat mental and substance use disorders. The NREPP is a searchable online registry that allows users to access descriptive information about interventions as well as peer-reviewed ratings of outcome-specific evidence across several dimensions. The NREPP provides information to a range of audiences, including service providers, policymakers, program planners, purchasers, consumers, and researchers. 

SAMHSA Center for Mental Health Services (CMHS) Evidence-Based Practice Implementation Resource Kits guide the implementation of mental health evidence-based practices. The toolkits contain information sheets for all stakeholder groups, introductory videos, practice demonstration videos, and workbooks or manuals for practitioners. The toolkits cover Illness Management and Recovery; Assertive Community Treatment; Family Psychoeducation; Supported Employment; and Integrated Dual Diagnosis Treatment.  

SAMHSA Guide to Evidence-Based Practices (EBP) connects the public with information about interventions to prevent and/or treat mental and substance use disorders. The guide links to websites with specific evidence-based practices or provide comprehensive reviews of research findings. The guide can be used by stakeholders throughout the behavioral health field to promote awareness of current intervention research and to increase the implementation and availability of evidence-based practices. 

References

Drake, R. E., Goldman, H., Leff, H. S., Lehman, A. F., Dixon, L., Mueser, K. T., et al. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52(2), 179-182.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press.

Littell, J. H. (2006). The Campbell Collaboration: A reliable source of evidence for practice. The APSAC Advisor, 18(1), 7-10. 

McNeece, C. A, & Thyer, B. A. (2004). Journal of Evidence-Based Social Work, 1(1), 7-25.