The Steps of the
EBP Practice Decision-Making Process
There are several steps in doing EBP, but the number varies a bit by
author. Still, the key content is essentially the same in them all.
Drisko & Grady (2012) have worked carefully to honor client values and
preferences along with research evidence and clinical expertise in
formulating these six steps of EBP:
1) Drawing on client needs and circumstances learned in a thorough
assessment, identify answerable practice questions and related research
2) Efficiently locate relevant research knowledge;
3) Critically appraise the quality and applicability of this knowledge
to the client's needs and situation;
4) Discuss the research results with the client to determine how likely
effective options fit with the client's values and goals;
5) Synthesizing the client’s clinical needs and circumstances with the
relevant research, develop a shared plan of intervention collaboratively
with the client;
6) Implement the intervention.
Our care in wording the steps of EBP starts with the fact that doing EBP
rests first on a well done and thorough clinical assessment. This is not
directly stated in the EBP practice decision-making model, but is the
foundation on which all good intervention planning rests (Drisko &
Grady, 2011). We also view intervention or treatment planning as
participatory and collaborative between client and clinician - not a
top-down process (as it appears in many EBM/EBP textbooks). Client
values and preferences are key parts of EBP. Finally, clinical expertise
is needed to insure the best research evidence really fits this the
views and needs of client in this situation.
Step 7. 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. Still, practice evaluation is a key part of all good
Step 8. A few authors (Gibbs, for one) also add sharing your results
with others and work toward improving the quality of available
evidence. 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.
Clinicians should publish about their work, but individual case outcomes
have ethical challenges and may not be much valued within EBP
hierarchies of evidence.
The University of Oxford offers a fine page on the
Steps of EBM.
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.
Drisko, J. & Grady, M. (2012). Evidence-based
practice in clinical social work. New York: Springer-Verlag.
Gibbs, L. (2003). Evidence-based practice for the
helping professions. New York: Wadsworth.
to Social Work Resources Home Page
text copyright J. Drisko page begun 3/17/04;
last update 09/4/12