Evidence%20Based%20Practice

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Evidence Based Practice

• Lecturer Foluke Blackburn

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The overall aim of this session is to Emphasise
the essential role of Evidence Based Practice in
making decisions about the welfare of people in
need of services

• By the end of the session you should be able to
• Define Evidence Based Practice
• Examine the components which contribute to EBP
• Explore the use / lack of use of EBP by
  practitioners

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• What is evidence based practice

EBP
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Evidence based practice

• (EBP) is an approach which tries to specify the
  way in which professionals or other
  decision-makers should make decisions by
  identifying such evidence that there may be for a
  practice, and rating it according to how
  scientifically sound it may be. Its goal is to
  eliminate unsound or excessively risky practices
  in favour of those that have better outcomes.

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Evidence Based Practice

• EBP uses various methods (e.g. carefully
  summarizing research, putting out accessible
  research summaries, educating professionals in
  how to understand and apply research findings) to
  encourage, and in some instances to force,
  professionals and other decision-makers to pay
  more attention to evidence that can inform their
  decision-making.

http//en.wikipedia.org/wiki/Evidence_based_practi
ce
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Evidence Based Practice

• Evidence Based Practice is the conscientious,
  explicit and judicious use of current best
  evidence in making decisions regarding the
  welfare of those in need of services
• (Sackett et al 1996).

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Evidence Based Practice
When Sackett writes of evidence-use as being
conscientious, judicious and explicit this
appears to entail three kinds of claim A moral
claim - conscientious suggests done according
to conscience as a moral duty. A wisdom claim.
Judicious suggests sound judgement, and is a
mark of practical wisdom and discretion. A claim
to transparency and openness. Explicit appears
to have the sense of leaving nothing merely
implied.
Ian Shaw University of York 2004
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Evidence Based Practice

• Macdonald says that evidence based practice
  represents an approach to decision-making which
  is transparent, accountable, and based on a
  consideration of current best evidence about the
  effects of particular interventions on the
  welfare of individuals, groups and communities
  (Macdonald, 2000b 123).

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Current Best Evidence

• Theories / Methods /Models
• Research
• Studies on the effectiveness of particular
  interventions
• Legislation / policies
• Experience

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• Mullen 2004 for the most part social work
  practitioners are not engaged in evidence based
  practice
• Kirk and Reid 2002 EBP remains on the cultural
  margins, struggling for a voice and
• following
• Go back over the last few slides and revisit
  your definition.
• Why is it that not all social workers use current
  best evidence in their practice?

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Why dont all practitioners use EBP

• General lack of awareness of available evidence
  based practices and the difficulty in processing
  or understanding identified research
• How to best access, evaluate, and translate
  evidence (Anderson, Cosby, Swan, Moore,
  Broekhoven, 1999 Mullen Bacon, In press).
• Misunderstanding of what constitutes an evidence
  based practice such as (Gibbs Gambrill, 2002)
• Were already using evidence
• Its a matter of opinion
• There is no evidence

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Why dont all practitioners use EBP

• Basic distrust for evidence, based on objections
  related to political, ethical, or control issues
• Politically motivated, guided by efficiency,
  researcher preferences, or simply a cost-cutting
  tool (something other than clients best
  interest)
• Devalues the practitioners professional judgment
  or clients preferences
• Trendy, more about research reputations, and
  malleable evidence
• (Gibbs Gambrill, 2002 Mullen Bacon, 2003)

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Why dont all practitioners use EBP

• Evidence or research that is available or
  accessible is not often particularly helpful
• Cookbook/stilted approaches
• Overly broad
• Ignores contextual or cultural issues
• Not realistic in practice
• Mismatch with current policy and technology
• The culture of knowledge transmission within
  social work has been historically unsupportive of
  the use of research evidence in practice
• (Barratt, 2003 Anderson, Cosby, Swan, Moore,
  Broekhoven, 1999 Gibbs Gambrill, 2002 ).

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Practice under the spot light

• Go through the reasons previously stated and
  discuss with someone which of these might apply
  to you.
• What are the benefits of using EBP?

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What are the strengths and benefits of Evidence
based Practice?

• Accountability to service users, employers and
  funding agencies
• - Service users preferred. SW who appeared
  clear about what they were doing and why they
  were doing it , and be able to explain the
  assumptions underpinning their work (Howe 1987,
  Munro 1998)
• - New managerial reforms focus on efficiency
  and effectiveness ( Taylor and White 2000)
• - Provides a safety net
• Framework for action
• -By understanding a broad range of
  theoretical frameworks, we are in a good position
  to develop practice strategies (Healy 2005)
• Builds on experience and expertise
• Improving quality services

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What are the strengths and benefits of Evidence
based Practice?

• Argument for resources
• Can Change legislation
• Raises public awareness
• Allows one to anticipate and plan
• With out it social workers would be forced to
  invent social work from scratch every time they
  started work with a new client (Healy 2005)
• Ethical
• ethical duty to offer the most effective help
  (Trinder 2000)
• Improves the profile (and Status)of the
  profession
• A profession has
• a) Series of indispensible features
• b) Being founded on a mission of service
• c) The use of specialist and definable body of
  knowledge and set of skills
• d) Regulation of entry to the professional group
  by a professional body (Fooke 2006)

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Evidence Based practitioners

• Make a conscious effort to keep a breast of
  research and the implications for social work
  practice.
• Study the effectiveness of particular
  interventions.
• Openly reviews options with service users based
  upon a thorough assessment and understanding of
  what is known to be effective in similar
  situations.
• Are aware of the evidence base that underpins
  their practice
• Seeks to identify and understand assumptions
  which influence the evidence and their practice
• Critically reflect on their own practice to
  identify what is effective

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Integration Skills What Needs Integrating?
Haynes, Devereaux, and Guyatt, 2002
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Evidence Based Practice

• What do we understand by these terms as
  associated with social work
• Theory
• Research
• Model
• Method
• Values
• Identify an example for each of these terms

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Theory
A theory is a group of related concepts
hypothesis, and constructs based on facts and
observations, it attempts to explain a particular
phenomenon. Theories provide workable
definitions of the world about us. According to
Howe (1997), a clear theoretical perspective
guides and influences practice in five key areas
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• Read Paragraph
• What are the issues here?
• Theories do not stand in isolation many are
  underpinned or influenced by various assumptions.
  
• Psychologically based social work theories locate
  the cause of the distress and its solution in the
  client
• Sociological theories suggest that society causes
  problems for people and that society should be
  targeted for change
• P Green from the University of Glasgow provides a
  useful framework for analysis of Theory. (seminar
  groups will look at this further)

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Theory

• Observation it tells us what to see, what to
  look out for
• Description it provides a conceptual vocabulary
  and framework within which observations can be
  arranged and organised.
• Explanation it suggests how different
  observations might be linked and connected it
  offers possible causal relationships between one
  event and another
• Prediction it indicates what might happen next
• Intervention it suggests things to do to bring
  about change
• (Howe 1997)

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Research

• Research is seeking through methodological
  processes to add to ones own body of knowledge
  and hopefully to that of others, by the discovery
  of non trivial facts and insights (Howard,K.and
  Sharpe,J 1983)
• Research is a systematic way of asking questions,
  a systematic method of enquiry. It is a process
  of discovery, a way of enhancing your existing
  knowledge. It involves

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Methods of research

• Quantitative
• Qualitative
• Action
• Case Studies
• Ethnographic
• Narrative analysis

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Research

• Consider Table 1 or 2
• What does this tell us?
• What should we be careful of?
• How should we/not use this information?
• Always question research (see handouts).

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Models

• A model defines, describes and imposes an order
  on what might otherwise be a jumble of
  information. It provides structure, offering
  principles and patterns which help our
  understanding and retention of a vast amount of
  information (Payne 1997)

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(www.changecycle.com/changecycle.htm
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Models

• How would you critique this model?

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http//www.stevenmsmith.com/my-articles/article/th
e-satir-change-model.html
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Methods

• Forms of practice, the way in which activities
  are undertaken, the approach.
• These are often based on theory and or research
  (it may embrace 2 or 3 of these).
• The method may follow a particular model or may
  be influenced by different perspectives, values,
  legislation policy and guidance.
• When asked to discuss social work methods, we
  refer to formal methods as identified in the
  literature

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(No Transcript)
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Integration

Values and Beliefs
Values and Beliefs
Haynes, Devereaux, and Guyatt, 2002
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Values and beliefs

• Social Worker values and beliefs that will
  influence choice of theories methods
• attitudes towards
• Age
• Loss
• retirement
• bereavement
• abuse
• Gender
• Health and wellbeing
• holistic (social issues)
• influence of medical model
• Risk assessment
• Importance of protecting client from risk
• Importance of respecting clients wishes and
  seeking to minimise risk
• Clients right to self determination
• the right to decide what constitutes acceptable
  quality of life
• the right to a view on whats best for him that
  clashes with his family