File Name: ocial work re earch and evaluation foundationof evidence ba ed practice .zip
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Evidence describing effective interventions exists, but research that addresses dissemination and implementation is generally lacking. This paper highlights existing literature on dissemination and explores the barriers, themes, and trends in EBP through eight expert interviews.
The interviews reflect the issues described in the literature and provide additional insight to the process of implementation and dissemination of EBP. Findings from the literature and interviews are synthesized into research and practice recommendations. While there is a call for Evidence-Based Practice EBP in social work and mental health services, there have also been a number of criticisms about the implementation of research findings into viable methods of practice.
These barriers range from the egregious lag-time between research development to dissemination of evidence to practice settings to a veritable lack of support and training for community practitioners. There is a growing body of evidence describing effective interventions, but there is not a substantial body of work addressing the dissemination of these programs and other research findings for use in the field.
This paper highlights some of the work around dissemination of EBPs in the field of social work with an emphasis on mental health services including an overview of the barriers to the use of evidence in practice and proposed models of conceptualization and implementation of EBP. To further highlight the current barriers, themes, and trends in EBP eight experts in the field of EBP were interviewed. The goal of the interviews was to survey the opinions of expert researchers in the area of EBP to supplement knowledge described in the literature.
Findings from the literature review and interviews are synthesized into recommendations for future research and practice efforts. Practice decisions based on research evidence have increasingly become an identified need in the treatment of mental illnesses. Even more broad health policy reports, such as Healthy People from the U. These national and international health and mental health reports are important to social work, not only as signposts of current trends in policy thought, but also as frameworks for future policy and funding activity.
These and other agencies are also outlining science-based program standards and rating systems. For example, the Center for Substance Abuse Prevention CSAP and SAMHSA recently constructed a comparison matrix of science based prevention programs examining the standards and effectiveness ratings of different programs sponsored by five different federal agencies According to Thomas Insel , director of the National Institute of Mental Health, social workers are doing the majority of front line work treating individuals with mental illnesses.
Citing a SAMHSA report, the current psychotherapy workforce is dominated by social work consisting of , social workers, 73, psychologists, 33, psychiatrists, and 17, psychiatric nurses Insel, For this project, research was conducted through a review of the literature, including both books and scholarly articles, on EBP in mental health services in social work as well as other relevant professions and by interviewing a convenience sample of experts currently conducting research related to the development and dissemination of evidence based interventions for mental illnesses.
Relevant literature was identified through a search of local social work and public health library holdings and by searching electronically using the following databases: Social Work Abstracts, PsychLit, and Medline. This review was limited to published literature that directly describes the use of research in social work practice specifically. The first widespread push for EBP in social work came out of a series of studies that began to appear in the s and called into question the effectiveness of existing social work interventions Fisher, ; Reid, The s and s witnessed a movement to develop evidence based models of practice in mental health and further the development of well researched psychosocial intervention models such as the behavioral, cognitive, interpersonal, and social approaches, as well as the biological and biopsychosocial theories of mental illness Turnbull, Evidence-based researchers in many disciplines pioneered models used in social work practice including: psychology, psychiatry, and social work.
In the late s and early s substantial evidence regarding the treatment of common mental health disorders were high-lighted by the publication of the results of studies such as the National Institute of Mental Health Treatment of Depression Collaborative Research Program Elkin, Shea, Watkins et al.
For a more detailed description of the history of the development and use of EBP in social work see Kirk and Reid These EBP interventions include: Assertive Community Treatment ACT , supported employment, intensive case management, wellness self-management, family psychoeducation, integrated treatment for co-occurring substance abuse and mental health disorders, medication and guidelines for practitioners to promote optimal prescribing practices , self-help and peer support services, and post-traumatic stress disorder PTSD treatment New York State Office of Mental Health, The commission also recommended emerging best practices including: consumer operated services, jail diversion, and community re-entry programs, school mental health services, trauma-specific intervention, wraparound services, multi-family group therapies, and systems of care for children with serious emotional disturbances and their families New Freedom Commission, While researchers have identified evidence-based mental health services, the translation and implementation of these services into practice has been problematic.
Moreover, social work is a profession that claims expertise and specialized knowledge, values, skills, and professional ethics aimed at addressing difficult human problems, including mental illness Gambrill, ; however, licenses, experiences, and training are not supported by evidence as necessarily related to helping clients through the use of evidence Dawes, The first strategy, and arguably the most common historically, has been to ignore the contradiction between claims and reality and to censure this information from the academic and practice community Gambrill, The second strategy is to investigate the values, skills, and knowledge needed to achieve certain outcomes and then to identify who has these resources and the capability to provide them Gambrill, Social workers can, in this way, become integral participants in the process of shaping and delivering supported and needed interventions for clients and communities.
Perhaps the most common subject described in the EBP literature has been the concrete and psychological barriers that impede dissemination and implementation of EBPs. These barriers, outlined by practitioners, researchers, and administrators alike, have generally revolved around four major themes: knowledge, lack of fit, suspicion, and resources. Gray, one of the foremost thinkers in evidence based healthcare and policy, likens research-based facts to uncut diamonds, which are valuable but of little use in their raw form Even when evidence is identified in journals, much journal evidence is three-to four-years-old by the time it is published Thyer, The lack of knowledge also includes arguments that are based on a misunderstanding of what constitutes an EBP.
Even if practitioners are able to identify and understand research they may still discredit its value. The lack of fit theme includes the reasons why practitioners feel that available evidence or research is not often helpful. Others have noted that the methodology of treatment may not be applicable within the confines of their practice.
Moreover, practitioners have noted that research and current policy are often at odds. Research findings are slow to develop, and once findings are presented, it may take considerable time before policies are aligned with new knowledge. Finally, the culture of knowledge transmission within social work has been historically unsupportive of the use of research evidence in practice Barratt, Related to the idea of the lack of fit between research findings and practice is the theme of suspicion.
This includes a basic distrust for evidence, based on objections related to political, ethical, or control issues. Gibbs sites a natural resistance to innovation including EBPs as one of the main barriers of teaching EBP to practitioners Gibbs, Other practitioners feel the experts are more often guided by their own view or model rather than an objective examination of the evidence Barratt, Landry, Amara, and Lamari point oat that there is an inherent disconnect between the goals and needs of researchers and practitioners.
Practitioners need and want guidance that is tailored to clients and practice. However, the degree to which research results are customized to only one or two users increase costs to the scholars. Their work becomes less generalizable to the wider world and they must reformat or repackage it if they want others to utilize their work.
It becomes a catch where researchers are pushed toward developing broad applications and their work becomes likewise less useful for the individual practitioner. The idea that research is suspect seems also, in part, due to the generally poor relationship that researchers and scholars have had with community agencies and practitioners in the past.
Without the necessary training, materials, time and staff dedication to researching the evidence, EBPs cannot often be employed. Interventions may be shaped instead by limitations rather than knowledge. A lack of technology is particularly troublesome in a day and age where most cutting-edge information is accessed through computers and the Internet.
Many agencies do not have access to these resources. The issue is not only what resources are realistically available, but also beliefs or policies about who can have access to these resources.
Some administrators feel that not all social workers should have access to computers and the Internet Barratt, The issue of a lack of resources is partly a result of generally poor or inconsistent funding for many social work agencies.
However, funds that are available are rarely routed toward identifying, instituting and maintaining research, technology, or EBPs. Despite the numerous barriers to dissemination outlined above, social workers in the mental health services arena do have a number of compelling reasons to implement evidence into their practice with mentally ill individuals.
Overall, the basic tenet of EBPs is that clients should receive the benefit of the best technology that social work has to offer.
It is, however, difficult to imagine the basis on which structured, fact-based and well-informed decision making and planning referenced to the best available published research can be viewed as counter either to the provision of effective outcomes for service users, or to the ethos of the social work professional, p.
There are many questions as to what exactly should be used as evidence to identify the best technology possible. Undoubtedly this argument will, and should, continue within the field. However, if some agreement upon what is a validated intervention can be secured, the question becomes one of dissemination and implementation. These authors reviewed over one hundred papers that evaluated or described efforts to facilitate the use of research.
Nearly two hundred individual practices or packages were identified through this review. Based on these, the authors developed a taxonomy of approaches by both intervention type format through which the information flows and mechanisms employed, as well as a brief description of the research or theory that lends support to the specific approach.
For example, one category of mechanisms described by the authors is incentives. The adoption of desired behaviors or information is encouraged through reward, or perhaps linking funding to specific practices. This mechanism is supported by learning theories, economic models of rational behavior, and power theory.
Using such taxonomy to organize and understand dissemination research could potentially prove useful. A number of researchers have taken the process a step further than individual mechanisms or approaches and proposed more developed frameworks for the delivery of research evidence into practice. While no single best method has been identified, there are a number of emerging social work implementation strategies described in the literature.
The following is a brief overview of this work. Based on interviews with community organization leaders, Anderson and colleagues suggest a model based on a relationship between researchers and community organizations that moves through three different stages. In the second stage, communication , mechanisms are built to facilitate the transfer of information.
Both community organizations and research stakeholders come together to formulate a plan for sharing skills and knowledge. A variety of methods may be employed such as: workshops, databases, and open houses. Finally, in the last stage, interaction , mutual activities toward common goals are shared and negotiated. This model is general, offers some specific recommendations, but seems to focus largely on encouraging local groups to work together in order to find the methods that match their shared needs, abilities, and resources.
The following suggestions are offered, 1 consider the quality and applicability of evidence, 2 consider the context or organizational environment, and 3 consider the process of implementing change Gibbs, The strategy proposed involves the use of Systematic Planned Practice SPP , a tool for treatment planning and evaluation that includes the planning and recording of critical elements of practice such as the presenting problem s , desired outcomes, interventions, and observed results Rosen et al.
Application is guided by forms that serve two functions: to prompt and guide the worker in laying out the treatment plan and as a rationale for decisions made and to provide documentation for treatment planning decisions, what is actually implemented, and the outcomes obtained Rosen et al.
A dissemination plan is proposed that combines SPP with components of practice guidelines to facilitate practitioner use and knowledge of evidence in practice Rosen, As in the Gambrill and Gibbs model, Rosen and Proctor place much of the burden of utilization on the practitioner to locate and implement research knowledge. While Anderson and colleagues frame the process as more of a partnership between researchers and practitioners, it lacks specificity in terms of implementation.
Another approach to the dissemination of EBPs is the tool kit method. Tool kits are materials constructed from original research and translated for use by practitioners, agencies, or institutions. Practitioners can order such tool kits from for profit and nonprofit enterprises at a cost. The idea is that the necessary research evidence is distilled into an attractive user-friendly format that is ready for implementation in the community.
Evaluation processes are also sometimes included to provide a conduit for user feedback and further refinement of the toolkit package Card, Using this format, treatment is directed by an outline of acceptable practices in specific areas of treatment. These practices would be determined by a professional body-charged with surveying, evaluating, and choosing both prescribed and proscribed interventions. Despite these objections, Howard and Jensen argue that practice guidelines can go a long way toward improving social work interventions for an excellent discussion of the potential problems and benefits of practice guidelines in social work please see the May issue of the journal Research on Social Work Practice.
Historically other models have been explored to marry research and practice.
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Evidence-based practice EBP is not a catchphrase. This page will provide and introduction to this procedure. Cincinnati: Anderson Publishing Co. Visit our website at. There are even fictional books based on real criminal justice issues that can be helpful for professionals in the field. Criminal law in the U.
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. 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. In April , 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 impact of evidence-based practice EBP has echoed across nursing practice, education, and science. The call for evidence-based quality improvement and healthcare transformation underscores the need for redesigning care that is effective, safe, and efficient. In line with multiple direction-setting recommendations from national experts, nurses have responded to launch initiatives that maximize the valuable contributions that nurses have made, can make, and will make, to fully deliver on the promise of EBP. Such initiatives include practice adoption; education and curricular realignment; model and theory development; scientific engagement in the new fields of research; and development of a national research network to study improvement. The article concludes with discussion of the next big ideas in EBP , based on two federal initiatives, and considers opportunities and challenges as EBP continues to support other exciting new thinking in healthcare.
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