There are many definitions of EBP with differing emphases.  In Sackett et al's (1996, 71-72) definition from evidence based medicine:  "Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens."

Some in social work view EBP as a mix of a) learning what treatments 'work' based on the best available research (whether experiential or not), b) discussing client views about the treatment to consider cultural and other differences, and to honor client self determination and autonomy, c) considering the professionals 'clinical wisdom' based on work with similar and dissimilar cases that may provide a context for understanding the research evidence, and d) considering what the professional can, and can not, provide fully and ethically (Gambrill, 2003; Gilgun, 2006).  With much similarity but some differences, the American Psychological Association (2006, p. 273) defines EBP as "the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences."

Evidence based practice is one useful approach to improving the impact of practice in medicine, psychology, social work, nursing and allied fields.  While all professions have directed considerable attention to "evidence" for many years (if not for as long as they have existed!), and to many different kinds of evidence, EBP puts particular emphasis on the results of experimental comparisons to document the efficacy of treatments against untreated control groups, against other treatments, or both.  Note that this frames evidence in a very specific and delimited manner. All the "underpinnings" of experimental research:  the quality of conceptualizations, the quality of measures, the clarity and specificity of treatments used, the quality of samples studied and of the quality and completeness of collected data are assumed to be sound and fully adequate to determining what works.  There is also an assumption that the questions framing the research allow for critical perspectives and are fully ethical.  International standards affirm basic ethical principles supporting respect for persons, beneficence and social justice (see The Belmont Report.)

Several web sites serve as portals to bodies of research useful to EBP.  The focus on these organizations varies, but the emphasis remains on (mainly) experimental demonstration of the efficacy of treatments.

Why Evidence Based Practice or EBP?

It is one step toward making sure each client gets the best service possible.

Some argue it helps keep your knowledge up to date, supplements clinical judgment, can save time and most important can improve care and even save lives.

Some say it's unethical to use treatments that aren't known to work. (Of course, services may need to be so individualized in unique circumstances that what works generally may not be the most salient factor in helping any particular client.  Still, using existing knowledge is always beneficial.)

How is EBP Implemented in Practice?

Profiling research that informs professionals and clients about what works is where evidence based practice starts.  These summaries tells us what we know about treatment and program efficacy based on experimental work - as well as what we don't know or aren't really sure about.

Having access to information on what works allows professionals, in conjunction with clients, to select treatments that are most likely to be helpful (and least likely to be harmful) before treatment is begun.  Practice evaluation is quite different in that takes place at the start of treatment, during treatment and after treatment.  Practice evaluation also uses single case methods rather than large sample, experimental research designs.  EBP and practice evaluation work together very well, but they have different purposes and use very different methods.

The creation of "User's Guides" is one way to make the results of research more available to practitioners.   In medicine, the idea is to get research results to the practitioner in an easy to assimilate fashion, though this often has a price.

Funding is being offered to support EBP from governments and private/insurance sources.

However, to understand and critically appraise this material, a lot of methodological knowledge is needed. Sites offering introductions to the technology of EBP are growing. 

How is EBP Taught?

There are some useful resources for Teaching and Learning about EBP.  One fine example is offered by Middlesex University in the United Kingdom which includes good information on critical appraisal of information in EBP.

The State University of New York's Downstate Medical center offers a (medically oriented) online course in EBP, including a brief but useful glossary.

The Major Sources of Research for use in EBP:

The Cochrane Collaboration [ www.cochrane.org ] sets standards for reviews of medical, health and mental health treatments and offers "systematic reviews" of related research by disorder.  The Cochrane Reviews offer a summary of international published and sometimes pre-publication research.  Cochrane also offers Methodological Abstracts to orient researchers and research consumers alike.

The Campbell Collaboration [ www.campbellcollaboration.org ] offers review of the impact of social service programs.  "The Campbell Collaboration (C2) is an organization that aims to help people make well-informed decisions about the effects of interventions in the social, behavioral and educational arenas.  C2's objectives are to prepare, maintain and disseminate systematic reviews of studies of interventions. C2 acquires and promotes access to information about trials of interventions. C2 builds summaries and electronic brochures of reviews and reports of trials for policy makers, practitioners, researchers and the public."

C2 SPECTR is a registry of over 10,000 randomized and possibly randomized trials in education, social work and welfare, and criminal justice. 

C2 RIPE [Register of Interventions and Policy Evaluation] offers researchers, policymakers, practitioners, and the public free access to reviews and review-related documents.  These materials cover 4 content areas: Education, Crime and Justice, Social Welfare and Methods.

The United States government also offers treatment guidelines based on EBP principles at the National Guideline Clearinghouse. [ http://www.guideline.gov/ ]    This site includes very good information on medication as wll as very clear statements of concern about medications indicated in guidelines which later prove to have limitations.

The U.S. government provides information on ongoing, government sponsored, clinical trials. 
 

Other Online Resources for EBP and Treatment Guidelines Derived from EBP Criteria and Procedures:

The American Psychiatric Association offers Practices Guidelines.  Please be aware that the numbers of practice guidelines are few.  Existing guidelines may be up to 50 pages in length.  If you are not allowed to enter via this hyperlink, paste the following URL into your browser:   http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm

The Agency for Healthcare Research and Quality also offers outcome research information.  AHRQ offers an alphabetical listing out outcome studies.

Note that there are a growing number of commercial [.com] sites that offer their consultation regarding EBP.  It is not always easy to determine their organization structure and purposes, the basis of their recommendations and any potential conflicts of interest.  In this regard, the sites of the government and of professional organizations are "better" resources as their purposes, missions and funding sources are generally more clear and publicly stated.

References:

American Psychological Association.  (2006).  APA presidential task force on evidence based practice.  Washington, DC: Author

Dobson, K., & Craig, K.  (1998).  Empirically supported therapies:  Best practice in professional psychology.  Thousand Oaks, CA: Sage.

Elwood, J.M.  (2007). Critical appraisal of epidemiological studies and clinical trials (3rd ed.) New York: Oxford University Press.

Gambrill, E.  (2003).  Evidence-based practice: Implications for knowledge development and use in social work.  In A. Rosen & E. Proctor (Eds.), Developing practice guidelines for social work intervention (pp. 37-58).  New York:  Columbia University Press.

Gibbs, L.  (2003).  Evidence-based practice for the helping professions.  New York: Wadsworth.

Gilgun, J.  (2006).  The four cornerstones of qualitative research. Qualitative Health Research, 16(3), 436-443.

Howard, M., McMillen, C., & Pollio, D.  (2003).  Teaching evidence-based practice: Toward a new paradigm for social work  education.  Research on Social Work Practice, 13, 234-259.

Mace, C., Moorey, S., & Roberts, B.  (Eds.). (2001). Evidence in the psychological therapies: A critical guide for practitioners.  Philadelphia, PA:  Taylor & Francis.

Mantzoukas, S. (2008). A review of evidence-based practice, nursing research and reflection: Levelling the hierarchy. Journal of Clinical Nursing, 17(2), 214-223.

Roberts, A., & Yeager, K. (Eds.). (2004). Evidence-based practice manual:  Research and outcome measures in health and human services.  New York: Oxford University Press.

Sackett, D., Rosenberg, W., Muir Gray, J., Haynes, R. Richardson, W.  (1996). Evidencebased medicine: what it is and what it isn't.  British Medical Journal, 312, 71-72.   http://cebm.jr2.ox.ac.uk/ebmisisnt.html

Sackett, D., Richardson, W., Rosenberg, W., & Haynes, R.  (1997).  Evidence-based medicine:  How to practice and teach EBM.  New York:  Churchill Livingstone.

Simpson, G., Segall, A., & Williams, J.  (2007).  Social work education and clinical learning:  Reply to Goldstein and Thyer.  Clinical Social Work Journal, (35), 33-36.

Smith, S., Daunic, A., & taylor, G.  (2007).  Treatment fidelity in applied educational research: Expanding the adoption and application of measures to ensure evidence-based practice. Education & Treatment of Children, 30(4), pp. 121-134. 

Stout, C., & Hayes, R. (Eds.). (2005). The evidence-based practice: Methods, models, and tools for mental health professionals.  Hoboken, NJ: Wiley.

Stuart, R., & Lilienfeld, S.  (2007). The evidence missing from evidence-based practice. American Psychologist, 62(6), pp. 615-616.

Trinder, L., & Reynolds, S.  (2000).  Evidence-based practice: A critical appraisal.  New York:  Blackwell.

Wampold, B.  (2007). Psychotherapy: The humanistic (and effective) treatment. American Psychologist, 62(8), pp. 857-873.

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text copyright by J. Drisko  page begun 3/11/04; updated 6/8/08