Evidence-Based Practice for Social Work: Friend or Foe?
Michael Saini & Corry Azzopardi
In a climate of increased demand for accountability and effectiveness, many organizations are moving towards the principles of Evidence-Based Practice (EBP) as the “gold standard” in service delivery. Concurrently, a large number of social workers continue to grapple with whether EBP fits with the fundamental values and day-to-day realities of social work practice. For some, EBP remains overwhelming, unclear, or irrelevant. Others have embraced EBP as a client-centred approach that is compassionate, responsible, and ethical. These are critical debates for the social work profession. In this article, we will briefly present the benefits and pitfalls of EBP by considering philosophical, scientific, and ethical arguments. The principles and values of EBP will be explored within the framework of social work’s Codes of Ethics and Standards of Practice.
What is EBP?
In a 1996 editorial for the British Medical Journal, Sackett and colleagues argued that clinical expertise should consider the best available external evidence from systematic research in a “conscientious, explicit and judicious” manner (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71). In addition to practice wisdom and scientific research, client demographics and preferences were soon added to the Evidence-Based Medicine (EBM) model, with EBM becoming an intersection of three points: 1) best research evidence; 2) best clinical experience; and 3) consistency with patient preferences and values (Institute of Medicine, 2001).
Although EBM originated in the field of medicine, it quickly morphed into “Evidence-Based Practice” in the social sciences and human service disciplines. The introduction of EBP within the profession of social work has required a fundamental paradigm shift. It has necessitated a movement from a traditionally hierarchical and authority-based profession towards one which is grounded in the best available evidence to resolve issues or problems.
To be considered “Evidence-Based Practice”, the process must follow certain steps to integrate research, practice wisdom, and client preferences. These include individualized assessment (client’s strengths, needs, values, and preferences), well-formulated question, well-executed search of research literature, deciding its applicability to clients, and considering the evidence together with the values and preferences of the client (Gibbs, 2003). Therefore, EBP involves a collaborative decision-making process, which includes clients being informed and involved in the decision-making.
EBP, as a client-centred approach, may come as a surprise to many as EBP is often confused with Evidence-Based Guidelines. Guidelines provide general overviews of practice based on the synthesis of scientific evidence on a specific issue or problem. In contrast, EBP involves the same scientific evidence but then integrates that knowledge with the knowledge gained from the social worker’s experiences, insight and knowledge gained from the experiences of clients.
Within EBP, there remains a strong focus on improving the quality of care for clients through the identification and promotion of practices that work and the elimination of those that are ineffective and harmful (Akobeng, 2005). For example, it was not long ago that social workers in neonatal care were recommending that babies sleep on their stomachs. In Dr. Benjamin Spock’s book Baby and Child Care (1958), which sold over 19 million copies, he recommended that babies sleep on their stomachs to prevent choking if they vomited during the night and to ensure that their heads were not flattened on one side. Based on scientific research that linked children sleeping on their stomachs with Sudden Infant Death Syndrome (SIDS), several campaigns were initiated to turn babies on their backs while sleeping. The results were dramatic, as thousands of cases of SIDS were prevented by adopting this very simple but important practice (Gough, 2004). There are many other examples that demonstrate that common sense, practice wisdom, and tradition alone may be insufficient to solve complex problems. By integrating practice wisdom with scientific evidence and client preferences, EBP provides a more complete and comprehensive view of the problem or issue.
The Benefits and Pitfalls of EBP
As social workers continue to grapple with the potential fit of the principles of EBP with their own practice, EBP has been critiqued on philosophical, scientific, and ethical grounds. EBP has been accused of denigrating clinical expertise; ignoring client values and preferences; being used only as a cost-cutting tool for administrators; being limited to clinical research with no application to policy; promoting a hierarchy of best research evidence and suffering from the ivory tower effect and resulting in therapeutic nihilism (Gibbs & Gambrill, 2002; Mullen & Streiner, 2004; Straus & McAlister, 2000). The very definition and process of EBP, as described above, counter most of these misconceptions, and it seems that more education regarding the process, principles, and goals of EBP is required to distinguish it from other types of activities (e.g. guidelines).
The feasibility of EBP has also been challenged. It has been regarded by some as an unrealistic expectation in everyday practice due to the time demands, knowledge and training, and technology required to implement. Rosen (1994) found that only two per cent of social workers in the sample made reference to research in their rationale for choosing certain interventions. Reasons for not including scientific evidence as part of the case planning have included lack of: time, easy access to research, mentoring, administrative support, funding for educational conferences, dialogue with other professionals, understanding about the role of social work as well as the lack of positive reinforcement (National Association of Social Workers, 2003). However, in the advent of easily accessible electronic databases, social workers have more research at their disposal than ever before. Minutes spent doing an initial search of information contained in systematic reviews increases the practicality of EBP, and may consequently save many hours invested in an intervention that is ineffective.
Ethical Implications of EBP
There are inherent moral and ethical implications involved in deciding whether to accept the principles of EBP; however, EBP is rarely presented as an ethical issue. EBP promotes social work ethics by focusing on informed consent, using effective services, allocating scarce resources, involving clients in the practice process, and making individualized and personalized decisions (Gambrill, 2003).
According to the Ontario College of Social Workers and Social Service Workers Code of Ethics (2008), college members must “ensure that any professional recommendations or opinions they provide are appropriately substantiated by evidence and supported by a credible body of professional social work knowledge” and “provide clients with accurate and complete information regarding the extent, nature, and limitations of any services available to them.” The Canadian Association of Social Workers (CASW) Code of Ethics (2005) stipulates that social workers “respect the client’s rights to make choices based on voluntary, informed consent” and “uphold the right of clients to be offered the highest quality service possible.” In addition, the CASW Guidelines for Ethical Practice (2005) state that social workers “promote the self-determination and autonomy of clients, actively encouraging them to make informed decisions on their own behalf” and “discuss with clients their rights and responsibilities to provide them with honest and accurate information regarding the following: the nature of the social work service being offered, the purpose, nature, extent, and known implications of the options open to them, the potential risks and benefits of proposed social work interventions.” In other words, clients have the right to be provided with information about the potential effectiveness of interventions provided to them. Likewise, they have the right to know that no such evidence exists. In both cases, clients should be provided the autonomy to decide how they want to proceed after they have been given all of the important information and best available evidence to assist them in decision-making.
Sole reliance on a preferred theory, client testimonial, intuitional mandate, or anecdotal experience, even if well-intentioned, is insufficient and not in the client’s best interest. EBP advances the core values and objectives of the social work profession and augments the ability of social workers to maximize the use of the best available evidence and provide the necessary information for clients to make informed decisions, which promotes self-determination; it, therefore, honours the requirements set out in social work codes of ethics and standards of practice.
We invite you to consider and respond to the questions below related to Evidence-Based Practice (EBP) for Social Work, and please click on to the link: http://www.surveymonkey.com/s.aspx?sm=ztmobaIVPVgj_2bQ3AoUIizA_3d_3d to answer the questions by Survey Monkey:
1) Has your understanding of the definition of EBP changed after reading this article?
2) Do you currently apply EBP in your work?
a. Why or why not?
b. If yes, in what areas?
c. If no, will this change after reading this article?
3) Do you agree with the authors’ position that EBP is compatible with social work codes of ethics and standards of practice?
4) Are you in support of OASW’s Children & Youth Issues Advisory Task Group assigning priority to this issue in its work plan?
5) Do you differentiate between evidence–based guidelines and evidence-based practice?
6) How comfortable are students/practitioners using EBP in their day-to-day practice?
Michael Saini, PhD, MSW, RSW, Assistant Professor at the Factor-Inwentash Faculty of Social Work, University of Toronto, specializes in child welfare, child custody, parenting after divorce or separation and alternative dispute resolutions including child protection mediation. He is also involved in a number of systematic reviews of interventions related to social work and he supports evidence-based practice, knowledge transfer (KT) and evaluation of KT activities and products for professional practice. Mike is a member of the Executive on OASW’s Board of Directors, and he is an active member of the Association’s Children &Youth Issues Advisory Task Group.
Corry Azzopardi, MSW, RSW, social worker with the Suspected Child Abuse and Neglect Program at The Hospital for Sick Children in Toronto, provides direct clinical services to children and families in the area of child maltreatment, professional consultation, and leadership within the pediatric sexual assault initiative for the Ontario Network of Sexual Assault/Domestic Violence Care Centres. Corry is also involved in research, student field instruction and teaching, and is an active member of several committees including OASW’s Children & Youth Issues Advisory Task Group.
Editor’s Note: References to this article are available upon request at the OASW Office.