Study Points

Evidence-Based Practice in Social Work

Course #71482 - $15 • 3 Hours/Credits

  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
  1. Evidence-based practice is defined as

    DEFINITIONS OF EVIDENCE-BASED PRACTICE

    Evidence-based practice is defined as the "conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients" [5]. Various terms have been used to describe evidence-based practice, including evidence-based treatment, evidence-based intervention, and evidence-informed intervention. These terms are generally used interchangeably [6]. However, for the purpose of this course, the term "evidence-based practice" will be used.

    Click to Review
  2. How many steps are involved in practicing evidence-based social work practice?

    DEFINITIONS OF EVIDENCE-BASED PRACTICE

    There are five steps to practicing evidence-based social work [11]. First, a question must be posed around the practice area or need, and the question must be answerable. For example, "What can be done to solve homelessness?" is not an easily answerable question. Next, the best available evidence should be searched in order to find an answer to the question that has been posed. The evidence should be critically evaluated regarding its scientific validity and usefulness, using systematic reviews whenever possible [50]. The evidence is then evaluated and integrated based on the practitioner's experiences, observations, and client values and situation before being applied to the practice decision. Finally, it is vital to evaluate the outcomes of the decision, if possible using single case designs. Some assert both quantitative and qualitative studies should be used, depending on the question posed [51]. Ideally, these steps are done with all clients—integrating evidence to make an informed intervention plan. For client problems that are not necessarily unique or that occur frequently (e.g., abuse), some experts recommend that evidence can be generally collected and analyzed without being applied to a specific client [12]. For problems that are more unusual, practitioners should always search for available current evidence formulated by others [12].

    Click to Review
  3. The final step in evidence-based practice is

    DEFINITIONS OF EVIDENCE-BASED PRACTICE

    There are five steps to practicing evidence-based social work [11]. First, a question must be posed around the practice area or need, and the question must be answerable. For example, "What can be done to solve homelessness?" is not an easily answerable question. Next, the best available evidence should be searched in order to find an answer to the question that has been posed. The evidence should be critically evaluated regarding its scientific validity and usefulness, using systematic reviews whenever possible [50]. The evidence is then evaluated and integrated based on the practitioner's experiences, observations, and client values and situation before being applied to the practice decision. Finally, it is vital to evaluate the outcomes of the decision, if possible using single case designs. Some assert both quantitative and qualitative studies should be used, depending on the question posed [51]. Ideally, these steps are done with all clients—integrating evidence to make an informed intervention plan. For client problems that are not necessarily unique or that occur frequently (e.g., abuse), some experts recommend that evidence can be generally collected and analyzed without being applied to a specific client [12]. For problems that are more unusual, practitioners should always search for available current evidence formulated by others [12].

    Click to Review
  4. Evidence-based practice as it is known today can be traced back to

    A HISTORICAL OVERVIEW OF EVIDENCE-BASED PRACTICE

    As noted, the concept of evidence-based practice is not necessarily a new one. Even dating back to ancient times, there are some indications of attempts to make decisions regarding medical interventions based on prior testing. In the 1850s, Florence Nightingale's efforts to sanitize hospital conditions were based on evidence-based practice steps—Nightingale identified the problem and critically evaluated and appraised the evidence [20; 52]. Evidence-based practice as it is known today can be traced back to World War II [2]. However, it was not until 1972, and the work of Dr. Cochrane, then director of the Medical Research Council Epidemiology Research Unit in Cardiff and involved in an evaluation research project to assess a governmental agency, that the concept of evidence-based practice began to gain notice [2]. He also published a book titled Effectiveness and Efficiency: Random Reflections on Health Services. These steps laid the foundation for evidence-based practice in a variety of disciplines today.

    Click to Review
  5. The National Institute of Mental Health Task Force on Social Work Research published a report recommending that

    A HISTORICAL OVERVIEW OF EVIDENCE-BASED PRACTICE

    In 1988, the National Institute of Mental Health created a task force to examine social work research and social work faculty's level of involvement in social work research [24]. This Task Force on Social Work Research published a report recommending that seven Social Work Research Development Centers be housed in social work programs, with each center testing intervention models and approaches for different population groups [24].

    Click to Review
  6. Which of the following would be considered an example of "hard" data?

    THE DEBATE ABOUT EVIDENCE-BASED SOCIAL WORK PRACTICE

    Debates about evidence-based practice in social work abound. First, there is a question of the context in which it should be employed. For example, should evidence-based practice be used in a micro (with individuals) or macro (with organizations) context [1]? The terms used are also a source of controversy; semantics in employing the term "interventions" versus "treatment," or "client" versus "client systems" have emerged. The term "evidence" alone has raised questions regarding ownership of data and expertise. In evidence-based practice, evidence is defined as research findings of various quality (levels of evidence) according to the study structure and statistical weight of the resultant data [13]. Some experts differentiate between hard and soft data. Hard data refers to quantifiable evidence that is supported by research studies that follow the empirical process, while soft data refers to qualitative studies and anecdotes from clients' experiences; observations from interviews with clients, service providers, and other stakeholders; and formal and informal observations [14]. It is also unclear how practitioners should act if evidence does not exist or if there is conflicting evidence regarding a particular intervention [13].

    Click to Review
  7. Empirically supported interventions differ from evidence-based practice in what way?

    THE DEBATE ABOUT EVIDENCE-BASED SOCIAL WORK PRACTICE

    The term "empirically supported intervention" is also used in the social work literature. However, empirically supported interventions utilize even more rigid criteria than evidence-based practice. For example, an evidence-based practitioner can use literature on systematic reviews to understand the effectiveness of an intervention or treatment, but in order for an intervention to be considered empirically supported, it must be based on evaluation of randomized clinical trial study data by at least two independent investigators [16]. Unlike psychology, social work does not tend to use descriptors such as strong, modest, or controversial to differentiate the evidence [56]. The empirically supported interventions paradigm has been advocated by the National Association of Social Workers, the National Association of Public Child Welfare Administrators, the National Institutes of Health, the Joint Commission, and the Council on Accreditation [16]. However, empirically supported interventions are still not well-distinguished in the literature [56]. Other terms are used, including research-supported, empirically supported, evidence-driven, or evidence-guided. However, the emergence of these new terminologies has introduced more confusion [51].

    Click to Review
  8. All of the following differences between medical and social work practice have been used to argue against the incorporation of evidence-based practice in social work, EXCEPT:

    THE DEBATE ABOUT EVIDENCE-BASED SOCIAL WORK PRACTICE

    As evidence-based practice was originally derived from medicine, some argue that differences between the two professional fields mean that the practice cannot be applied to social work [26]. Often, medical interventions can be broken into distinct steps to be followed for all or most patients. However, social work takes into account all social, biologic, psychologic, cultural, and institutional factors, making developing a set of universal steps for interventions much more difficult [26; 52]. Medicine is also highly positivistic (i.e., focusing on measurability), while social work is interpretivistic/constructivistic, relying on reflexivity and the social context [29; 52]. This leads to unpredictability and difficulty in quantification of social work experiences.

    Click to Review
  9. Which of the following is an argument against the incorporation of evidence-based practice in social work?

    THE DEBATE ABOUT EVIDENCE-BASED SOCIAL WORK PRACTICE

    Opponents argue that the empirical knowledge base in social work is narrow and limited—meaning empirical information is not available for every clinical issue and every client population. It is important to note that if practitioners are unable to locate literature that meets evidence-based criteria, this does not necessarily mean that an intervention is "bad" [26]. The reality is that research topics are influenced by a host of factors, including funding sources and priorities, perception of what is "important," and other hidden social values [26].

    Some assert that evidence-based practice privileges certain knowledge––specifically, knowledge that is quantifiable and measurable [30]. Studies that use experimental designs that feature randomization and control and experimental groups are valued in evidence-based practice. However, other types of quantitative and qualitative methods have value as well and can provide insight into clients' realities [26,30]. Social work as a field deals with diverse social problems, and change in clients' lives frequently occurs gradually and in small ways that cannot always be captured using the experimental designs favored by evidence-based practice [30]. Furthermore, the insights and opinions of social workers and other service providers are valuable [57].

    The importance of practitioners' clinical experiences and intuition in shaping practice decisions should not be ignored [20]. Opponents of evidence-based social work practice posit that the essence of the art of clinical work with clients (e.g., use of self, intuition, rapport building with clients, past experiences) is not captured in evidence-based practice.

    Some experts maintain that a focus on evidence-based outcomes could potentially risk the client autonomy that social work values [30,56]. For example, evidence-based literature may demonstrate that a certain medication is effective, but a client may rather avoid pharmacologic interventions and employ alternative treatment. In this case, should the practitioner push for what the literature supports despite the client's wishes?

    Opponents of evidence-based social work practice maintain that agencies often have limited resources (e.g., money, time, expertise) with which to promote evidence-based practice. Furthermore, given how long the scientific process can take when it comes to data collection, evaluation, and publication of findings in peer-reviewed journals, the literature may be outdated even before public scrutiny and critiques of the findings are possible [31].

    Click to Review
  10. All of the following are arguments for the incorporation of evidence-based practice in social work, EXCEPT:

    THE DEBATE ABOUT EVIDENCE-BASED SOCIAL WORK PRACTICE

    Proponents of evidence-based social work argue that professionals are expected to practice good social work, which entails providing clients the best treatment possible [14]. In order to do so, social workers should amass and evaluate the available evidence before making informed decisions and formulating a client's intervention plan. In a climate that emphasizes efficiency, transparency, and accountability, social workers are also expected to demonstrate effectiveness to their funders [58]. The National Association of Social Workers Code of Ethics states [32]:

    Social workers practice within their areas of competence and develop and enhance their professional expertise. Social workers continually strive to increase their professional knowledge and skills and to apply them in practice. Social workers should aspire to contribute to the knowledge base of the profession.

    Although there may be challenges to implementing evidence-based practice, ethical codes demand that practitioners address these challenges rather than avoid them [19].

    As noted, one of the criticisms of evidence-based social work is that it is too mechanistic and procedural. In response to this, proponents claim that the steps in evidence-based practice are focused on each individual client. If followed correctly, the decisions that result from the process are deliberate and client-centered [19].

    In addition, evidence-based practice does not violate client self-determination. All collected evidence is synthesized taking into account the client's background, characteristics, environment, support system resources, and preferences [19].

    Some experts object to the argument that evidence-based practice ignores the practitioner's vast clinical experience and background. One of the steps in evidence-based practice is the evaluation of evidence based on experience and the specific situation, which highlights the role of the practitioner's clinical background and intuition [19].

    Taking a more broad definition of evidence-based practice and using a range of "hard" and "soft" data as best evidence, evidence-based clinical practice is advantageous because it moves away from client insight as being a sign of progress. Instead, it focuses on observable behavioral change [28]. This behavioral change can trigger clients' understanding of their emotional life [28].

    Proponents of evidence-based practice in social work maintain that using empirically tested interventions is fundamental to building a core knowledge base in social work [1]. By expanding this core knowledge base, social work as a discipline can be more legitimate and "professional," ultimately increasing its credibility.

    Click to Review
  11. What percentage of individuals diagnosed with a psychiatric disorder who use the Internet proactively used digital media to find health-related information?

    THE DEBATE ABOUT EVIDENCE-BASED SOCIAL WORK PRACTICE

    In an increasingly technology-oriented society, consumers have greater access to information and are becoming more educated about the services they receive. Because of this, they expect service providers and professionals to be updated on the latest developments in their field [51]. For example, 80% of adult Internet users (18 years of age and older) search online for information on a health topic each year [33]. Among individuals with diagnosed psychiatric disorders who use the Internet, 64.7% have proactively employed the Internet to find more health-related information [34]. Because social work clients are active consumers, they can be encouraged to use the Internet to research and can offer feedback in terms of what they discover [9]. This becomes a vehicle for empowerment, improving communication and reducing the power disparities between practitioners and clients. However, this easy access to information increases the risk that clients will obtain erroneous information; it is the responsibility of social workers to educate clients to critically evaluate information [51].

    Click to Review
  12. Which of the following is NOT one of the four cornerstones of evidence-based practice in social work, as defined by Gilgun?

    THE DEBATE ABOUT EVIDENCE-BASED SOCIAL WORK PRACTICE

    Using the definition that evidence-based practice is the "integration of the best research evidence with clinical expertise and client values in making practice decisions," some experts advocate for an evidence-based practice model that bridges the viewpoints of proponents and opponents [1]. Best research evidence may refer to employing both applied (e.g., intervention and outcome research) and basic research studies [1]. Clients' values are based on their culture, upbringing, expectations, and environment, and these values are not discarded when using evidence-based practice. Instead, they should be at the forefront, shaping decisions made by both the client and social worker [1]. The practitioner's clinical expertise is also part of this equation. Similarly, Gilgun suggests that [18]:

    There are four cornerstones of evidence-based practice in social work: (1) what we know from research and theory; (2) what we and other professionals have learned from our clients, or practice wisdom, which also includes professional values; (3) what we, as social workers, have learned from personal experience; and (4) what clients bring to practice situations. All four come into play and mutually affect each other as we go about our daily work with clients. In sum, evidence-based practice promotes a high degree of practitioner reflection and mindfulness.

    Click to Review
  13. Which of the following is a logistical barrier for social workers to fully implement evidence-based practice?

    IMPLEMENTING EVIDENCE-BASED PRACTICE

    There are logistical barriers for social workers and practitioners to fully implement evidence-based practice. Some social service organizations do not have the technology, hardware, datasets, and informational technology specialists to assist practitioners to access information needed for evidence-based practice [35]. Implementing evidence-based practice well requires social workers to spend time learning how to use resources, search for literature, and develop research skills, but social workers and other practitioners often have heavy caseloads and are extremely busy seeing clients [26,59,60]. Some social workers have expressed that their agencies are not supportive of evidence-based practice [55]. Social workers often do not have sufficient research skills to conduct outcome studies and evaluate interventions, and locating and appraising evidence-based literature requires additional training [35,59]. Some social workers are anxious about their ability to formulate answerable research questions and use quantitative and qualitative methods and data analysis [51,57]. In addition, many social workers view research and the empirical literature as irrelevant and impractical. The research produced from clinical studies is often university-based and viewed as outdated or not reflecting the problems of the real world [29,57,60]. Consequently, some social workers tend not to employ research literature and do not view mutual collaboration between practitioners and researchers favorably [29].

    Click to Review
  14. Many of social workers' fears regarding the incorporation of evidence-based practice involve the

    IMPLEMENTING EVIDENCE-BASED PRACTICE

    Social workers' fears may also influence the willingness to employ evidence-based models. Many anxieties involve the perception that evidence-based practice is a top-down, mechanistic, one-size-fits-all approach that devalues client autonomy and clinical experience and wisdom [29]. However, if used correctly, evidence-based practice supports client and practitioner expertise.

    Click to Review
  15. Which of the following factors predicts adoption of evidence-based practice by social workers?

    IMPLEMENTING EVIDENCE-BASED PRACTICE

    Not surprisingly, social workers who are willing to alter their interventions in light of new evidence are more open to implementing evidence-based practice [35]. Social workers' desire and readiness for change should be supported by colleagues, employers, and the profession as a whole. When staff perceive that an organization is committed to fostering change and when practitioners are encouraged to take on challenging tasks that will help them grow, use of evidence-based practice increases [35]. When there is an organizational culture of continuous quality improvement and collaboration between clinicians, researchers, and policymakers, adoption rates for evidence-based practice increase [60]. Practitioners who are given external positive incentives (e.g., monetary bonuses, extra vacation time) for learning new skills and interventions are more likely to adopt evidence-based practice [35]. Because time and energy are often constrained due to heavy caseloads, social workers may feel more motivated if the time they put into implementing a new intervention is rewarded in the incentive structures of an agency [35]. Organizations may also provide education on the principles of evidence-based practice. Practitioners who participate in education and training that focuses on specific skills, such as research, library database searches, and critically appraising intervention studies, are more likely to incorporate evidence-based models into their practice [35]. Studies indicate that time and resources are important facilitators to evidence-based practice; practitioners with high levels of self-efficacy and time/resources are more likely to carry out evidence-based practice [61]. This speaks to the need to train and empower social workers to execute evidence-based practice.

    Click to Review
  16. The incorporation of evidence-based practice in social work involves all of the following ethical principles, EXCEPT:

    IMPLEMENTING EVIDENCE-BASED PRACTICE

    It is important that social work practitioners and researchers explore the ethical implications of conducting evidence-based practice [36]. Specifically, this type of practice can involve the ethical principles of beneficence, self-determination, conflict of interest, and confidentiality [37; 62]:

    • Beneficence: Beneficence refers to the duty to do good, and practitioners should consider the benefits of conducting evidence-based research. What specific benefits will the group being studied obtain? What are the risks and does it have any negative outcomes for vulnerable populations? What additional safeguards can be implemented to promote the welfare of the client(s) and mitigate risks?

    • Self-determination: Self-determination refers to the duty to maximize an individual's rights to make his/her own decisions. Clients' self-determination and autonomy should be protected. For example, when implementing an intervention, do the clients feel they have no choice but to comply or risk having services somehow negatively affected?

    • Conflict of interest: Potential dual-role issues and conflicts of interest can arise when a social worker is both the practitioner working with the client and the researcher collecting evidence about his/her own practice and interventions. What will the social worker report to the agency if the findings about the intervention are negative? When a practitioner is evaluating his/her own practice, he/she must ask whether the client's interest are prioritized.

    • Confidentiality or anonymity: All social workers should implement adequate safeguards to promote clients' privacy, anonymity, and/or confidentiality.

    • Study design: The study design and data collection procedures should serve to answer the research question. If not, this raises the issue of inconveniencing the clients, which is not ethical. Do the study design and procedures ultimately serve to empower the clients?

    Click to Review
  17. Which of the following categories of intervention studies involving a diverse population is considered the most culturally sensitive?

    IMPLEMENTING EVIDENCE-BASED PRACTICE

    Historically, there are four ways that intervention studies have dealt with the issue of diversity [39]. These four categories may be viewed as existing along a continuum, with one end of the continuum consisting of full involvement of the cultural group (the most culturally sensitive) and the other end not recognizing the importance of including racial and ethnic minorities in the sample (the least culturally sensitive). The categories are:

    • Full partnership: With this approach, researchers collaborate with the community and consider the diverse interests of the group when formulating a culturally sensitive and competent intervention, identifying the research question(s), collecting data, analyzing and interpreting data, and disseminating research findings.

    • Ad hoc involvement: In this category, the population of interest and the community are asked to provide input after the intervention has been implemented or after the research question has been posed. The targeted group may be viewed as an ad-hoc advisory group.

    • No involvement in the process: In some cases, researchers include racial and ethnic minorities in the sample, but they do not attempt to target the intervention to the specific group, nor do they attempt to gain insight into the group's perspective about the intervention.

    • No diversity represented in the sample: Some researchers do not actively recruit diverse racial and ethnic minorities in the study sample. If there is some diversity in the sample, there are no sufficient numbers to be able to conduct statistically valid analyses.

    Click to Review
  18. If a professional adopts an etic perspective, it means that he or she

    IMPLEMENTING EVIDENCE-BASED PRACTICE

    Another way to explore the issue of cultural competency is through the debate about emic and etic perspectives. The etic perspective maintains that, along important dimensions, all humans are basically similar. On the other hand, the emic perspective argues that it is vital for professionals to begin from the paradigm that unique cultural characteristics exist in various cultural groups. This emic orientation acknowledges individual differences within culturally different populations while simultaneously viewing clients/patients within the context of their primary cultural group [40]. It is believed that etic interventions can be used for all groups and if modification is necessary, it would be minimal. In contrast, emic interventions focus on formulating interventions that reflect the group's characteristics and value systems, with the belief that these interventions will be more effective for the target group [41]. Either approach may be taken when conducting evidence-based practice. However, the emic perspective is considered culturally sensitive and ethically sound, and these interventions may have a greater likelihood of success.

    Click to Review
  19. The PICO approach to formulating strong research questions involves what four components?

    IMPLEMENTING EVIDENCE-BASED PRACTICE

    The first step in conducting evidence-based practice is to formulate a question that will drive the research [69]. This research question is a descriptive clinical inquiry of an intervention and potential outcome(s) [60]. The question will dictate the evidence used to answer and should be succinct, clear, and as specific as possible. One way to develop the question is to use the PICO formula: population, intervention, comparison, and outcome [45]. Some use PICOT, with the T representing time period of data collection [69]. Using this approach, the first step is to pinpoint the client population. The more detailed one can be regarding the attributes or characteristics of the client population, the more helpful the question will be and the more applicable the research findings will be. If possible, the practitioners should identify gender, socioeconomic status, racial/ethnic minority status, health conditions, religion, and other factors. Examples of strong population component include:

    • Male clients diagnosed with generalized anxiety disorder

    • Chinese immigrants who came to the United States in the last five years

    • Hispanic adolescents residing in single-parent households

    Click to Review
  20. Which of the following is NOT a database social workers may use when searching for articles and reports to use when adopting evidence-based practice?

    IMPLEMENTING EVIDENCE-BASED PRACTICE

    Databases

    Several databases are available for social workers to use in their search for articles and reports to use when adopting evidence-based practice. Some are free, while others require a paid subscription. Please note that this is far from a comprehensive list, and practitioners are encouraged to explore other options provided by their agency or organization.

    ACP Journal Club
    https://www.acpjournals.org/loi/ajc
    Agency for Healthcare Quality and Research
    https://www.ahrq.gov/prevention/guidelines/index.html
    American Psychological Association Databases and Electronic Resources
    https://www.apa.org/pubs/databases
    BioMed Central
    https://www.biomedcentral.com
    California Evidence-Based Clearinghouse for Child Welfare
    https://www.cebc4cw.org
    The Campbell Collaboration
    https://www.campbellcollaboration.org
    The Cochrane Library
    https://www.thecochranelibrary.com
    Essential Evidence Plus
    https://www.essentialevidenceplus.com
    Evidence-Based Behavioral Practice
    https://ebbp.org
    Evidence-Based Mental Health
    https://ebmh.bmj.com
    Evidence Alerts from BMJ
    https://www.evidencealerts.com
    Health Services/Technology Assessment Texts (HSTAT)
    https://www.ncbi.nlm.nih.gov/books/NBK16710
    Human Services Research Institute
    https://www.hsri.org
    Joanna Briggs Institute
    https://joannabriggs.org
    Medline/PubMed PICO Search
    https://pubmedhh.nlm.nih.gov/nlmd/pico/piconew.php
    National Association of State Mental Health Program Directors Research Institute
    http://www.nri-inc.org
    The National Working Group on Evidence-Based Health Care
    http://www.evidencebasedhealthcare.org
    Public Library of Science (PLOS)
    https://plos.org
    PubMed
    https://pubmed.ncbi.nlm.nih.gov
    Research in Practice
    https://www.researchinpractice.org.uk/all
    Substance Abuse and Mental Health Services Administration National Registry of Evidence-Based Programs and Practices
    https://www.samhsa.gov/ebp-resource-center
    Turning Research Into Practice (Trip) Database
    https://www.tripdatabase.com

    The key to searching and learning how to best use the different databases is to practice. As an additional resource, the article "Evidence Searching for Evidence-Based Psychology Practice" provides an excellent summary of the different types of databases and their strength and weaknesses [45]. The article may be accessed online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077562.

    With the increased use of the Internet, there have been more open-access sources for information that has not been peer reviewed. It is important to ensure that the information is credible. Experts recommend assessing the following elements in any potential source of information [60]:

    • Credentials and affiliations of the authors

    • Abstract containing a summary of the research

    • Reference list

    Click to Review

  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.