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 information needs;

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.

Additional Steps?

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 practice.

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.

References

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.
 

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text copyright J. Drisko  page begun 3/17/04; last update 09/4/12