Evidence-Based Practice: An Alternative to Authority-Based Practice

Abstract

KEY QUESTIONS REGARDING knowledge and practice include the following: What values, knowledge, and skills increase the likelihood of attaining outcomes valued by clients? Do social workers have this? Do social workers have specialized knowledge that makes them more effective than empathic nonprofessionals? Do they draw on knowledge that maximizes the likelihood of helping clients attain outcomes they value? Is there any evidence that special training, credentials, or experience contributes to doing more good than harm? And in relation to all these questions, how do we know? Unlike the humanities, we have clients with real-life problems; we can look and see whether problems have decreased, increased, or have not changed and explore helper characteristics related to different outcomes. Social work claims to be a profession that provides special expertise to address certain kinds of problems. Schools of social work purport to provide this specialized knowledge to students. Consider the claims made in the "policies" approved by the NASW Board of Directors in January 1999 for inclusion on the assembly's final agenda.Professional social workers possess the specialized knowledge necessary for an effective social services delivery system. Social work education provides a unique combination of knowledge, values, skills, and professional ethics which cannot be obtained through other degree programs or by on-the-job training. Further, social work education adequately equips its individuals with skills to help clients solve problems that bring them to social services departments and human services agencies. (NASW News, p. 14) These claims all relate to knowledge. To my knowledge, there is no evidence for any of these claims. In fact, there is counterevidence. In Dawes' (1994) review of hundreds of studies, he concluded that there is no evidence that licenses, experience, and training are related to helping clients. If this applies to social work and, given the overlap in helping efforts among social workers, counselors, and psychologists, it is likely that it does, what are the implications? If social work is a profession based on claimed rather than demonstrated effectiveness in helping clients attain hoped-for outcomes, how is this embarrassing situation handled? One strategy has been to ignore the contradiction between claims and reality and to censor related data by not sharing this with students. This strategy is to simply pronounce what is and what is not even though there is no evidence for claims as seen in the proposals in the NASW News (March 1999) described earlier (i.e., to rely on authority) (Gambrill, in press). A second strategy is to investigate what values, skills, and knowledge are needed to achieve certain outcomes and then to determine who has them and the role of education or experience in providing them. These strategies reflect two different approaches to the relationship between practice and knowledge: evidencebased (the second) and authority-based (the first). The consequences of these different ap...

Management des conduites professionnelles par les résultats probants de la recherche. Une analyse critique

“…Ces groupes professionnels sont traversés de combats internes sur le plan épistémologique, débats ravivés par l'expansion de la perspective Evidence Based Practice, qui se présente comme une opportunité de reconnaissance de leur conception de la profession par les tenants de la grandeur scientifique d'inspiration médicale (Sheldon, 2001). Il s'agit pour eux d'une posture de combat contre le pouvoir discrétionnaire inhérent au caractère tacite et incertain d'une pratique trop constructiviste (Gambrill, 1999 ;Proctor, 2002 ;Wennberg, 2004). Ce désir d'accroissement de la scientificité de ces professions répond, du point de vue des tenants de la perspective Evidence Based Practice, au scepticisme interne et externe aux métiers relationnels quant à leur efficacité inobjectivable, leur scientificité douteuse, et donc leur professionnalité (Sheldon et Chilvers, 2000).…”

The Evidence For and Against Evidence-Based Practice

“…We have been asked how anyone could object to it. In turning to a discussion of this question, we draw from prior analyses of arguments for and against EBP (Gambrill, 1999(Gambrill, , 2001(Gambrill, , 2003Gibbs & Gambrill, 2002;Pawson, 2002;Sackett et al, 2000;Straus & McAlister, 2000;Webb, 2001). …”

“…However, it is probably safe to say that no innovation has generated as much argument and heat as the introduction of evidence-based practice (EBP) and policy. EBP has been both heralded as one of the major advances in health care, education, criminal justice, and the human services, promising to revolutionize both policymaking and practice (e.g., Gambrill, 1999;Gibbs & Gambrill, 2002;Gray, 2001;Macdonald, 1999;Marshall, 1995;Sackett, Richardson, Rosenberg, & Haynes, 1997), and excoriated as a development that will reduce professionals to mindlessly (and soullessly) following recipe books for the betterment of insurance companies (e.g., Grahame-Smith, 1995;Morgan, 1995). It has led, on the one hand, to a number of journals, texts, and centers based on its principles (e.g., Evidence-Based Mental Health, Evidence-Based Medicine, Evidence-Based Nursing, ACP Journal Club;Gibbs, 2003;Gray, 2001;Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000), and on the other, to articles in leading journals holding it up to ridicule (e.g., Britton, Evans, & Potter, 1998;CRAP Writing Group, 2002;Webb, 2001).…”

Pratiques fondées sur les données probantes en travail social : un débat émergent1

“…Il s'agit donc d'une posture de combat contre NPS, vol. 16, n o 2 le pouvoir discrétionnaire inhérent au caractère tacite et aléatoire de la pratique (Gambrill, 1999 ;Proctor, 2002), combat qui permet une actualisation rigoureuse de l'approche empirique répondant au scepticisme externe à la discipline, en ce qui concerne son efficacité, sa professionnalité et sa scientificité (Webb, 2002).…”