Examining the Premises Supporting the Empirically Supported Intervention Approach to Social Work Practice

Over the past decade, federal, state, and local policymakers, funders, and human service system architects have increasingly organized human service delivery functions around empirically supported intervention (ESI) guidelines. The rising popularity of the ESI approach, defined as the selection and implementation of scientifically validated therapeutic interventions, has been partly in response to public demands for cost-effective programming and partly in furtherance of improving the quality and performance of clinical programs serving historically disadvantaged client populations (Gambrill, 2006; Rizzo & Fortune, 2006; Zlotnick, 2007). ESI standards are now commonly used to organize service provision in the major fields of practice employing social workers, including the child welfare, health, mental health, and substance abuse treatment sectors (Chaffin & Friedrich, 2004; Gray, 2001; Norcross, Beutler, & Levant, 2005). Partly in response to these trends, the Oregon legislature passed an ESI requirement law (Senate Bill 267) in 2003. The bill requires that state agencies providing human services dedicate increasing proportions of their biennial budgets to the implementation of ESIs. According to the law, an ESI is an efficacious intervention whose components are based on scientific research, including the use of systematic, empirical methods that draw on experiments or observation; rigorous data analysis methods to test formal hypotheses; and measures, research designs, and observational methods that allow for reliable and valid data collection. Under the law, the Department of Corrections, Department of Human Services, Oregon Commission on Children and Families, and Oregon Youth Authority are required to devote 25 percent of their program funding to ESIs in fiscal years (FYs) 2005--07, 50 percent in FYs 2007-09, and 75 percent in FYs 2009-11. These agencies serve the great majority of children, youths, and families requesting human services in Oregon. The Oregon case represents a trend in which human service systems are devoting increasing training, resources, and personnel to the ESI approach. Although other evidence-based models (Gambrill, 2005; Gibbs, 2003; Shlonsky & Stern, 2007) and consumer-centered models (Linhorst, Eckert, & Hamilton, 2005; Segal, Silverman, & Temkin, 1993) have been proposed for use by social work scholars, these models may in the future be crowded out by the ESI approach. In such a scenario, social work practitioners in certain fields of service may be required to select and implement programs that meet the stringent criteria of ESIs. It is therefore important to critically examine whether the national trend toward ESIs is scientifically supportable and clinically and culturally appropriate. That is, is the evidence base sufficient for an ESI approach to social work practice? This article presents four major arguments concerning the ESI approach and examines the evidence for each argument. EXAMINING THE VALIDITY OF THE ESI APPROACH IN SOCIAL WORK To be considered an ESI, a therapeutic intervention must meet specific evidentiary criteria: It must be subjected to evaluation under randomized clinical trial conditions by at least two independent investigators and found to be associated with positive client outcomes (Walker, Briggs, Koroloff, & Friesen, 2007). In addition, program delivery should adhere to a treatment fidelity protocol, as prescribed by the original program designers and researchers, which is generally in the form of a manual detailing intervention components and forms to use while implementing specified program procedures and a description of the specific sequence in which these activities are to occur (Lonigan, Elbert, & Johnson, 1998; U.S. Department of Health and Human Services, 1999). The ESI model has been promoted by the National Institutes of Health, the Centers for Medicare and Medicaid Services, and other federal funding agencies; private accrediting bodies, including the Joint Commission and the Council on Accreditation; and professional membership organizations such as the National Association of Social Workers, the National Association of Public Child Welfare Administrators, and the American Psychological Association. …