Listeners of the Social Work Podcast, followers of the Social Work Podcast Twitter feed (@socworkpodcast), and fans on the Social Work Podcast Facebook page responded to a request to vote for their preferred definition of Evidence Based Practice. The results were surprising:
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Danielle E. Parrish, Ph.D. is an Assistant Professor with the University of Houston, Graduate College of Social Work. Dr. Parrish's research broadly focuses on the development and implementation of evidence-based behavioral health interventions for adolescents and adult females. She has conducted research to identify more efficient ways to implement efficacious interventions in real-world settings using the evidence-based practice (EBP) process model. Dr. Parrish was the PI on a recent large cross-sectional survey, which assessed the views and implementation of evidence-based practice among a diverse sample of behavioral health practitioners in Texas and validated a short version of the Evidence-Based Practice Process Assessment Scale (EBPPAS-Short Version), which she co-authored with Allen Rubin. She has also developed and evaluated a training model for community practitioners on the EBP process, and made numerous invited and peer reviewed presentations on this model and the integration of EBP into social work education. Dr. Parrish's prior clinical experience includes working in the following public mental health settings with children, adolescents, adults and families: juvenile justice mental health, infant mental health, and outpatient mental health.
Room: 312 Social Work Building
University of Houston Faculty Page
Jonathan Singer: You've probably heard of it. Maybe your professors asked you to write a paper on it, or your agency said you had to do it. Maybe you research it. Maybe you teach it. Maybe you love it. Maybe you hate it. Maybe you wish I would define the pronoun "it". Ok. Fair enough. Today's episode of the Social Work Podcast looks at the dance craze that's sweeping the profession – the Evidence Based Practice.
Ok, it's not really a dance craze; in fact I don't think it is even a dance. But I could see some enterprising social work students creating a flash mob evidence-based practice dance. If you do, upload it and send me a link – we'll post it on the Social Work Podcast website. But I digress...
I wanted to do an episode on Evidence-Based Practice because it has been the subject of a lot of debate in Social Work. One of the controversies is over how to define evidence based practice. So, how do you define it? Last week I created a poll on the Social Work Podcast website and asked people to vote on one of four possible definitions of evidence-based practice. I let people know about the poll through a brief podcast update, a tweet on the SWP twitter feed, and a message on the Facebook fan page. In seven days 183 people voted. One person said EBP was "a waste of time." Seven people (3% of respondents) said that EBP was "when practitioners are mandated to use certain interventions/programs by a funding source (e.g., managed care)." Fifty-eight people - almost 1/3 of respondents – said that EBP was "using empirically supported treatments (e.g. DBT or MST)." 117 people - nearly two thirds of respondents – said that EBP was "a process that uses the best available research, along with client values and practitioner expertise, to answer a variety of practice questions." So, who is right? Well, according to a 2011 article written by today's guest, Danielle Parrish and her co-author Allen Rubin, EBP is ‘‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individuals [clients]" (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71) and "the integration of best research evidence with clinical expertise and [client] values" (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000, p.1). In other words, EBP is a process that uses the best available research, and practitioner expertise and client values, to answer a variety of practice questions. So, why isn't Dialectical Behavior Therapy, or one of the agency-mandated programs considered Evidence-Based Practice? Stay tuned and find out.
In today's interview, Danielle and I talk about the difference between the process of evidence-based practice and evidence-based practices, also known as empirically-supported treatments. We talk about why social workers should use the evidence-base practice process. Danielle identified some of the limitations of the EBP process, resources for social workers interested in accessing the evidence-base, and ways that social workers could support each other in being evidence-based practitioners. Today's episode does not cover the history of evidence-based practice. That was covered by Bruce Thyer in a 2009 episode of Living Proof, the podcast series of the University at Buffalo School of Social Work.
Oh, and I'm talking to Danielle because she's one of our profession's experts on this subject. Check out her bio: Danielle E. Parrish, Ph.D. is an Assistant Professor with the University of Houston, Graduate College of Social Work. Dr. Parrish's research broadly focuses on the development and implementation of evidence-based behavioral health interventions for adolescents and adult females. Dr. Parrish was the PI on a large cross-sectional survey, which assessed the views and implementation of evidence-based practice among a diverse sample of behavioral health practitioners in Texas and validated a short version of the Evidence-Based Practice Process Assessment Scale (EBPPAS-Short Version), which she co-authored with Allen Rubin. She has also developed and evaluated a training model for community practitioners on the EBP process. She's published articles and book chapters on the process of Evidence-Based Practice and made numerous invited and peer reviewed presentations on this model and the integration of EBP into social work education.
Today's interview was recorded in Portland at the 2011 Society for Social Work and Research conference. And now, on to episode 65 of the Social Work Podcast: The Process of Evidence-Based Practice: An interview with Danielle E. Parrish, Ph.D.
Jonathan Singer: Thanks so much for being here and talking with us today about evidenced-based practice and my first question for you is what is evidenced-based practice?
Danielle Parrish: Well, that’s a really good question and I think that it's a question that’s caused a great deal of confusion for a variety of practitioners and researchers. I’d like to start out by mentioning that there have been really two definitions floating out there but that the primary definition of evidence-based practice is the definition that is a process in which you integrate the best available research with your own practitioner expertise and the client’s values, characteristics and preferences.
And, as a part of this process it's really been operationally defined in five steps. The first step is to pose any answerable practice question. The second step is to search electronically for the best available evidence to answer that question. The third step is to critically appraise the research that you find. The fourth step is to take what you’ve found and integrate it as I said earlier with your own practiced expertise, context of practice in the client’s values, culture and preferences.
So, it's really this process of offering the client the information or involving them in the process of informed consent about what the research is for various options for their particular situation and empowering them to make a choice collaboratively with you as the practitioner and then finally the fifth step is to evaluate the outcomes of whatever practice decision was made to see if it's working.
Jonathan Singer: Okay, so it's, it's a process. That’s one of the definitions, it's a process and you mentioned informed consent, what do you mean by that?
Danielle Parrish: Well, that’s really, you know, the process of empowering the client to kind of join with you in, in knowing and being very transparent with them about what the choices are and what, what the evidence is for the various choices that they can pursue and just really involving them in that process and being – and if there is an evidence, being transparent about that, too.
Jonathan Singer: Okay. So, that was one definition. What was the other definition?
Danielle Parrish: I think the other definition that’s it's really kind of been out there is primarily probably among practitioners. When I have done training with practitioners in the past on the evidence-based practice process, they're surprised by this definition because what they're hearing more often in their practice is that evidence-based practice is doing an intervention that’s on an approved list of, you know, treatments or programs that have a certain amount of evidence or that will be, that are reimbursable and the problem with that – I mean, I don’t think that those are necessarily bad approaches but I think that—
Jonathan Singer: Hopefully, they're good approaches because what they have—
Danielle Parrish: Yeah, I hope they would—
Jonathan Singer: – they have an evidence-based – so, so, so like an example might be dialectical behavior therapy–
Danielle Parrish: Right. And as—
Jonathan Singer: – right, or–
Danielle Parrish: – quite a wide, yeah, base of support. But I think that what we're missing when we, when we take something off a list and we apply it to everybody is that we're not taking into consideration the variation and how clients present and what might be culturally appropriate for them or, or acceptable and so I think that the process allows us a little bit more ability to kind of take those contextual issues into account and – but also still consider the research evidence.
Jonathan Singer: So, the process of evidence-based practice would allow you to see a client, figure out what they need, figure out what you're comfortable doing, figure out what the research says is best to do in this situation if there is research on whatever your client is coming in with. And that’s different from evidence-based practices—
Danielle Parrish: Right.
Jonathan Singer: – or—
Danielle Parrish: Or as some people would say empirically-supported interventions. That’s I guess one way to differentiate and, and keep it less confusing is that we have the evidence-based practice process and then we have empirically-supported interventions.
Jonathan Singer: Okay. So, that will be – so from now on anybody who’s listening to this will say empirically-supported interventions or treatments rather than evidence-based practice for those off-the-shelf manual kinds of approaches because making a paradigm shift here so.
Danielle Parrish: I think that’d be wonderful.
Jonathan Singer: Okay.
Danielle Parrish: I think it’d be less confusing but I don’t know if it's going to happen.
Jonathan Singer: Okay. Well, we'll do – this will be like our single system design.
Danielle Parrish: Right.
Jonathan Singer: Like is there a change after this podcast.
Danielle Parrish: Right, we'll evaluate this practice.
Jonathan Singer: Right, this is the A-B (single-system) design right? There you go. Okay. What are some of the assumptions behind advocating for social workers taking an evidence-based approach to service delivery?
Danielle Parrish: That’s a great question. I think, I think the primary assumption to this approach is that research is an important part of, of decision making in practice and that, however, I think the EBP process approach says it isn't the only important aspect of making practice decisions.
So, it's, it's kind of – so, I think that’s how it differs from practice is that largely we've relied on authority or a tradition or supervisors to kind of direct us in the right path for our different practice decisions that we're making and the process really says let's integrate one more thing into this decision making process. Let's consider the research in a systematic way.
And, I suppose that the assumption, the reason we have this assumption is because we know from the past that we – there are things that have made sense theoretically that should have worked but, but really haven't and have been harmful.
Jonathan Singer: So, what's an example?
Danielle Parrish: So, one example is critical incident stress debriefing which is an approach that’s typically used after a major disaster or traumatic event where you, you kind of involve – get a group of people together and—
Jonathan Singer: Like first responders or something, yeah.
Danielle Parrish: Right, like first responders and, and basically what we found through research over time – it made sense at first to kind of just address it and, you know, make people feel safe and process the event. However, what we found over time is that it, it actually results in, in an increase in the number of people that developed PTSD. That’s one example. The DARE program which we've sunk a lot of money into over the, the last several years, I guess what, decades–
Jonathan Singer: Decades, yeah.
Danielle Parrish: – which, and which, which wasn’t effective and we knew for a long time that that was the case, the Scared-Straight Program and you know part of the problem is that we could be harming individuals and the other issues that we could be wasting resources.
Jonathan Singer: So, what you're saying is that it's, it's not enough to just use practice wisdom. You also want to integrate the research but you want to critically appraise the research to make sure that whatever you're using actually works.
Danielle Parrish: Absolutely. Yeah, something could, could make sense theoretically or based on common sense but, but when you test it out, we could learn something that we didn’t know or that it may not be readily apparent. And it also helps to know what's best. Something might be a lot more brief, you know, and a lot less, a lot more cost-efficient than, than alternatives. So, I think that, you know, relying on the research to, to answer those types of questions is very valuable.
Jonathan Singer: So, what are some of the limitations of evidence-based practice?
Danielle Parrish: So, what do you mean specifically?
Jonathan Singer: Well, I guess I’m thinking and if, you know, if I were a practitioner I would absolutely want to do the best for my clients but if I’m taking into consideration what my clients need and what I know how to do, like my practice wisdom which is what I've been doing but now I have to include the research, that means I have to have access—
Danielle Parrish: Mm-hmm.
Jonathan Singer: – to the research. And let's say I actually do have access to the research which I’m not sure how I would get access to, reading it is a nightmare like it's all statistics and, and like methods and, you know, and it's not written for me as a practitioner and so I want to do it but I don’t know how to take something from this research article and then put it into my practice.
Danielle Parrish: Mm-hmm.
Jonathan Singer: That’s sort of what I mean by like a limitation.
Danielle Parrish: Mm-hmm. I think it's definitely a challenge in implementing the process. I think there are a few things that can be done. The first is that there are a lot of resources available online. So, if you start with the first point that you made about access to information, things are sprouting up like crazy. There are so many different resources out there.
The first thing that practitioners usually don’t realize is that they have access to their local libraries, the public library. Typically if you have a membership, most libraries these days have electronic access that you can get anywhere where you have internet access home, work and you can search databases that are very similar to a lot of the public libraries or university libraries I should say.
And that doesn’t solve the, the concern about reading research but I do think that there are some ways to make that process easier and perhaps more practitioner-friendly. I think typically if, if you can shoot for trying to find a systematic review first – basically what the systematic review does is it, it synthesizes a large amount of literature in a particular practice area in one article instead of a lot of articles.
Jonathan Singer: So, it does the work for you.
Danielle Parrish: Basically, yeah, and we have some great organizations on the web such as the Campbell Collaboration and the Cochrane Collaboration that actually put these online, the summaries at least. I know Campbell puts the whole review but if – as a practitioner if you read the summary, they typically do give you implications for practice from the overall review and so that can be really helpful in terms of knowing what the findings mean.
Campbell typically focuses on areas that are very relevant to social work, social welfare, criminal justice as some examples and the Cochrane Collaboration typically focuses more on medicine but there are a lot of resources in the area of mental health. So, those are both great resources. You can pretty much Google the two names that I've given and they'll come up but – and there are a lot of other resources out there as well that kind of summarize the literature in different areas and I’m happy to provide a list of those resources if you’d like to post them on your site.
Jonathan Singer: Yeah, I know. That would be great. We'll post that on the Social Work Podcast website. That’ll be great and we'll post the links to the Cochrane [http://www.cochrane.org/] and the Campbell [http://www.campbellcollaboration.org/] websites. Okay. So, those are, those are places that clinicians can go to get summaries of the research and, and they can also to their library. It sounds like to access journals and books and that sort of stuff.
Danielle Parrish: Right. Right. And the other, the other thing that some practitioners have found helpful is, is to kind of get into teams. So, if within an agency, if there were some individuals that were interested in various steps of the EBP process, you know, the kind of like a work team that could get together, identify practice questions and kind of divvy up the various steps of the process and generate knowledge for their particular agency and share it, that’s one way to kind of make the process more feasible.
And if practitioners are in private practice, they can kind of maybe get together and form a journal club or some sort of an evidence-based practice process club where they come together and identify similar questions that they have and took a team approach to answering those questions.
Jonathan Singer: Let's say I am working in an agency and I am working with kids the way of conquering disorders and I remember from my MSW program that there's not much research out there on these kids and let's say I am even able to do a review and I don’t find any research.
Danielle Parrish: Mm-hmm.
Jonathan Singer: Like am I not able to do evidence-based practice at that point?
Danielle Parrish: That’s a great question. I would, I would argue that if you have gone through the process to look for the evidence and it's not there that you're still engaging in the evidence-based practice process because you’ve looked for the research. And that particular case it might be, you know, a situation where you take the research that most applies and you integrate that with your practice expertise or the expertise of, of your fellow practitioners and, and, and try to find the best course of action and then, of course, it becomes even more important to evaluate your practice.
Jonathan Singer: Like if you're working with Latino youth and the only research out there is with white or African-American kids, like—
Danielle Parrish: Right.
Jonathan Singer: – you’d want to evaluate it to see if there are any cultural differences or something like that.
Danielle Parrish: Absolutely.
Jonathan Singer: So, are students learning evidence-based practice or the process of evidence-based practice in schools of social work?
Danielle Parrish: I think they are learning it more than in the past. Allen Rubin and I did a survey I would say about five years ago of MSW faculty in the U.S. It was interesting because at that point in time we found out that even faculty were very divided in how they define evidence-based practice. As I was mentioning earlier, there's these two definitions so some people saw it as a process.
Some people saw it more as a kind of list of empirically-supported interventions. So, and we also have found there are a lot of, there was a lot of variation in how faculty viewed what kind of evidence was necessary for deeming something as being empirically-supported or evidence-based and so that led to the Austin Initiative.
It was hosted by UT Austin and kind of organized by Allen Rubin and it resulted in a, the gathering of hundreds of faculty across the United States and, and really started a discussion I think about what evidence-based practice is, how we define it in social work and kind of how we can start teaching and educating students about the evidence-based practice process and so since that time I keep hearing about various developments at different schools.
There's actually a collection of syllabi on the CSWE website. There's an evidence-based practice section. There are courses that are being taught specifically on the evidence-based practice process, entire courses and some of those are on there. There are syllabi there that kind of integrate the process into other subject matter and I know that the Brown School has adopted the evidence-based practice process as, as the model for their, for their curriculum.
Jonathan Singer: Okay. So, it sounds like students are learning this. There's the process of evidence-based practice and that there are empirically-supported treatments. There are a lot of resources for social workers. There are things that social workers can do in their agencies or in private practice to support each other. Did I get that?
Danielle Parrish: Yeah, I think you summed it up really well actually.
Jonathan Singer: Fabulous. Okay. Well, Danielle thanks so much for being here today and talking with us about evidence-based practice.
Danielle Parrish: Thank you for having me. It's been my pleasure.
Useful Internet Sites for Reviews, Practice Guidelines & Databases
Compiled by Danielle Parrish, Ph.D.
Updated: October, 2010
- Google: http://www.google.com/
- Google Scholar: scholar.google.com
- Campbell Collaboration (C2): The Campbell Collaboration Library and Database: http://www.campbellcollaboration.org/
- Cochrane Collaboration: http://www.cochrane.org/
- APA Guidelines: http://www.div12.org/
- National Guidelines Clearinghouse (DHHS): http://www.guidelines.gov/
- Search Pilots (On National Center for Post-Traumatic Stress Disorder Website): http://csaweb113v.csa.com/ids70/quick_search.php?SID=ghl2laqhc0qde1aj4rspo4p237
- OJJSP Model Programs Guide: www.ojjdp.gov/mpg/search.aspx
- California Evidence-based Clearinghouse for Child Welfare (CEBC): http://www.cachildwelfareclearinghouse.org/
- BMJ Clinical Evidence: www.clinicalevidence.com/ceweb/conditions/index.jsp
- Department of Health and Human Services: Agency for Healthcare Research and Quality Evidence Based Practice: www.ahcpr.gov/clinic/epcix.htm
- SAMHSA’s National Registry of Evidence-Based Programs and Practices: http://www.nrepp.samhsa.gov/
- Civic Research Institute: http://www.civicresearchinstitute.com/
- PsycINFO: www.apa.org/pubs/databases/psycinfo/index.aspx
- SumSEARCH: sumsearch.uthscsa.edu
- Evidence-Based Mental Health (BMJ): ebmh.bmj.com
- PubMed: www.ncbi.nlm.nih.gov/sites/entrez
- The National Institute for Health and Clinical Excellence (NICE): www.nice.org.uk/guidance/index.jsp
- American Academy of Child and Adolescent Psychiatry: www.aacap.org/cs/root/member_information/practice_information/practice_parameters/practice_parameters
- Information for Practice: blogs.nyu.edu/socialwork/ip
Parrish, D., & Rubin, A. (2011). Validation of the Evidence-Based Process Assessment Scale—Short Version. Research on Social Work Practice, 21, 200-211, first published on November 23, 2010 doi:10.1177/1049731510389193
Parrish, D.E., & Rubin, A. (2011). An Effective Model for Continuing Education Training in Evidence-Based Practice. Research on Social Work Practice, 21, 77-87. First published February 17, 2010 as doi: 10.1177/1049731509359187.
Rubin, A., & Parrish, D. (2010). Validation of the EBP Process Assessment Scale. Research on Social Work Practice. First published August, 18, 2010 as doi: 10.1177/1049731509347851.
Parrish, D. (2009). Cognitive behavioral coping skills therapy for adults. In The Clinician’s Guide to Evidence-Based Practice (Eds. Rubin, A., & Springer, D.). John Wiley and Sons.
Rubin, A., & Parrish, D. (2009). Development and validation of the EBP Process Assessment Scale: Preliminary Findings. Research on Social Work Practice. First published on March 4, 2009 as doi: 10.1177/1049731508329420.
Rubin, A., & Parrish, D. (2008). Locating credible studies for evidence-based practice. In Social Workers’ Desk Reference 2nd Edition (Eds. Roberts, A., & Greene, G., Associate Ed.Thyer, B.), Part XVI: Evidence-Based Practice, pp. 1127-1136. New York: Oxford University Press.
Rubin, A., & Parrish, D. (2007). Challenges to the future of evidence-based practice in social work education. Journal of Social Work Education, 43, 405-428.
Rubin, A., & Parrish, D. (2007). Problematic phrases in the conclusion of published outcome studies: Implications for evidence-based practice. Research on Social Work Practice, 17, 334-347.
Rubin, A., & Parrish, D. (2007). Views of evidence-based practice among faculty in MSW programs: A national survey. Research on Social Work Practice, 17, 110-122.
Episode 18 - Dr. Bruce Thyer: Looking at Evidence-Based Practice: How Did We Get Here? (2009, April 20). Living Proof Podcast Series. [Audio Podcast] Retrieved from http://www.socialwork.buffalo.edu/podcast/episode.asp?ep=18
APA (6th ed) citation for this podcast:
Singer, J. B. (Host). (2011, March 9). The process of evidence-based practice: An interview with Danielle E. Parish, Ph.D. [Episode 65]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2011/03/process-of-evidence-based-practice.html