SOCW 553: Research Knowledge and Evidence in Clinical Social Work Practice

​Evidence-based practice (EBP) emphasizes the conscientious application of evidence pulled from literature, in addition to clinical expertise, and patient values/preferences, in making decisions about the care of individuals or patients. It is otherwise known as evidence-informed practice, evidence-driven practice, evidence-guided practice, evidence-based medicine, or evidence-based health care. 

Newman, Moseley, Tierney, & Ellis (2005) express the following statements around evidence-based practice and social work:

"Social care practitioners are expected to base their work, like that of other professions, on evidence of 'what works' and to 'take responsibility for maintaining and improving their knowledge and skills' (p.2)." 

"In order to discharge their obligations ethically, professionals must continue sound to learn, and adapt their practice accordingly. This adaptation must draw on sound up to date evidence of what appears to be effective, and ineffective, and even more importantly, what appears to do harm (p.4)."

"Evidence-based practice cannot deliver certainties, just increase probabilities, and this is the most that any approach claiming to be 'evidence-based' can hope to achieve (p.5)."

For further reading:

Parrish, D. E. (2018). Evidence-based practice: A common definition matters. Journal of Social Work Education, 54(3), 407-411. doi: 10.1080/10437797.2018.1498691

Authority is important to support understanding the varying perspectives that contribute to EBP: the evidence, the clinician's experience, and the patient's needs.

EBP is not a vacuum of information - it relies on all of the following elements:

1. Expert Knowledge - taking into consideration formal studies of relevant populations and applicable grey literature 
2. Practice Experience - taking into consideration past experience with a population via professional practice
3. Personal Experience - taking into consideration that you may identify as a member of the population
4. Beliefs - taking into consideration the sentiments of the population themselves and how that may differ from how other populations see them. For example, a population may see an intervention in a certain way that goes against expert knowledge, practice or personal experience. 

The EBP process steps to be taken are important to follow, to ensure that the evidence drawn will contribute positively to a client's situation or need, and will not produce or extend harm. 

Phase 1. Formulate a clinical question - PICO

Phase 2. Search literature for evidence related to question

Phase 3. Rate the quality of the available studies

Phase 4. Apply evidence to the patient or clinical question

Phase 5. Assess outcomes of decisions

Another foundational piece of EBP is the consideration of the quality of evidence you are using to draw your conclusions for practice. The following diagram displays the common examples of evidence used in various evidence syntheses. The evidence increases in quality as it rises to the top of the pyramid. 

Systematic reviews, and other evidence syntheses, are considered to be at the top of the pyramid - to bring together the best quality evidence available on a topic and to answer clinical questions. We will discuss this further on later pages in this guide. 

The thing to remember about this evidence pyramid is that it is only a guide to better understanding all of the types of research that are out in the world today. There are topics and disciplines that do not follow this pyramid in the same way. Social work often prioritizes practice-based knowledge and expert opinion in many situations, but it is still important to remember and consider research-based evidence when necessary - and even combining the two, such as EBP recommends, to ensure the whole picture is being considered.