The Evidence-Based Practice Debate – Keeping Current With Research is Imperative for Quality Practice

There is much ongoing debate about the push toward evidence-based practice in social work. It seems a fear exists of becoming too text-book, of losing the “art” in the name of the “science,” of instituting cookie-cutter guidelines forcing practitioners into a certain model.

While I understand those concerns, I see the incorporation of evidenced-based treatments to inform practice models as an effective melding of the disciplines of art and science which are both inherent in social work practice. Hands on practice, and research to study, inform and direct treatment have always been part of social work in the United States and elsewhere.  The push toward evidence-based practice is a necessary step in our professional development; it is the only way to build a base of knowledge to inform treatments.

A January 10, 2013 article in Science Daily, which you can access at the following link: Kidneys Sometimes Removed Unnecessarily Due to Misdiagnosis of Genetic Disorder, states “Thousands of individuals have had kidneys removed unnecessarily because doctors misdiagnosed their disease.” The story, reporting findings from an international study, reveals “one of every five individuals with kidney tumors common in patients with tuberous sclerosis complex (TSC), a genetic disorder, has had a kidney removed.” There are effective, non-invasive treatments for this type of tumor. If this information isn’t widely available and readily accessed by treating professionals to inform their practices with the most current research, unnecessary, and potentially harmful surgery will continue to be performed.

An article in Autism Science Foundation, Beware of Non-Evidence-Based Treatments, explains another important aspect of the need to build and use evidence-based treatments:

“It is important to remember that anyone can start a journal or post a study on the Internet to tout the efficacy of dangerous or useless interventions. Healthcare fraud is a huge business in the US, and parents of children with autism are often targeted. Fringe treatment providers prey on desperation and fear, and deceive parents with numerous unfounded claims.”

Fringe, uniformed treatments, miracle cures, and fraud have always existed. In earlier times, a scientific base for research wasn’t available. Now, with the advent of the computer age, we have an ease of data collection, and an ability to easily perform complex statistical analyses unknown to previous generations.  To not use this capability to better inform practice interventions would be remiss of our profession.

As a study titled, A Meta-analysis of the Psychological Treatment of Anger: Developing Guidelines for Evidence-Based Practice, in the Journal of the American Academy of Psychiatry and the Law (online) states: “There is no clear evidence to guide mental health professionals in assessing and treating angry clients.” To further the point, there is limited evidence to guide mental health professionals in assessing and treating a wide variety of clients for a wide variety of disorders.

For example, look into treatments for personality disorders and the lack of informed studies is clear. An assortment of literature on antisocial personality disorder, borderline personality disorder and narcissistic personality disorder exists to a greater degree than any literature on avoidant personality disorder, or dependent personality disorder, and even less on the potential overlap of these types of disorders, on the assessed impact on society in terms of social service outputs, and of effective treatments. It speaks to the squeaky wheel getting the most oil perhaps, as these “louder” disorders garner more attention, however, “louder” doesn’t equate to greater needs and larger losses in terms of human potential and social service outputs. The report goes on to state, “Within the current demand for evidence-based practice (EBP), there is an increased onus on forensic psychiatrists to become more sophisticated in the areas of risk assessment and management and more capable of distinguishing effective treatments from inadequate and harmful approaches.” Why would the onus of distinguishing effective treatments from inadequate and harmful approaches be any less stringent for professional social workers?

If we ignore science, fail to avail ourselves of current research, and choose to opt out of contributing to an ongoing construction of the knowledge base which informs our practices, then we are failing to provide our clients with the best professional practice we can offer. It is our professional obligation to keep current. Knowledge is gained in stages through shared dissemination of newer information. We can only grow as professionals by taking an interactive part in learning our craft. If not for the pursuit of building an evidence base, we might still believe the world is flat.

Evidence-based practice provides practitioners with a set of treatments with known, reproducible outcomes.  It is something to be added to, and built upon, not something to be fear or ridiculed. If we choose to close our eyes and minds to newer understandings, we are failing to progress as a profession. As Nikki Giovanni said, “Everything will change. The only question is growing up, or decaying.” If we fail to progress, we are making a choice to stagnate and ultimately decay.

Use this link from the Texas Department Of Family and Protective services. It provides links to other resources including searchable databases of interventions.  Some of the links include: SAMHSA, Harvard Family Research Practice, Office of Juvenile Justice and Delinquency Prevention.

Written by, Michelle Sicignano, LMSW, SJS Staff Writer