Whose Evidence and for What Purpose

Evidence-based practice (EBP) is one of the predominant new ways of thinking about what social workers should do in their practice and how they should decide to do it. EBP involves using the "best available" evidence, often interpreted to mean research-based "knowledge," about specific types of practices with particular problems. Although its advocates tout EBP as an imperative for social workers, others have raised questions regarding potential drawbacks of this approach. This editorial is intended neither to advocate nor to oppose EBP, but rather to identify issues that we believe social workers should consider. Origins and Characteristics of EBP Before there was EBP, there was EBM--"evidence-based medicine"--a didactic approach first used with medical students in Canada and later applied to the solution of clinical problems. Widely adopted in the United Kingdom, and increasingly in the United States, EBM is used to determine the most desirable ways to promote health and especially to treat illnesses. Its more general form, EBP, has become a major dimension of professional education in the United Kingdom and a way of attempting to arrive at a consensus about what collective bodies of research findings have to recommend. Gambrill's (1999) thoughtful and informative article advocating EBP in social work documents some of these fundamental and influential British sources. The medical origins of EBP are evident in the value placed on randomized clinical trials, similar to what social workers call experimental designs. Information generated by randomized clinical trials is taken to be the "gold standard" of evidence. Although results from studies using less traditional research controls such as case accounts are used by EBP, they occupy a lower status in the hierarchy of credible evidence. Judgments about evidence also are based on systematic reviews of treatment-outcome studies and meta-analyses that aggregate several research studies statistically. Assessing such evidence is a complex process requiring a high level of research sophistication and knowledge of the subject matter. For example, even with a large group of randomized clinical trials on a topic, small alterations in the definitions of problems or "interventions" can lead to changes in what is considered best practice. A review of readily accessible online reports of EBP or evidence-based medicine studies (see, for e xample, Research Triangle Institute, 2000) shows that various types of "psychosocial" treatments are sometimes aggregated across studies, and that medically precise definitions of "outcomes" may be hard to reconcile with social workers' espoused views of taking into account all relevant aspects of a social situation. Social Work and EBP Today, EBP has become a common term in many professions, including social work. Attempts to deal seriously with systematic evidence as a way to reduce uncertainty and improve practice have a long history in social work, as anyone familiar with the extended and legally oriented presentation concerning evidence as a basis for social work in Mary Richmond's Social Diagnosis (1917) will recall. Similarly, social surveys historically have provided evidence of the existence and effects of structural inequalities in society, often with suggestions for reform and documentation of the social benefits of reforms. The contemporary social work version of EBP (like its predecessor, empirical clinical practice) is focused more on weeding out ineffective therapies and practices and recommending interventions that logically are related to predetermined changes. Social workers' current advocacy or adoption of EBP can be thought of as an expression of the profession's recent attention to research activities and ways of thinking. The idea of systematically basing our practice on scientific evidence is appealing in our "tell me what works" society. Paralleling medicine to a degree not seen in years, recent concerted efforts to place social work in the mainstream of scientifically oriented professions can be considered the enactment of cultural beliefs about what a profession should do and be. …