157

Families in society: the Journal of contemporary social services ©2012 alliance for children and Families issn: Print 1044-3894; electronic 1945-1350

2012, 93(3), 157–164 Doi: 10.1606/1044-3894.4220

http://www.familiesinsociety.org/showabstract.asp?docid=4220

Practitioner Perspectives of Evidence-Based Practice tracy c. Wharton & Kathleen a. Bolland

social work practitioners decide when and how to use evidence in their practice. there remains, however, little evidence

to date about social workers’ perspectives about and implementation of evidence-based practice (eBP). this survey of a

national sample of social workers adds to our knowledge about how social workers locate information, how they deter-

mine the usefulness of the information, what barriers exist for the use of an eBP process, and whether their workplaces

are oriented toward eBP. Findings suggest that barriers may be more complex than previously reported, but that social

workers find evidence, read the professional literature, and consult with peers and mentors, often despite poor workplace

support. suggestions for dissemination of information are made, and a model of evidence use in practice is proposed.

imPliCations For PraCtiCe

• Practitioners generally first consider the proximal

similarity of information and the trustworthiness of the

source before directly translating research into their

clinical practice, thus demonstrating the importance of

clarity and transparency.

s ocial work practitioners determine when and how to use evidence in their practice; so it is practitio- ners who determine whether a new intervention

becomes embedded in practice, no matter how strong the evidence base. Certainly policy and other external pressures may inf luence the choices social workers make, but for interventions to remain viable options, the social workers and their clients must deem them useful and feasible. although top-down pressure may be embedded in the workplace, “individual acceptance of an innovation is proposed to rely on both organi- zational and individual factors” (aarons & sawitzky, 2006, p. 62).

The national institutes of health (nih) has identi- fied critical goals related to understanding “the nature and impact of clinical practice dissemination and im- plementation of social work services and interventions with proven effectiveness” (nih, 2007). additionally, the educational Policy and accreditation standards of the Council on social Work education (CsWe, 2008) make it clear that social work practitioners are expected to be evidence-based practitioners. two competency state- ments highlight this emphasis:

2.1.3: social workers distinguish, appraise, and integrate multiple sources of knowledge, including research based knowledge and practice wisdom.

2.1.6: social workers use practice experience to inform research, employ evidence-based interventions, evaluate their own practice, and use research findings to improve practice, policy, and

social service delivery. (Council on social Work education, 2008)

although there is a substantial body of work debating relative merits of evidence-based practice (ebP) and pro- posing models of practice and implementation, there is a surprising gap in direct feedback from the front lines of service—the “swampy lowlands of practice” (Crawford, brown, anthony, & hicks, 2002, p. 289). There is little clarity about what is considered as evidence by social work practitioners, how evidence is being accessed and applied, and what the barriers are to implementation of research-supported best practices (bellamy, bledsoe, & traube, 2006). Proctor (2007) pointed out that, histori- cally, research findings have not been used much in the delivery of services, and that social work education, at least through 2006, has been inadequate to prepare prac- titioners to implement an ebP process in clinical settings. regardless, there has been growing pressure on agencies and practitioners to use empirically supported treatments and to practice in an “evidence-based way,” with a num- ber of state legislatures moving toward requiring a cer- tain level of evidence for all mental health interventions (glisson & schoenwald, 2005; rapp, goscha, & Carlson, 2010; sheehan, Walrath, & holden, 2007).

Defining EBP in Practice

although in its infancy, there is a growing body of re- search on practitioners’ perspectives and practices about ebP (aarons & sawitzky, 2006; Mullen, bledsoe, & bel- lamy, 2008; Manuel, Mullen, fang, bellamy, & bledsoe, 2009; Mullen & bacon, 2004; olsson, 2007; Proctor, 2007; regehr, stern, & shlonsky, 2007). although some have ad- vocated for implementing practices with a strong evidence base (e.g., see glisson & schoenwald, 2005; sheehan et al., 2007), currently the call is for adoption of ebP as a process. grounded in the sackett definition: “The conscientious, explicit, and judicious use of current best evidence in mak- ing decisions about the care of individual patients…inte- grating individual clinical expertise with the best avail-

Families in society | Volume 93, no. 3

158

able external clinical evidence from systematic research” (sackett, rosenberg, gray, haynes, & richardson, 1996, p. 71), ebP is being defined in social work as “a decision- making process integrating best research evidence, practi- tioner expertise, and client or community characteristics, values, and preferences in a manner compatible with the organizational systems and context in which care delivery occurs” (Manuel et al., 2009, p. 614) and as “a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, search- ing objectively and efficiently for the current best evidence relative to each question, and taking appropriate action guided by evidence” (gibbs, 2003, p. 6). Proctor (2007) de- scribed the process approach required for implementing specific interventions:

evidence must be accessed, and potential ebPs need to be identified; the utility and advantages of ebPs must be accepted, and processes of critical thinking about evidence must be adopted; practices deemed most effective and appropriate need to be implemented with fidelity; and the effectiveness of the practices must be evaluated. (p. 584)

such definitions incorporate the language used by prac- titioners and touch on issues identified in this study as critical to consider, such as context, values, preferences, and efficiency. our study explored the definitions held by participants, in light of descriptions of ongoing efforts to engage practitioners in a process-oriented ebP model: regehr et al. (2007) eloquently noted that a “major chal- lenge includes continued education efforts to reconcile the (process-based) ebP model…with the complexity of popu- lations and issues dealt with by social work practitioners and agencies” (p. 415; emphasis added).

based on an extensive review of english-language lit- erature and a preliminary pilot study of mental health practitioners, this internet-based survey yielded both quantitative and qualitative data. The purpose was to in- crease knowledge about definitions of ebP currently used in social work practice settings, exploring the barriers and benefits to the uptake of an ebP practice model, social workers’ general feelings toward ebP, and the realities of enactment in practice.

a number of studies merit particular note. one (Manuel et al., 2009) investigated the barriers and facilitators to ebP enactment, comparing perceptions of ebP before and af- ter a training intervention at three sites. six studies used surveys with large samples. one investigated attitudes and beliefs about treatment manuals (addis & Krasnow, 2000); one investigated feelings about training and research skills (booth, booth, & falzon, 2003); one looked at views about practice guidelines (gerdes, edmonds, haslam, & Mc- Cartney, 1996); one examined evaluation of practice (Mul- len & bacon, 2004); one explored the relationships among

mental health providers’ opinions about organizational culture and climate and ebP (aarons & sawitzky, 2006); and one study, conducted in the united Kingdom, inves- tigated the attitudes, skill levels, and professional devel- opment opportunities related to research use in practice (sheldon & Chilvers, 2002). in another study, researchers conducted focus groups to explore attitudes and imple- mentation challenges toward ebPs in two community mental health centers (nelson, steele, & Mize, 2007), and in a similar study, researchers explored the perspectives of agency directors on the same topic (Proctor et al., 2007). a small mixed-method longitudinal study of an intensive program to embed a new cultural perspective in a group of community mental health practitioners followed 14 social workers at various levels of training in a single community mental health outpatient clinic for 2 years (gioia & dzi- adosz, 2008).

all the studies noted poor workplace support, specifi- cally for development of skills and encouragement of ap- plication of research. in all the studies, time, concerns about professional autonomy, power or control issues, and the sometimes questionable applicability of research find- ings to particular clients were noted as obstacles to use of research. The studies agreed, in general, that while practi- tioners may feel positively about the idea of ebP, there are varying degrees of workplace support for them to imple- ment such models; sheehan et al., (2007) found that 62% of the respondents in their study had no agency requirements to provide ebP. additionally, these studies agreed that is- sues such as population diversity and productivity require- ments may affect attitudes, and that rather than support- ing innovation, clinical supervision is usually focused on risk-management and administrative issues. all studies supported further research about practitioners’ behaviors and feelings about ebP.

Research Questions The purpose of this study was to increase knowledge about the current state of ebP in real-life social work practice settings. in the beginning of the survey, we did not define ebP for respondents, choosing instead to explore attitudes and beliefs about how it was being conceptualized and operationalized before providing a definition for respon- dents to use when responding to later survey questions. The definition we provided halfway through the survey was: “evidence-based practice is a process of including the best available research evidence alongside practice wisdom to make clinical decisions, and evaluating the outcomes of your decisions.”

This exploratory study was framed by the four following research questions: 1. What is being considered as evidence by social work

practitioners and how are they defining effective prac- tice in real-life settings?

2. What are the barriers that practitioners encounter in

Wharton & Bolland | Practitioner Perspectives of Evidence-Based Practice

159

accessing research evidence, and is there a difference between actual and perceived barriers?

3. is the social work practice environment oriented toward evidence-based practice?

4. What is the attitude of practitioners toward the con- cept of implementing an ebP model?

Sampling and Recruitment

This study focused on master’s-level social workers prac- ticing in the united states. unfortunately, it is impossible to get a list of names and contact information or even the number of master’s-level social workers practicing in this country. one report, published by the national associa- tion of social Workers (nasW) Center for Workforce de- velopment, noted that there may be as many as 840,000 practitioners, depending on the definition being used (nasW, 2006). a research service with the u.s. Postal service (usPs) has more than 600,000 individuals self- identified as social workers in the united states (Collins, personal communication, 2009). to reach a broad sample, we used three recruitment methods: direct email, social networking site invitations, and direct mail. a list of email addresses was obtained from nasW which contained 5,556 individuals having a master of social work (MsW) degree in the “education” category. of these, 1,666 had valid email addresses and had not opted out of surveys with survey Monkey. an initial email included informa- tion and a hyperlink; a reminder email was sent in the next month, and an email containing a thank-you for partici- pation and a reminder of the hyperlink was sent approxi- mately one month later. an invitation to participate in this research was posted on several social networking sites (e.g., facebook, linkedin). Where possible, the text used in the email invitations was used; where a simple, short post was required, a two-line invitation stating “Please help with re- search about social work practice. www.ebPsurvey.com” was posted. Posts were made on the same time schedule as the email invitations (i.e., whenever a post was sent to the email list, a social network post was made).

a mailing list was purchased from usPs, and postcards were created for a mailing using the usPs Click2Mail ser- vice. a usPs staff researcher pulled 1,000 random entries of people who self-identified as social workers. The list was scanned by that researcher to ensure that there were no du- plicates, and mailing addresses were provided. The usPs staff researcher indicated that her search returned indi- viduals identified as working in a variety of types of social work practice fields (e.g., school, medical, child, gerontol- ogy), as well as a geographically diverse sample. The search universe was reported as approximately 600,000 people. one thousand records were purchased and uploaded di- rectly to the postcard service, where 4 × 6 postcards were printed and mailed. of these, 144 were returned as unde- liverable; we presume the remaining 856 were delivered.

a total of 228 individuals logged on to take the survey. of these, 69 were excluded as a result of nationality other than united states or because it was not clear that they had earned an MsW, leaving a total of 159.

The Survey The survey consisted of 32 closed-response questions and four open-ended questions. There were comment fields af- ter each question, and a comment field at the end of the survey. respondents could skip questions or stop and return later to complete the survey. it was posted online using survey Monkey after institutional review board ap-

Table 1. Descriptive Information of Sample (N = 159) Characteristics M range

age 58 28–77

Year of MsW 1982 1957–2009

Caseload size 27 1–90

n %

gender

female 124 78

Male 29 18

no response 6 4

race/ethnicity

White 137 86

non-White (all categories) 17 11

no response 5 3

Practice setting

Private practice 77 48

nonprofit 25 16

government/public 19 12

Medical/palliative 13 8

education (all types combined) 11 7

other 5 3

Works with more than one type of population

109 69

has a workplace policy about ebP 22 14

regularly reads journal articles 115 72

regularly consults with peers 114 72

regularly consults with supervisors/experts

111 70

regularly gets practice information from the internet

110 69

subscribes to a professional mailing or e-list

77 48

uses professional org. websites to find practice info

71 45

uses popular search engines to find practice info

65 41

uses WebMd to find practice info 54 34

Families in society | Volume 93, no. 3

160

proval was obtained. during survey development, consul- tation was sought from several social work practitioners to ensure that jargon was kept to a minimum and that language use was appropriate. after a pilot test (n = 89), several changes were made to streamline and shorten the survey as much as possible.

findings

Who Responded to the Survey? The convenience sample (n = 159) consisted of experienced, licensed social workers from across the united states, with a mean age of 58 years, which is somewhat older than respondents in other available studies (Whitaker & ar- rington, 2008). They tended to have obtained their MsW degrees in the early 1980s. They were more likely than not to be female and White. They generally had access to the internet at home and work, and were highly likely to be subscribed to electronic discussion groups or organiza- tional email lists. in general, this group worked in one or two settings, with nearly half working in a private practice setting at least part of the time. They worked with more than two types of client population groups and had a mean caseload size of 27, ranging from an average of 26 in private practice to 53 in public settings. see table 1 for a summary of descriptive information.

How Do Social Workers Make Practice-Related Decisions and How Do They Feel About EBP? Consistent with previous findings (nelson et al., 2007), respondents to this survey were more likely to consult with peers or mentors than to seek relevant research before making practice decisions. They relied on their training and experience and they were influenced heav- ily by clinical observation and common sense, being more likely to rely on a comparative, intuitive approach to thinking about research than on an empirical evalu- ation of applicability. Practice-based evidence appeared to guide most of their practice decisions, because they believed that research is often produced outside of real- life settings.

ebP appeared to be perceived as more technical (i.e., the use and application of specific practices) than pro- cedural—a finding that is consistent with previous re- search indicating that perceptions of ebP may be a bar- rier to uptake (Manuel et al., 2009; regehr et al., 2007). although practitioners may be making decisions based on subjective criteria, they are not opposed to a procedur- al approach to ebP, where several types of information (such as practice wisdom, client preference, and contex- tual issues) are considered alongside empirical evidence. respondents indicated that they had skills and access to literature, as well as an inclination to stay current on available research, despite, as one respondent put it, “how boring it is” to read.

Where Do Social Workers Get Evidence for Practice? nearly 70% of respondents (111 of 159) indicated that they consult with supervisors or experts; 114 respondents indicated that they regularly consult with peers, and 104 of these did so frequently. Consulting with peers, men- tors, supervisors, or experts was a distinctly preferred op- tion for decision making in practice, over other choices such as accessing journal articles or research databases, although searching the internet using popular search en- gines, WebMd, or professional organizational informa- tion pages was common.

few people (n = 13) indicated that accessing a database would be their first or second choice for getting informa- tion about treatment decision making, although a sub- stantial number of people (n = 94) indicated that they had accessed one, with only 20 people indicating that they never had. a majority of the respondents (n = 77) were subscribed to an organizational mailing or e-list, and more than two thirds of the sample (n = 110) indicated that they conducted internet searches regularly for prac- tice-related information. The most popular places for ob- taining information seemed to be portals of professional organizations, such as the nasW, american evaluation association, and american Psychological association (n = 71), with standard, popular search engines such as google, Yahoo, or university-based search engines (n = 65), and WebMd (n = 54) also quite popular.

How Do Social Workers Determine the Utility of Evidence and the Validity of Expertise? respondents to this survey reported that they make these determinations by applying practice wisdom; consider- ing the context in which they work; comparing client details to those found in research; and consulting with peers, mentors, and experts. as consulting with experts appears to be a deeply embedded behavior for the practi- tioners in this survey, the perception of what constitutes an expert is important. respondents to the survey ques- tion “What do you think makes someone an expert?” were definitive in their assertion that practice experience, preferably over an extended period of time, is critical. in addition, an ability to understand and conduct research, backed up with appropriate training and credentials, was noted as an important quality.

Are Workplaces Oriented Toward EBP? although many respondents to this survey were private practitioners, their practice environment is as important as the environment of agency-based practitioners: The im- pact of a variety of systems, such as insurance and billing requirements, client needs or preferences, and political or professional pressure may be constantly in play. over- whelmingly, respondents indicated they had internet ac- cess at work, as well as access to research databases and

Wharton & Bolland | Practitioner Perspectives of Evidence-Based Practice

161

journal articles. They generally consulted with supervisors or experts at least monthly, with a few indicating that they did not engage in this behavior. They endorsed behaviors related to continuing education. only 22 people indicated that their workplace had a policy related to ebP. although this sample is heavily weighted toward private practice, this same trend can be seen in respondents from nonprofit and government/public settings; there may be differences in policy implementation across types of practice fields, although the small sample size in this study prevented deeper investigation of this point. These data suggest that social workers in private practice are less likely than oth- ers to be asked to justify treatment choices or to be asked specifically about evidence-based or research-informed practice, although this is not universally true. The heavy bias toward private practice in this sample precluded solid examination of this area.

in general, this group of people regularly accessed super- visors or experts, although a significant segment of private practitioners indicated that they received no formal super- vision, but consulted with experts or mentors as needed. They participated in continuing education opportunities and attended conferences at least annually, tended to have no imposed policies related to ebP, were not frequently asked about ebP concepts, and were not often asked to jus- tify their treatment choices. Their work environments ap- peared to offer access to research information and the time to consume it, although there was little encouragement to use research findings.

Barriers to Uptake There appeared to be some difference between barriers per- ceived to be problematic for the profession as a whole and barriers actually experienced by the people who responded

to the questions (see table 2). although lack of time to ac- cess literature was endorsed by respondents as a barrier to ebP in the profession as a whole, when asked specifically about the frequencies of those behaviors, the majority of this sample indicated that they did have time in their work schedule to access and read research. More than half of the respondents indicated that they read journal articles and other professionally oriented material at least monthly. The issue here may be more closely related to time management than to the simple provision of time. family commitments was also both endorsed and perceived as a barrier to con- suming research, which may be related to the issue of time management, because family responsibilities may burden the ability to manage time for searching and reading.

access and cost were recognized as important barriers, although not substantially so. respondents’ reports that they regularly read research literature and attend con- tinuing education and conferences seem to indicate that these are not substantial barriers. Perhaps there are unseen trade-offs; while some access is clear, given less cost or in- creased opportunity, greater engagement might occur. it seems logical that if people endorse cost and lack of access as barriers, but demonstrate that they engage in associated behaviors anyway, there must be some decision points sur- rounding trade-offs regarding accessing information.

both lack of knowledge and overwhelmingness (i.e., re- search is overwhelming to read) were perceived to be more significant barriers to the profession as a whole than to the individuals who responded to the question, although most people did not find them to be important issues. These find- ings are supported by narrative data, which indicate that there is a general feeling that social workers have the skills to consume research and do not find it overwhelming, al- though they may find it “boring” or not relevant to their clinical practice. experience with research, or the ability to understand and interpret it, though, were identified as qualities in an expert; so it seems likely that although most respondents felt sufficiently able to engage with research on their own, they felt that there were people who could do it better than they. given that consulting with others is an embedded practice, relative ability to access and consume research information might be less important. if practitio- ners had regular access to experts, they might not need to have the expertise to understand complicated data, since there would be support available to help it make sense.

Implications for Social Work Practice

The William t. grant foundation (2010) identified sever- al different types of evidence use, based on Weiss, nutley, and davies’s definitions of evidence. Instrumental use de- scribes information used directly in practice; conceptual use describes instances where understanding is changed by exposure to information; and imposed use describes instances where use of information is mandated by

Table 2. Barriers Toward Utility of Evidence-Based Practice

Problem for profession

Problem personally

barriers M (SD) M (SD) significant difference

time 1.54 (0.73) 1.76 (0.93) .004**

access 2.59 (1.07) 2.73 (1.03) .152

Cost 2.18 (0.99) 2.54 (1.16) <.001**

skills/lack of knowledge to interpret

2.63 (0.99) 3.21 (0.88) <.001**

research is overwhelming

2.45 (0.97) 3.04 (0.96) <.001**

family commitments

2.05 (0.88) 2.23 (0.99) .045*

lack of workplace support

2.23 (1.17) 2.84 (1.22) <.001**

Note. scale: 1 = very important to 4 = definitely not important (higher score = less important). two-tailed test: *significant at 0.05; **significant at 0.01.

Families in society | Volume 93, no. 3

162

policy. Most respondents to this survey seemed to ap- proach information use as conceptual, expecting research information to change how they understood something. relatively rarely did the respondents apply information instrumentally—directly translating research into their clinical practice—without first considering its proximal similarity or trustworthiness and consulting other sourc- es. it also appeared that there was concern, both in the literature and among respondents to this survey, that use of evidence would be imposed, forcing practitioners to give up flexibility and to sacrifice client preference, points that are identified as deeply embedded aspects of social work practice (nelson et al., 2007; regehr et al., 2007). such concerns are well founded, as some states have be- gun to restrict the types of interventions and practices that can be used with some populations to include only “evidence-based” ones, and there is pressure from some research and academic sectors to reduce practice to ap- proaches that can be empirically measured and proven effective (institute for the advancement of social Work research, 2007; rapp et al., 2010).

Consistent with previous research, there was concern among these respondents about “lack of fit of the evi- dence with the complexities of…practice, including the diversity of clients, situations, and circumstances” (Man- uel et al., 2009, p. 623). although attitudes about ebP were fairly positive in general, there was concern about research being created by sources outside the practice

field. This finding has an important implication for re- searchers: Knowing that practitioners consider the proxi- mal similarity of the data and the trustworthiness of the source, making these things clear and transparent could assist practitioners in translating research to practice. additionally, the dissemination of information with an eye toward the locating mechanisms being used by prac- titioners could assist in increasing reach. The knowledge that peer consultation, continuing education, and inter- net searches through professional networking sites and popular search mechanisms are the preferred means of getting information for practice is quite valuable. by tar- geting the dissemination of empirical evidence through these channels, a broader access may be facilitated than by compiling collections of systematic reviews in less fa- miliar or inaccessible databases, a sentiment consistent with previous findings (Mullen et al., 2008; nelson et al., 2007). although respondents indicated that lack of skills was not an issue, the extent to which this is actually true is unclear, and it is possible that limited or rusty skill sets related to database use may have limited the inclination to use research-oriented search engines or databases, when easier and faster approaches were readily available.

although practitioners in this study had access to the internet and to research information, it is important to recognize that few workplaces have policies related to the use of an ebP practice model, and that practitioners are not frequently asked to justify their treatment choices.

Figure 1. Instrumental and conceptual evidence use in practice.

Training and experience

Setting context

Political or external pressure

Resources

Instrumental use of evidence

Conceptual use of evidence

Intermediary organizations

Acquisition & interpretation of

research evidence

Proximal similarity & trustworthiness of

source

Interactions with peers & experts

Wharton & Bolland | Practitioner Perspectives of Evidence-Based Practice

163

although access is a necessary first step, explicit support within the work environment would have direct practice implications in this area. no matter the personal orienta- tion of a social worker, if the workplace is not supportive of good practice habits such as supervision, continuing edu- cation, clear formulation of treatments, and use of research findings, there is little chance that behaviors will become embedded in the worker’s practices. additionally, barriers to ebP in clinical settings, such as skills, time, and access, might be mitigated by other factors; time management and lack of agency support, for example, can be addressed through formal or in-service education as administrators become aware of these issues.

findings from this study can be framed in a model to describe how practitioners use evidence (see figure 1). This model includes two ways evidence might be used: instru- mental use (directly putting something into action) and conceptual use (changing the way information is under- stood). in this model, all factors but one related to instru- mental use of evidence are routed through a decision point about proximal similarity and trustworthiness of source. evidence may be acquired through training and experi- ence, from interactions with peers, experts, or intermedi- ary organizations (such as the nasW); these in turn are influenced by political or external pressures and setting context. The same routes of information acquisition ap- ply to the conceptual use outcome, with the exception that practitioners may not feel the need to decide the proximal similarity or trustworthiness of source in the same way, as this outcome is primarily concerned with a conceptual un- derstanding and not a direct translation of research into action. The model acknowledges that there are instances in which political pressures may change settings and influ- ence resources, which may have a direct impact on the in- strumental use of evidence in practice, circumventing the judgment of individual practitioners.

Limitations and Proposed Future Research The small sample size limits the consideration of contrib- uting details, such as practice environment, and use of a convenience sample limits the generalizability of the con- clusions. although respondents resembled “typical” social workers in many ways (see section “Who responded to the survey?” and table 1), they tended to be a little older; younger social workers, educated since the 1980s, might have somewhat different attitudes and practices with re- spect to ebP. one might also speculate that social workers less inclined to respond to internet surveys might also be less inclined to use the internet to seek evidence regarding practice, but we hesitate to make such a suggestion, absent evidence. Certainly the findings suggest trends that call for further investigation.

a more in-depth investigation of the differences be- tween private practice and other fields of social work prac- tice is clearly called for by this research. Just as previous

research uncovered differences across settings (Manuel et al., 2009; Mullen & bacon, 2004; nelson et al., 2007), in- formation that sheds light on the uniqueness of work in the private sector and the factors at work in such environments could be extremely valuable to the profession. similarly, as consultation with peers, experts, and mentors is clearly indicated as a source of information and support among practitioners in this study, further investigation of this phe- nomenon is called for. finally, with ever-increasing and un- precedented global access to information, consideration of the differences in acquisition and interpretation of research evidence is needed. While social workers are faced with similar tasks and professional parameters, the contexts in which they practice, the political and external pressures, and the resources available vary widely. how research in- formation is obtained, how utility of information is deter- mined, and how decisions are made about client treatment are important pieces of information that could introduce better ways of disseminating information and supporting the technical needs of social workers in practice.

References aarons, g., & sawitzky, a. (2006). organizational culture and climate

and mental health provider attitudes toward evidence-based practice. Psychological Services, 3(1), 61–72.

addis, M. e., & Krasnow, a. d. (2000). a national survey of practicing psychologists’ attitudes toward psychotherapy treatment manuals. Journal of Consulting and Clinical Psychology, 68(2), 331–339.

bellamy, J., bledsoe, s., & traube, d. (2006). the current state of evidence based practice in social work: a review of the literature and qualitative analysis of expert interviews. Journal of Evidence- Based Social Work, 3, 23–48.

booth, s. h., booth, a., & falzon, l. J. (2003). the need for information and research skills training to support evidence- based social care: a literature review and survey. Learning in Health and Social Care, 2(4), 191–201.

Council on social Work education. (2008). Educational policy and accreditation standards handbook. alexandria, Va: author.

Crawford, P., brown, b., anthony, P., & hicks, C. (2002). reluctant empiricists: Community mental health nurses and the art of evidence-based praxis. Health and Social Care in the Community, 10(4), 287–298.

gerdes, K., edmonds, r., haslam, d., & McCartney, t. (1996). a statewide survey of licensed clinical social workers’ use of practice evaluation procedures. Research on Social Work Practice, 6(1), 27–39.

gibbs, l. (2003). Evidence-based practice for the helping professions. Pacific grove, Ca: brooks/Cole.

gioia, d., & dziadosz, g. (2008). adoption of evidence-based practices in community mental health: a mixed-method study of practitioner experience. Community Mental Health Journal, 44, 347–357.

glisson, C., & schoenwald, s. (2005). the arC organizational and community intervention strategy for implementing evidence- based children’s mental health treatments. Mental Health Services Research, 7(4), 243–259.

institute for the advancement of social Work research. (2007). Partnerships to integrate evidence-based mental health practices into social work education and research. report from april 12, 2007 symposium sponsored by the national institute of Mental health. Washington, dC: author.

Families in society | Volume 93, no. 3

164

Manuel, J., Mullen, e., fang, l., bellamy, J., & bledsoe, s. (2009). Preparing social work practitioners to use evidence-based practice: a comparison of experiences from an implementation project. Research on Social Work Practice, 19(5), 613.

Mullen, e. J., & bacon, W. (2004). a survey of practitioner adoption and implementation of practice guidelines and evidence based treatments. in a. r. roberts & K. Yeager (eds.), Evidence based practice manual: Research and outcome measures in health and human services (pp. 210–218). new York, nY: oxford university.

Mullen, e., bledsoe, s., & bellamy, J. (2008). implementing evidence- based social work practice. Research on Social Work Practice, 18(4), 325–338.

national association of social Workers. (2006). licensed social workers in the united states, 2004. supplement: Chapter 2: Who are licensed social workers? NASW Membership Workforce Study. Washington, dC: nasW Center for health Workforce studies.

national institutes of health. (2007). Research on Social Work Practice Concepts in Health (R01), PA-07–292 (funding opportunity announcement). Washington, dC: retrieved from http://grants. nih.gov/grants/guide/pa-files/Pa-07-292.html

nelson, t., steele, r., & Mize, J. (2007). Practitioner attitudes toward evidence-based practice: themes and challenges. Administration of Policy in Mental Health & Mental Health Services Research, 33, 398–409.

olsson, t. (2007). reconstructing evidence based practice: an investigation of three conceptualisations of ebP. Evidence and Policy, 3(2), 271–285.

Proctor, e. (2007). implementing evidence-based practice in social work education: Principles, strategies, and partnerships. Research on Social Work Practice, 17(5), 583–591.

Proctor, e., Knudsen, K., fedoravicius, n., hovmand, P., rosen, a., & Perron, b. (2007). implementation of evidence-based practice in community behavioral health: agency director perspectives. Administration and Policy in Mental Health, 34, 479–488.

rapp, C., goscha, r., & Carlson, l. (2010). evidence-based practice implementation in Kansas. Community Mental Health Journal, 46, 461–465.

regehr, C., stern, s., & shlonsky, a. (2007). operationalizing evidence- based practice: the development of an institute for evidence- based social work. Research on Social Work Practice, 17(3), 408–416.

sackett, d., rosenberg, W., gray, J., haynes, r., & richardson, W. (1996). evidence-based medicine: What it is and what it isn’t. British Medical Journal, 312(7023), 71–72.

sheehan, a., Walrath, C., & holden, e. W. (2007). evidence-based practice use, training and implementation in the community- based service setting: a survey of children’s mental health service providers. Journal of Child and Family Studies, 16, 169–182.

sheldon, b., & Chilvers, r. (2002). an empirical study of the obstacles to evidence-based practice. Social Work & Social Sciences Review, 10(1), 6–26.

Whitaker, t., & arrington, P. (2008). social workers at work. NASW Membership Workforce Study. Washington, dC: national association of social Workers.

William t. grant foundation. (2010). understanding the acquisition, interpretation, and use of research evidence in policy and practice (request for research proposals). Research Use RFP 2010. Washington, dC: author.

Tracy c. Wharton, PhD, lCsW, senior research specialist, Va ann arbor Healthcare system Geriatric research, education and Clinical Center. kathleen A. Bolland, PhD, assistant dean, educational Pro- grams and student services, University of alabama school of social Work. Correspondence: [email protected]; Veterans administra- tion GreCC, 2215 Fuller road (11G), ann arbor, mi 48105. Authors’ note. We wish to thank Christy Gabany for her assistance in the preparation of this manuscript. the opinions expressed herein are those of the authors and do not necessarily reflect those of the U.s. government or any of its agencies.

manuscript received: september 13, 2011 revised (1): november 25, 2011 revised (2): march 7, 2012 accepted: march 9, 2012 Disposition editor: susan e. mason

Executive-, Senior-, and Management-Level Positions

H u M a n S E rv i c E S coMP EnSat ion

in the United StateS

The Latest competitive Data to attract and Retain the Best talent

20 12

Questions: 414-359-6578 alliance1.org/pubs/compensation

©2012 Alliance for Children and Families. All Rights Reserved. 12-117

Report provides data about compensation for management positions, including:

• Current compensation practices and packages with details about salaries, benefits, and personnel practices

• Compensation data breakdowns by organization budget category, organizational structure, geographic region, individuals’

educational degree, and years in the human services industry

• Information pertaining to level of education (New to 2012 report)

12-117 ERS 2012 Comp Report Ad.indd 1 7/19/12 1:47 PM

79

Families in society: the Journal of contemporary social services ©2013 alliance for children and Families issn: Print 1044-3894; electronic 1945-1350

2013, 94(2), 79–84 Doi: 10.1606/1044-3894.4283

Evidence-based practice or Evidence-guided practice: A Rose by Any Other Name would Smell as Sweet [Invited Response to gitterman & knight’s “Evidence- guided practice”] Bruce a. thyer

Gitterman and Knight (2013) expand upon the original model of evidence-based practice (eBp) by proposing an

approach they label evidence-guided practice (eGp). they justify this by highlighting some supposed limitations of

the original eBp model and by presenting some additional features to amend eBp into eGp. i attempt to show that

the limitations they say characterize eBp are not actually a part of the real eBp model and are based upon either a

misreading of the eBp literature, or by overlooking some of the features of eBp. i also try to demonstrate that most

of the add-on elements to eBp they propose to label eGB are actually already present in the original model of eBp.

one of their add-ons, an increased reliance upon formal theory as evidence, in addition to empirical research, seems

to me a retrograde step and will perpetuate the harmful influence of some aspects of theory in social work practice.

However, i judge their eGp model to be an improvement upon current social work practice, which largely tends to

ignore empirical research findings to assist in decision making.

i t is encouraging to see such distinguished social workers as Alex Gitterman and Carolyn Knight (2013) address the issue of evidence-based practice (EBP), try and identify

some of the shortcomings of EBP, and propose some con- structive improvements for the model of EBP, resulting in a related perspective they label “evidence-guided practice” (EGP). In their article I find a number of points about EBP and its supposed limitations that have appeared in the social work literature, as well as a number of new ideas. Their goal is admirable—to improve upon the practice models which can promote social workers’ efforts to improve practice outcomes. I share this goal and it is in this spirit that I will try and address what I believe to be some misconceptions in their presentation of EBP—misconceptions which, once cor- rected, demonstrate that EBP already possesses most of the features of their proposed alternative, evidence-guided prac- tice. It goes without saying that I appreciate their willingness to engage in this dialog, as well as the invitation from the co-editors of Families in Society to author this response. It is worth noting that the first article introducing the topic of evidence-based practice to a social work audience appeared in this journal (Gambrill, 1999).

to begin my response in a simplified manner, it seems to me that gitterman and Knight (2013) make some claims about the model of ebP and say it is associated with certain limitations or undesirable features, which i will generically call features abC. They propose their alternative model, egP, which is said to possess the more desirable attributes of features XYZ. What i will try and do in this response is to demonstrate that the undesired features abC said to characterize ebP, are actually not a part of the ebP model. Moreover, i will try and demonstrate that the desired features XYZ are ac-

tually already present in ebP. Thus, there is no need for any modification or amplification of ebP as it is pres- ently construed in the primary sources of information about this practice model.

Undesired Features Said to be Associated with Evidence-based practice

evidence-based proponents argue that social workers should base their practice decisions on a critical review of available intervention strategies for particular client’s challenges and difficulties. the intent is to identify and employ those techniques that have been found to help an individual, family, or group with a specified problem. the social worker selects the most relevant, empirically verified approach. (gitterman & Knight, 2013, p. 70)

This misrepresentation asserts that the social worker selects the intervention based on the research evi- dence. There is no apparent role for client input or consideration of other factors, such as environmental considerations. in reality, ebP is much more holistic than that. so that the reader has a clear understand- ing of what ebP really is, i provide the definition pub- lished originally in Evidence-Based Medicine (now in its fourth edition):

evidence-based medicine (ebM) requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances....by patient values we mean the unique preferences, concerns and expectations each

Families in society | Volume 94, no. 2

80

patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient....by patient circumstances we mean their individual clinical state and the clinical setting. (straus, glasziou, richardson, & haynes, 2011, p. 1, emphasis in original)

understanding this definition of real ebP is cru- cial to avoid any implication that ebP is only about research evidence. it is equally about client values, expectations, and circumstances. research does not trump these other considerations—they are all equally and compellingly important. This is largely ignored in presentations on ebP which appear in the social work literature and convey the impression that in ebP one merely selects the best supported treatments. This is a massive distortion and its repetition is likely respon- sible for some of the resistance to this approach.

since the professions of social work and medicine have different functions, social work’s renewed reliance on medical tenets is puzzling. (gitterman & Knight, 2013, p. 71)

This is the hoary canard that ebP is a medical model. it is not. it originated in medicine, but is itself atheo- retical with respect to etiology (biological or psychoso- cial), neutral with respect to who provides the services (physicians versus social workers), and neutral with respect to what those services should be (e.g., biologi- cal or psychosocial). in contrast, the medical model asserts that a given condition has a biological etiology, interventions are focused on biological interventions such as drugs or surgery, and the service providers should be physicians. ebP possesses none of these fea- tures of the medical model. ebP is a broadly scientific model but its origins in medicine need no more imply adherence to a medical model than the use of split-plot factorial studies in social work research means that one is following an agricultural model (from whence r. a. fisher derived this type of experimental design in statistical science). The disciplinary backgrounds of the founders of a model need have no direct bearing on that model’s applicability to social work. ebP is being widely adopted across all the health care and human service professions because of its utility in operation- alizing a more scientific approach to practice, not be- cause it is somehow intrinsically medical.

evidence-based practice proposes that specific interventions exist to solve most types of problems, and social workers can find them and then use the most effective—the “best”—intervention. (gitterman & Knight, 2013, p. 71)

no, ebP requires one to search the current best litera- ture to find out what methods of assessment and inter- vention possess the greatest amount of scientific sup- port. There is no a priori assumption that the answer already exists, only the mandate that one seek out the available evidence. and there is no assertion that one must use the “best” evidence, if the most promising in- terventions are somehow unsuitable. amputation of the hands of convicted thieves might effectively deter na- scent criminals from stealing, but the ethics and laws of our country prohibit cruel and unusual punishment. if a client is clinically depressed, the research might well indicate that cognitive behavior therapy (Cbt) is a well-supported treatment. if, however, the client was intellectually disabled and unable to comply with the self-monitoring and homework exercises required of Cbt, the evidence-based social worker may suggest an intervention less well-supported. a practitioner can still adhere to the original ebP model while not offering the best research-supported interventions if there are con- flicting or counterproductive ethics, client preferences and values, or environmental considerations present. This flexibility is inherent in the approach.

Complex social problems do not lend themselves to narrow and discrete interventions that are the foundation of evidence-based practice. (gitterman & Knight, 2013, p. 71)

it depends. sometimes complex social problems require complex interventions, and sometimes they respond well to simple interventions. ebP lends itself equally well to simple as well as complex interventions. Witness the large amount of work being undertaken in the field of social policy using the traditional ebP model (boruch, 2012; bogenschneider & Corbett, 2010; Vanlandingham & drake, 2012) and the fine work of the Coalition for ev- idence-based Policy (see http://coalition4evidence.org). a review of the completed systematic reviews available on the websites of The Campbell Collaboration (http:// www.campbellcollaboration.org) and The Cochrane Collaboration (http://www.cochrane.org) reveals many examples of complex health and social problems (e.g., the effectiveness of welfare-to-work programs) which have been extensively investigated using high-quality research studies. What alternative to evidence-based practice do we have to tackle complex social problems? The status quo?

evidence-based social work practice emphasizes studies that typically involve brief, cognitive, and skill-focused interventions...less straightforward, harder-to-measure problems and interventions are excluded. (gitterman & Knight, 2013, p. 71)

Thyer | Evidence-Based Practice or Evidence-Guided Practice: A Rose by Any Other Name Would Smell as Sweet

81

similar complaints have been registered with respect to the application of randomized controlled trials (rCts) in general. if the advocates of longer term and more complex interventions fail to undertake cred- ible evaluations of their own methods, whose fault is that? are we surprised that a new model such as ebP is initially explored with simpler practice issues rath- er than more complex ones? There is a natural pro- gression to the types of intervention research studies needed to investigate the effectiveness of treatments, usually from simpler to more complex problems, in- terventions, and environments. This can take many years. but it is being done.

There is nothing with the original model of ebP to preclude more complex studies. in any event, this sup- posed limitation is being overtaken by events since rCts, meta-analyses, and systematic reviews are being conducted on complex problems and interventions. to illustrate, the december 2011 issue of the Clinical Social Work Journal contains a number of articles discussing a widely cited meta-analysis of the effectiveness of long- term psychodynamic psychotherapy. see also rosebor- ough, Mcleod, and bradshaw (2012) for an innovative social work outcome study on psychodynamic psycho- therapy, and drisko & simmons (2012) for a compre- hensive survey of the evidence base for psychodynamic psychotherapy. ebP places no limitations on the types of problems investigated or interventions tested. if an intervention can be applied, its outcomes can be evalu- ated. if client functioning can be validly measured, the potential impacts of intervention can be assessed. More complex interventions and problems increase the diffi- culty of the task but they do not preclude it.

the realities of contemporary social work practice work against a purely evidence-based orientation. Most social workers simply do not have access to bibliographic databases and the peer-reviewed literature, both of which are required to practice from an evidence-based foundation...practicing social workers lack the skills and expertise necessary to operate from an evidence-based foundation. (gitterman & Knight, 2013, p. 72)

The increasing ease of access to these databases and literature is rendering this point moot. Much useful information is available via open-access electronic sources (see, for example, gary holden’s wonderful resource information for Practice, available at http:// ifp.nyu.edu/); government-maintained websites, such as the national registry for evidence-based Programs and Practices, supported by the substance abuse and Mental health services administration (see http:// www.nrepp.samhsa.gov); and the national Coalition for evidence-based Policy, cited above. greater num-

bers of colleges grant library access privileges to their alumni. at one point, office computers were said to be too expensive to be made widely available for use by social workers. time took care of that problem. The problem of limited access to the research literature is similarly being taken care of. regardless, this limita- tion is one that is shared with gitterman and Knight’s alternative, egP, which also requires access to such da- tabases and literature.

it is embarrassing and limiting for us to assert that our graduates lack the skills and expertise necessary to operate from an ebP perspective. again, if true, whose fault is this? are social workers any less intelligent or re- search-trained than, say, nurses, public health workers, or other largely bachelor’s- and master’s-level profes- sions which have widely adopted ebP? We have barely begun focusing our professional training in the research skills needed to effectively engage in ebP (shlonsky, 2009)—namely how to formulate answerable questions (gambrill & gibbs, 2009), track down the best available literature (rubin & Parrish, 2009), critically analyze it (bronson, 2009), apply any lessons learned to our work with our own clients, and evaluate our effectiveness in carrying out ebP. instead, we teach a wide array of re- search methods with little connection to those needed to carry out ebP (e.g., how to conduct a survey study), in lieu of how to conduct outcome research on our own practice—a crucial skill needed for ebP.

Desired Features Said to be Associated with Evidence-guided practice

We intentionally use the term evidence-guided to refer to an approach to practice in which interventions are suggested, rather than prescribed, by research findings...it also recognizes the uniqueness of the individual and the inherent dignity and worth of the person. evidence-guided practice reinforces client empowerment and clients’ right to self- determination...it adopts an ecological view of client problems and worker interventions. (gitterman & Knight, 2013, p. 72–73, emphasis in original)

Yet, these features are also true of ebP. The evidence in ebP is only used as a guide, and taken into account when considering clients’ preferences and values, professional ethics, and clinical and environmental circumstances. it only takes a reading of the primary sources describ- ing ebP to realize this. for example, here is what the founder of the term evidence-based medicine, gordon guyatt, asserted as central to this model:

as a distinctive approach to patient care, ebM involves two fundamental principles. first, evidence alone is never sufficient to make a clinical decision.

Families in society | Volume 94, no. 2

82

decision makers must always trade the benefits and risk, inconvenience and costs associated with alternative management strategies, and in doing so consider the patients values. (guyatt & rennie, 2002, p. 8, emphasis added).

Knowing the tools of evidence-based practice is necessary but not sufficient for delivering the highest quality of patient care. In addition to clinical expertise, the clinician requires compassion, sensitive listening skills, and broad perspectives from the humanities and social sciences. these attributes allow understanding of patient’s illnesses in the context of their experience, personalities and cultures...for some of these patients and problems, this discussion should involve the patient’s family. for other problems-attempts to involve other family members might violate strong cultural norms. (guyatt & rennie, 2002, p. 15, emphasis added)

understanding and implementing the sort of decision-making process patients desire and effectively communicating the information they need requires skills in understanding the patient’s narrative and the person behind that narrative... Most physicians see their role as focusing on health care interventions for their patients....they focus on individual patient behavior. However, we consider this focus too narrow....Physicians concerned about the health of their patients as a group, or about the health of the community, should consider how they might contribute to reducing poverty (guyatt & rennie, 2002, p. 16, emphasis added)

any presentation of ebP that solely focuses on ap- plying research evidence to make important practice decisions and ignores the unique features of indi- vidual clients or larger societal or contextual issues is either a mischaracterization, a misunderstanding, or uninformed.

unlike evidence-based practice, egP explicitly recognizes relevant theory. theories, as well as research, provide significant guidelines for practice.... evidence-guided practice reflects...a solid grounding in theory. (gitterman & Knight, 2013, p. 74)

This is a legitimate observation, but i consider the atheoretical nature of ebP to be a strength, not a limi- tation to this approach. although nothing in the ebP model precludes a judicious consideration of relevant theory as possibly pertinent to one’s searching for evi- dence, in terms of helping to make practice decisions it posits a decided preference for relying on sound data-based studies in lieu of theoretical conceptualiza-

tions. Though there is nothing as practical as a good theory, there is also nothing as harmful as a bad one (Thyer, 2012). Many theories in social work have been and are actively injurious to practitioners and clients. They waste our time, most are not well-supported empirically, and many have led to the development of interventions which do not work and in some cas- es are harmful. give me a good empirical study over theoretical speculation any time. given how academic social work has traditionally prized theory develop- ment and extension (Thyer, 2002), i suspect that the relative lack of focused attention on theory in ebP is a source of much resistance to this model, as it flies in the face of some our most cherished views. Yet egP provides no guidance on how to select theory—surely all theories are not equally valid? ignoring this issue leaves the field wide open to every wildly speculative conceptualization proposed by someone. We now have social workers being taught reiki (using one’s hands to realign a client’s supposed invisible body energies) by our academic programs (i am not making it up), as if it were a legitimate model of practice for our field. Why? because it is an appealing theory to some.

When social workers rigidly adhere to prescribed interventions, they are unable to be authentically present or actively listen to clients’ verbal and nonverbal responses. [gitterman and Knight go on to critique the use of practice manuals.] (gitterman & Knight, 2013, p. 75)

first off, practice manuals and guidelines are an en- tirely different model of practice than ebP, having pre- ceded it by many years. There is nothing in the ebP literature that elevates practice manuals above any other form of evidence; rather, manuals would still need to be located, critically reviewed, and used only if the evidence is sufficiently supportive. ebP is actually rather suspicious of practice guidelines, since so many of them are of poor quality. for example, straus et al. (2011) note:

While substantial advances have been made in the science of guideline development, less work has been done to enhance the implementability of guidelines. often, recommendations lack sufficient information or clarity to allow clinicians, patients, or other decision-makers to implement them. and guidelines are often complex and contain large numbers of recommendations with varying evidential support, health impact and feasibility of use in practice and decision making...ideally, guidelines should include some mentions of values, who assigned these values (patient derived or author derived) and whether they came from one source or many sources. the

Thyer | Evidence-Based Practice or Evidence-Guided Practice: A Rose by Any Other Name Would Smell as Sweet

83

values assumed in a guideline, either explicitly or implicitly, may not match those of our patient or our community. (pp. 128–129)

are gitterman and Knight correct in their cautions about the role of practice guidelines and treatment protocols? indeed, and in doing so they share views identical with those of ebP and reservations which i have expressed elsewhere (Thyer, 2003).

Summary

it is very important that social workers who wish to learn more about evidence-based practice take the time to read the original sources on this innovative and influential model. Much of the social work litera- ture on ebP relies on second- and third-hand inter- pretations. sackett, straus, richardson, rosenberg, and haynes (2000); straus, glasziou, richardson, and haynes (2011); and guyatt and rennie (2002) are good places to begin.

it is particularly important to recognize that ebP is independent from, and has nothing to do with, other similar-sounding initiatives (Thyer & Myers, 2011), such as the empirically supported treatment (est) initiative of division 12 (society of Clinical Psychol- ogy) of the american Psychological association, or the empirical clinical practice model developed within social work (Jayaratne & levy, 1979). Yet ebP is often confused with the est model which does rely solely on lists of “approved” treatments for various disorders, or upon the earlier and continuing practice guideline movement which describes intervention protocols for clients with various conditions. ebP does not designate any treatment as “evidence-based.” doing so would elevate the research elements of the model above the other equally important ones, such as clinical exper- tise, client’s personal values, expectations, and situa- tion. as i have written earlier, there are no such things as evidence-based practices (Thyer & Pignotti, 2011). nowhere in the primary ebP literature will you find lists of approved treatments or practice guidelines, yet this is the common conception of the model and one seemingly shared by gitterman and Knight. abandon this misconception, carefully read the real ebP liter- ature, and you will find that it shares almost all the features proposed by gitterman and Knight in their evidence-guided practice model.

eileen gambrill, who introduced to the concept of ebP into the social work literature (1999), has recently used the phrase evidence-informed practice in lieu of ebP, in part due to her concern that the phrase evi- dence-based inadvertently perpetuates the misconcep- tion that ebP ignores other nonresearch factors in ar- riving at decisions (gambrill, 2010; gambrill & gibbs,

2009). now gitterman and Knight suggest the term evidence-guided practice, in part for the same reason. good luck with that. The ebP train has left the station and it will prove very difficult to amend this crucial phrase. however, it makes little difference to me, ebP or egP, so long as the five steps of the original ebP model (straus et al., 2011) are adhered to, perhaps with some additions. i believe that this is the case with git- terman and Knight’s practice model. With apologies to William shakespeare, let me close by paraphrasing Juliet from Romeo and Juliet:

o ebP, ebP! wherefore art thou ebP? deny thy father and refuse thy name; ’tis but thy name that is my enemy; thou art thyself, o, be some other name! What’s in a name? that which we call a rose by any other name would smell as sweet; so ebP would, were he not ebP call’d, retain that dear perfection which he owes Without that title. ebP, doff thy name; and for that name, which is no part of thee, take all myself.

References bogenschneider, K., & Corbett, t. J. (2010). Evidence-based

policymaking. new York, nY: routledge. boruch, r. (2012). deploying randomized field experiments in the

service of evidence-based crime policy. Journal of Experimental Criminology, 8, 331–341.

bronson, d. e. (2009). Critically appraising studies for evidence- based practice. in a. r. roberts (ed.), Social workers’ desk reference (2nd ed.; pp. 1137–1141). new York, nY: oxford university Press.

drisko, J. W., & simmons, b. M. (2012). the evidence-based for psychodynamic psychotherapy. Smith College Studies in Social Work, 82, 374–400.

gambrill, e. (1999). evidence-based practice: an alternative to authority-based practice. Families in Society: The Journal of Contemporary Human Services, 80, 341–350. doi:10.1606/1044- 3894.1214

gambrill, e. (2010). evidence-informed practice: antidote to propaganda in the helping profession. Research on Social Work Practice, 20, 302–320.

gambrill, e., & gibbs, l. (2009). developing well-structured questions for evidence-informed practice. in a. r. roberts (ed.), Social workers’ desk reference (2nd ed.; pp. 1120–1126). new York, nY: oxford university Press.

gitterman, a., & Knight, C. (2013). evidence-guided practice: integrating the science and art of social work. Families in Society: The Journal of Contemporary Social Services, 94(2), 70–78. doi:10.1606/1044-3894.4282

guyatt, g., & rennie, d. (eds.). (2002). Users’ guides to the medical literature: Essentials of evidence-based clinical practice. Chicago, il: american Medical association.

Jayaratne, s., & levy, r. l. (1979). Empirical clinical practice. new York, nY: Columbia university Press.

roseborough, d. J., Mcleod, J. t., & bradshaw, W. h. (2012). Psychodynamic psychotherapy: a quantitative, longitudinal perspective. Research on Social Work Practice, 22, 54–67.

Families in society | Volume 94, no. 2

84

rubin, a., & Parrish, d. (2009). locating credible studies for evidence-based practice. in a. r. roberts (ed.), Social workers’ desk reference (2nd ed.; pp. 1127–1136). new York, nY: oxford university Press.

sackett, d. l., straus, s. e., richardson, W. s., rosenberg, W., & haynes, r. b. (2000). Evidence-based medicine: How to practice and teach it (2nd ed.). new York, nY: Churchill livingstone.

shlonsky, a. (2009). evidence-based practice in social work education. in a. r. roberts (ed.), Social workers’ desk reference (2nd ed.; pp. 1169–1176). new York, nY: oxford university Press.

straus, s. e., glasziou, P., richardson, W. s., & haynes, r. b. (2011). Evidence-based medicine: How to practice and teach it (4th ed.). new York, nY: Churchill livingstone.

thyer, b. a. (2002). the role of theory in research on social work practice. Journal of Social Work Education, 37, 9–25.

thyer, b. a. (2003). social work should help develop interdisciplinary evidence-based practice guidelines, not discipline-specific ones. in a. rosen & e. K. Proctor (eds.), Developing practice guidelines for social work intervention: Issues, methods, and research agenda (pp. 128–139). new York, nY: Columbia university Press.

thyer, b. a. (2012). the potentially harmful effects of theory in social work. in b. a. thyer, C. n. dulmus, & K. M. sowers (eds.), Human behavior in the social environment: Theories for social work practice (pp. 459–487). new York, nY: Wiley.

thyer, b. a., & Myers, l. l. (2011). the quest for evidence-based practice: a view from the united states. Journal of Social Work, 11, 8–25.

thyer, b. a., & Pignotti, M. (2011). evidence-based practices do not exist. Clinical Social Work Journal, 39, 328–333.

Vanlandingham, g. r., & drake, e. K. (2012). results first: using evidence-based policy models in state policymaking. Public Performance and Management Review, 35, 550–563.

bruce A. Thyer, phD, lCsW, professor, Florida state University. Cor- respondence: [email protected]; College of social Work, Florida state University, 296 Champions Way, tallahassee, Fl 32306.

invited response submitted: December 21, 2012 accepted: January 9, 2013 invited response editors: Jessica strolin-Goltzman and susan e. mason

Practice & Policy Focus

Unique perspectives on social work Each free e-issue of Practice & Policy Focus, the newsletter supplement to Families in Society, provides an in-depth guide to practice recommendations, policy analysis, historical perspectives, and emerging research models.

alliance1.org/ppf

The latest newsletter focuses on trauma-informed practice, including:

• influences of personal trauma on professional viewpoints • strengths-based models for self-healing • social supports and coping with trauma • survival capabilities of children who experience abuse • exploratory therapy used to overcome childhood trauma

Recent topics delved into issues such as:

• considering immigration issues in social work

• strengthening supports in LGBTQ families • understanding spirituality in practice • examining the intersection of poverty and gender

Practice & Policy Focus

13-066 P&PF FIS ad 6x3.indd 1 3/18/13 4:07 PM