Evidence-Based Practice and Social Work: An Illustration of the Steps Involved

Abstract

The current focus of the health care system involves a commitment to the process of considering evidence when making decisions (Donald, 2002). The principles of an emerging paradigm referred to as evidence-based (EBP) are ideally suited to fulfill this commitment. Evidence-based is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of clients (Gibbs & Gambrill, 2002, p. 452). Theoretically, EBP works by converting information from thousands of studies into risk estimates and thereby provides a framework for addressing questions asking is the chance certain things harm or benefit people, according to a fair and scientifically rigorous process (Donald). EBP offers social work practitioners and administrators a philosophy of that is compatible with obligations described in the profession's code of ethics and educational accreditation policies and standards (for example, informed consent, to draw on practice--and policy-related research findings) (Gambrill, 2003). Unfortunately, however, Gambrill noted that the philosophy and technology of EBP described in health care are typically not described in the social work literature. If social workers do not take the time to comprehend the systemic, client-oriented vision of EBP, then we risk losing critical opportunities to decrease gaps between professional, ethical obligations and accreditation standards and what is done in everyday practice (Gambrill, p. 18). Thus, in an era in which social workers must defend their domain from encroaching disciplines, adding the role of evidence-based practitioner to the plethora of other social work roles is fundamental. Using the vaccine safety dilemma as an example, we present the five steps involved in EBP and demonstrate their utility to social work practice. EVIDENCE-BASED PRACTICE Step 1: Converting Client Needs into Answerable Questions The first step of EBP involves converting client information needs into answerable questions (Sackett, Richardson, Rosenberg, & Haynes, 1997; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Questions that lend themselves to searching for the best evidence must be specific enough to generate an answer in an electronic search, by designating the patient population or problem, identifying the intervention or area of interest, identifying a comparison intervention or status if applicable, and designating measurable outcomes (Gibbs, 2003; Melnyk & Fineout-Overholt, 2002). Features of a well-built question include the client type or problem, the intervention or what you (the social worker) might do, an alternate course of action, and what you (the social worker) would like to accomplish (Gibbs). Example Social workers working in a health care domain are confronted with an array of client concerns and needs. One example of a client concern stems from the current health care debate about the safety of childhood vaccines. An increase in the number of vaccinations that children receive has yielded an increase in adverse events following vaccinations and thereby an increase in parental concern about the safety of vaccines (Centers for Disease Control and Prevention [CDC], 2002; Gellin, Maibach, & Marcuse, 2000). Using this as an example, the client type is children, the problem is adverse reactions to vaccines, the intervention is vaccines, an alternate course of action is no vaccines, and what you (the social worker) would like to establish is the probability of vaccine adverse reactions based on data from empirical studies. Incorporating these features to form an answerable question would result in the following: If a child receives a mandatory childhood vaccine, what is the probability of the child's developing an adverse reaction to the vaccine? Step 2: Locating the Best External Evidence to Answer the Question The second step of EBP involves searching for, with maximum efficiency, the best evidence with which to answer the question. …