SWRM#5

COMMENTARY

A Reflection on Reasons, Preconditions, and Effects of Implementing Evidence-Based

Practice in Social Work Huang Yunong and Ma Fengzhi

O ver the past decade, there has been an increasing recognition that social work should be evidence based. The potential

contribution of evidence-based practice (EBP) to the effectiveness, efficiency, and accountability of social work education and practice has been emphasized (Gambrill, 1999,2007; Gellis & Reid, 2004; Gilgun 2005;Thyer, 2004).This article reflects on reasons, preconditions, and effects of adopting EBP in so- cial work. These issues are important but are rarely examined. We fmd that the proponents of EBP in social work are conservative toward the problem that research evidence is not used by practitioners. They neglect the preconditions for implementing EBP and are not sensitive to the negative effects of adopting EBP in social work.

MEANING AND PERFORMANCE OF EBP IN SOCIAL WORK In terms of the meaning of EBP, many scholars in social work (for example, GambriU, 1999; Gibbs & Gambrill, 2002; Gilgun, 2005;Thyer, 2004) follow the definition of evidence-based medicine, such as "the integration of best research evidence with clinical expertise and patient values" (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000, p. 1). Regarding the performance of EBP, five steps of evidence-based medicine formulated by Sackett et al. (2000) are also followed by social work scholars (for example, Gibbs & Gambrill,2002;Thyer,2004). The five steps are as follows: first, to covert one's need for information into an answerable question; second, to search the best evidence to answer that question; third, to critically evaluate that evidence; fourth, to integrate the critical evaluation of research evidence with one's clinical expertise and with the patient's unique biology, values, and circumstances; and fifth, to evaluate one's own effectiveness and

efficiency in undertaking the previous steps and to strive for self-improvement.

REASONS TO ADVOCATE EBP IN SOCIALWORK A review of literature on EBP in social work reveals two fundamental reasons for academics to advocate EBP in social work. According to Gibbs and Gam- brill (2002), Rosen (2003), and Grisp (2004), one obvious reasons to advocate EBP in social work is that social workers in service agencies have seldom applied research evidence to their practice. These academics all based their arguments on studies by Kirk and Rosenblatt (1981), Rosen (1994), and Rosen, Proctor, Morrow-HoweU, and Staudt (1995), in which the findings revealed that social workers rarely use and value research evidence in their deci- sion making for interventions and other practices. Another reason is that EBP is believed to be able to promote the utilization of research findings in social work education and practice. For example, to advocate EBP in social work education, How- ard, McMillen, and PoUio (2003) highlighted the importance of empirical research to effective social work practice; they argued that scientific findings should guide the selection and application of social work practice and that social workers should remain current with a growing scientific database.

DISCUSSION AND SUGGESTIONS EBP has potential benefits to social work. First, social work has been obsessed with professional status (O'Neill, 1999). The emphasis of research evidence in EBP social work can enhance the cred- ibility of the social work profession. Second, it has been found that social workers seldom use research evidence in practice (Rosen, 1994; Rosen et al., 1995; Sheldon & Ghilvers, 2000).The emphasis of

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research evidence in EBP social work can promote the integration of research evidence into social work practice. However, realization of the benefits of adopting EBP in social work is subject to many factors, such as the relevance of evidence to social work practice.A reflection on reasons, preconditions, and effects of adopting EBP in social work indicates that the present implementation of EBP may result in much harm.

Reflection on the Reasons to Advocate EBP A reflection on two fundamental reasons to ad- vocate EBP in social work will reveal beguiling rationale when we make a simple comparison of it with consumers' neglect of industrial products or business services. In the business field, no matter how attractive, useful, or wonderful an entrepreneur believes his or her product or service is, people have every reason to overlook and not to buy the product or service. If such a thing happens, it is the entrepreneur who should examine and reflect on his or her own problems, including the price, the sale strategy, the logistic system, the design, and so on, to find effective ways to improve people's acceptance of the product or service. Rarely are consumers criticized for not buying the product or service of the entrepreneur.

In social work, some studies (for example, Rosen, 1994; Rosen et al.,1995; Sheldon & Chilvers, 2000) have revealed that many practitioners do not use re- search evidence. Instead of examining and reflecting on the quality, dissemination, and cost of research evidence to find effective ways to improve practi- tioners' acceptance, some academics (for example, Gellis & Reid, 2004; Gilgun, 2005; Rosen, 2003) tend to regard it as a failure in practice or a problem with practitioners. They advocate EBP and believe that practitioners will use research evidence.

Kuhn (1962) argued that scientific communi- ties are noted not for their open-mindedness but for their conservatism. He pointed out that once a scientific paradigm is accepted by a scientific community, a period of normal science begins to operate in which anomalies are likely to be regarded as failures of researchers' theories or experimental techniques rather than problems with the paradigm. Similar to Kuhn's arguments, the proponents of EBP in social work (for example, Gambrill, 1999, 2007; Gellis & Reid, 2004; Gilgun, 2005) tend to regard practitioners' neglect of research evidence as

a failure in practice or a problem with practitioners rather than problems with or failures of researchers. Such conservatism may exacerbate the problem of practitioners not using research evidence in social work. Research indicates that utilization of social science research knowledge is contingent on the researchers' behaviors, the users' contexts, and so on (Landry, Amara, & Lamari, 2001).

Reflection on the Preconditions for Implementing EBP The implementation of EBP in social work is subject to at least three preconditions, about which its proponents (for example, Gellis & Reid, 2004; Gilgun, 2005; Rosen, 2003) are rarely concerned. First, research evidence must be relevant to social work practice; otherwise, it is meaningless and a waste of practitioners' time to use it. Second, social work practitioners should have adequate time and financial resources. Research evidence is not free of charge for the majority of social work practitioners, and using evidence is not easy. Except for a few practitioners who have ready access to social work journals and books or are professional statisticians, most practitioners must pay to access journals and books, learn new statistical methods to understand many books and articles, read and analyze a lot of books and articles, and so on so that they can keep up with professional literature to find the best evidence to support and critically evaluate their practice.These efforts require intensive investments ofsociai work practitioners' time and financial resources. Third, the benefits for using evidence for social workers should outweigh or at least be equal to the costs of using it. In other words, social workers must invest a great deal of money and time to apply the best research evidence. Accordingly, after adopting EBP, their salaries should be increased and their workloads decreased. Otherwise, it would not be reasonable to expect them to accept the EBP approach.

Regarding the first precondition, it has been argued that social work practitioners do not use the professional literature partly because it is irrelevant or not serviceable to practice (Epstein, 1995; Goldstein, 1992; Lindsey & Kirk, 1992). Even if the research evidence is relevant to social work practice, there is another question: Is research evidence applicable to the diverse and often unique situations that confront social workersPThis question is rarely examined and remains to be clarified. For the second precondition, some evidence indicates that social work practitio-

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ners may not have the time or financial resources to afford the best research evidence. For example, a survey in the southwest of England revealed that 98.3 percent ofsocial workers and social care staffs reported a lack of time at work as an obstacle to keeping up with professional literature (Sheldon & Chilvers, 2000). Khinduka (2001) also observed that the status of social work in the hierarchy of professions is relatively low all over the world. So- cial workers' salaries are low, and their workloads are heavy. The third precondition has rarely been examined and remains to be studied.

In short, there are preconditions for implementing EBP in social work, and the proponents ofEBP rarely concern themselves with them. Some evidence indicates that preconditions for implementing EBP are not satisfied in social work.

Reflection on the Effects of Adopting EBP It has been argued that EBP reflects a primarily positive epistemology and that its ontological and epistemological assumptions are too narrow to em- brace human behaviors and the metaphysical world that social workers strive to understand (McNeill, 2006; Webb, 2001). Another major issue regarding the adoption of EBP in social work is related to the contested meaning of evidence. In EBP social work, McNeill (2006) stated that "evidence is much more of a relative concept than proof; it can range from clinical observations to the results of both large-scale epidemiological studies and randomized control trials" (p. 150). Because of the contested meaning of evidence in social work and the neglected pre- conditions for implementing EBP, as discussed in the previous section, the present adoption of EBP is likely to result in the following effects.

First, social work practitioners'will have to spend more money and time accessing, reading, and analyz- ing a lot ofsocial work books and journal articles, even though the information in the books and journal articles may not be relevant to their practice. Unless social workers' time constraints and heavy workload can be reduced, and their salary can be increased, adopting EBP will increase social workers' stre.ss, workload,and monetary input.This will likely force many social workers to leave the social work profession and look for other jobs. As a result, the status ofsocial work in the hierarchy of professions will become much lower.

Second, the contested meaning of evidence implies that claiming practice as evidence based is

not just a technical matter; it involves such matters as power and prestige. Given the ever-growing literature in social work and other professional literature, as well as the contradictory evidence, such as disengagement theory and activity theory in gerontological social work, it would not be difficult for social workers to find some evidence supporting their practice. At the same time, it would not be difficult for their managers or evaluators to find some contradictory evidence showing that their practices are not based on evidence. As a result, those people who have the power and prestige to determine the quality of evidence become the judges ofsocial work practices. A brief search of social work journals, such as Social Work and The British Jotirnal of Social Work, can easily reveal that the majority of journal articles are written by professors ofsocial work. In addition, nearly all of the editors ofsocial work journals are also profes- sors ofsocial work. Furthermore, the majority of social work books are written by professors. It is actually the professors ofsocial work who hold the unrivaled power and prestige to judge the qual- ity of evidence and publish research evidence in various social work journals and books. However, little evidence demonstrates that the professors of social work are professional in practice. Epstein (1995) argued that social work practitioners do not use the professional literature partly because it is irrelevant to their practice. This also suggests that the production of books and articles on social work most likely serves other areas ofsocial work academia rather than contributes to actual practices. Therefore, the present adoption of EBP in social work makes people who might not be professional in practice the judges of practice.

Third, the contested nature and ever-growing quantity of evidence implies that evidence can be used as a neutral tool to inform decision making but may also be used to serve the interests ofsocial work managers. For example, it has been argued that the growing popularity of evidence-based manage- ment in health care "can be understood primarily as a function of interest served by the universalization of certain forms of managerialist 'evidence' rather than any contribution to organizational effective- ness" (Learmonth & Harding, 2006, p. 245). Un- less something is done to ensure that social work managers use evidence as a neutral tool to inform decision making, they may select the evidence that serves management interests rather than contributes

Y U N O N G A N D F E N G Z H I / Reasons, Preconditions, and Effects of Implementing Evidence-Based Practice in SocialWork 179

It is possible that through direct

communication between social work

researchers and clients, a new approach

toward social work practice that connects

social work researchers directly to clients can

be built.

to social work practice. In such situations, adopt- ing EBP may merely serve to provide a source of legitimacy that contributes to the authority of social work managers.This is likely to put frontline social workers under increased managerial control and thus damage their incentives to remain social workers. Research in the public health sector has indicated that the introduction of managerial strategies into professional practice places constraints on profes- sional autonomy (Germov, 2005). Research has also shown that perceived job autonomy is a highly significant determinant of job satisfaction (Nguyen, Taylor, & Bradley, 2003) and that job satisfaction has a significant influence on staff turnover intentions and actual turnover (Castle, Engberg, & Anderson, 2007; Freund, 2005).

Suggestions On the basis of our earlier reflection, we provide the following suggestions. First, although various is- sues in social work have been debated (for example, Hudson & Surius, 1994;Thyer, 1997), more studies are imperative to explore the reasons that research evidence is not routinely used by social workers. Meanwhile, social work academics need to be sensitive to heavy workloads, time constraints, and low salaries of practitioners. They must be open- minded to reflect on research and education. To encourage knowledge utilization in social work, Hess and Mullen (1995) suggested partnerships between practitioners and researchers in developing knowledge relevant to social work practice. McNeill (2006) recommended knowledge brokers to help facilitate the efliective use of available knowledge. Besides these suggestions, academics may need to constantly improve research evidence, making it eas- ily accessible and understood by practitioners. At the same time, academics need to be actively engaged in the dissemination of research evidence and the optimization of evidence utilization. Eflbrts should also be taken to make research products serviceable

and attractive to practitioners. For example, in social work papers and books, sections or chapters on knowledge utilization can be developed to specify where, when, and how research evidence can be used by practitioners. Researchers can also use their research findings in practice to show practitioners the benefits of their research findings for social work practice and the effective ways to use research findings. In addition, researchers can make videos showing the practitioners what their research find- ings can bring to social work practice and how to use their research fmdings.

Second, EBP emphasizes that the practitioners use research evidence in social work practices. However, with the development of the Internet and other technology, many social work clients can easily obtain research evidence by themselves. Therefore, social work researchers could distribute 'evidence to social work clients directly through the Inter- net and help the clients learn how to use research findings to solve their problems. At the same time, social work clients can be encouraged to provide feedback on the applicabihty of research findings and the outcomes of using research findings online. Their feedback can assist social work researchers in reflecting on and improving their research. It is pos- sible that through direct communication between social work researchers and clients, a new approach toward social work practice that connects social work researchers directly to clients can be built. Such a new approach toward social work practice deserves further research.

Third, EBP has usually been advocated for in- dividual social work practitioners. However, EBP may be adopted in social work practice in another way: by designing social work positions as the steps of EBP are implemented and by appointing every practitioner to a position that fulfills the work of one specifically implemented step of EBP. Such a production-hne approach would make social work practice a subject of science and technical work and may contribute to the efficiency, effectiveness, and accountability of social work practice. More studies are necessary to examine this approach of social work practice.

CONCLUSION This article indicates that the proponents of EBP in social work hold a conservative attitude toward the problem that research evidence is not routinely used by practitioners.They neglect the precondi-

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tions for implementing EBP and are not sensitive to the negative effects of adopting EBP. We do not advocate the abandonment of EBP, because we value diversity and heterogeneity. EBP is a relatively new idea in social work. It has the potential of be- coming a useful approach if the preconditions for implementing it can be satisfied and the negative effects of adopting it can be avoided. B53

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HuangYunong is lecturer. Social Work Development Research Center, Southwest University of Finance and Economics,

Chengdu, Sichuan, China 610074; e-mail: yunoiigli@i^mail.

com. Ma Fengzhi, PhD, is associate professor. Department of Sociology, Peking University, Beijing.

Original manuscript received February 21. 2007 Final revision received March 3. 2008 Accepted [Vlarch 6. 2008

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