There are several steps in doing EBP, but the number varies a bit by author.

First Step.  Social worker Len Gibbs points out that the first step is to become motivated to do EBP.  One's introduction might be based on a carrot or a stick or a hammer!  If shown the utility of EBP to real world practice, professionals and students would begin with a positive orientation and motives.  On the other hand being forced to do EBP by managed care could create considerable resentment.  Most authors don't mention this step as part of EBP.

Core Steps:

Step 1.  Develop a clear and answerable question derived from the client's problem or need.  Such questions may be about diagnosis, treatment, side effects, prognosis as well as costs and benefits or efficiency of care (though now the concern shifts to overall benefit, not just to the client.)

Step 2.  Search the literature for relevant research that could help answer this question.  The EBP model places greatest credibility in results of randomized controlled trails [RCTs] or meta-analyses of experimental studies.  (See Rating the Evidence.)

Step 3.  Conduct a critical appraisal of this information and rank the evidence for its validity and applicability to the client's need and situation.  The client's wishes and needs (stated and implicit) must also be considered, along with the professional's competencies.  

Step 4.  Formulate and apply an intervention based on the most relevant and applicable findings which we can call the "best available evidence."  The assumption is that the evidence will clearly point to a best intervention.  In many situations the model may point to a "best intervention."  However, in many situations the evidence will be lacking, of variable quality or irrelevant, making the yield of this step a bit more ambiguous than the model suggests.  

Additional Steps:

Step 5.  A few authors (Gibbs, for one) appear to make practice evaluation an aspect of EBP.  That is, the professional should audit the intervention (to verify it was done appropriately) and evaluate its yield.  This makes some sense, but note that the practice evaluation of the single case would be done using methods quite different from those used in EBP.  Single case or single system designs can help identify progress, but are based on replication logic rather than the sampling logic underlying experimental research.  That is, the case studies one would use in practice evaluation are not highly valued in EBP research summaries.

Step 6.  A few authors also add sharing your results with others and work toward improving the quality of available evidence (Gibbs). This would be useful but again does not necessarily draw on the same core logic of experimental research EBP emphasizes.  In fact, case studies are often viewed as the least useful source of evidence in many EBP "evidence hierarchies".  Note, however, that such work may be very helpful in identifying to whom and in what circumstances the best research evidence does not work or is not appropriate.  Ironically, very small scale research may be very useful in shaping how and when and where to use large scale experimental evidence to best advantage.

The University of Michigan's Social Work Library offers a fine page on the steps of EBP (but also a disclaimer that the pages are not intended as a course for beginners.)

Note that all steps are meant to be transparent and replicable by others.  That is, the steps should be so clear you could re-do them yourself with enough time and access.  It also means many things are accepted at face value (or as face valid) such as definitions of mental and social disorders (usually defined via DSM or ICD) though these categories do change over time.  Measures of treatments are assumed to be adequate, valid, reliable and complete.  Treatments though often only broadly described, as assumed to be replicable by others in different settings, with different training and with different backgrounds. 

Note, too, that EBP focuses on the outcome of treatment, not the processes by which change occurs.  Understanding both outcome and change process is the cornerstone of science.

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text copyright J. Drisko  page begun 3/17/04; last update 06/8/08