Evidence-Based Practice

I recently read an article entitled Where Is the Evidence for "Evidence-Based" Therapy by Jonathan Shedler (2018). As the title implies, the article focused on therapy. The term evidence-based has become almost synonymous with manualized therapy which most often more scripted forms of cognitive behavioral therapy. Shedler points out that while it is accepted that evidence-based therapy is better than other forms of psychotherapy, this is not always the case and empirical research shows weak results for evidence-based forms of therapy. It is an interesting article and I am not here to offer a critique, but it did make me this about the state of evidence-based practice and what it all actually means.

I recall being in my BSW and MSW programs and there being a focus on "evidence-based" treatments and we understand the evidence for these comes from scientific, peer-reviewed journals. It my experience, which I am sure will resonate with others, if there is literature that shows the effectiveness of an intervention then that intervention is evidence-based. The more literature available the better evidence for that practice. Now this is a good starting point, but evidence doesn't end there.

This is an important venn diagram to better conceptualize evidence-based practice. You'll see in the middle of the diagram is EBM (evidence-based medicine) another term for evidenced based practice. EBM started in the medical literature and was later adopted to other areas such as therapy. In looking at this diagram, you'll see there are three areas that contribute to what evidence-based practice really is. You may remember seeing this in school, but I believe it is a good reminder that it is not just the scientific evidence/peer-reviewed literature; it also includes clinical judgement and consideration for a patient's/client's values and preferences.

What does this mean for social workers? According to the NASW Code of Ethics (2017) " Social workers should critically examine and keep current with emerging knowledge relevant to social work and fully use evaluation and research evidence in their professional practice". It is our responsibility to evaluate evidence that is presented in the literature, but also to temper this with one's own clinical judgement and the client's values and preferences. Clinical judgement is developed through practice is experience. Reading literature and attending training is important, however it does not take the place of actual practice experience. Furthermore, we social workers also need to be culturally competent. I don't want to get into the topic of cultural competence, because that is reserved for an entire discussion itself. The Code of Ethics states that, "Social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures" (NASW, 2017). Understanding culture is one aspect to understanding a client's values and preferences, it is also important to build rapport to understand the idiosyncratic values and preferences of each client. 

Employing evidence-based practice is good social work practice, but relying solely on literature to implement evidence-based practice is not the best practice. One's own clinical judgement and the client's values and preferences need to be consider in addition to the literature, but a social worker should be competent (NASW, 2017) in the services they provide and they should monitor and evaluation the interventions they use (NASW, 2017). What is not included in this discuss and may be assumed by some, is that whatever the intervention, one should monitor and evaluate it's effectiveness. Social workers need to set-up measures that look at effectiveness during the course of the intervention.

Good, ethical social work practice involves competence, critically examining literature, experience to develop one's clinical judgement, understanding of culture and the client's values/preferences and then monitoring and evaluating chosen interventions for effectiveness.