Three Perspectives on Evidence-Based Practice
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چکیده
This chapter will examine evidence-based practice (EBP) from three different vantage points. As discussed in Chapter 1, there are several definitions of EBP, often shaped by the role the individual has within the EBP process. To clinical social workers, EBP is most often understood as a practice decision-making process. This is indeed one key application of EBP. But clinical social workers also understand the impact of EBP in other related contexts. We find it useful to think of EBP from three different perspectives: (1) its application in practice decision making, (2) its applications to health care policy and administration, and (3) its impact on research methods and research funding. To limit discussion of EBP solely to its practice application omits attention to other, broader, issues of interest to clinical social workers. The policies that shape practice delivery, the day-to-day administration of clinical social work practice, and the kinds of research evidence valued in making policy choices are also being affected by EBP. This is the context in which EBP is changing clinical social work practice. In addition to guiding practice decision making, both evidence-based medicine (EBM) and EBP are being used at a policy level to reshape clinical practice. Cost containment, cost cutting and, in many cases, profit making are shaping the policies that orient health care practice. Beyond shaping policies, EBM and EBP are increasingly being used administratively. Improving the quality of care while reducing costs is the recent mantra of managed care providers. Large-scale research and EBM/EBP provide one valuable framework for examining service quality. At policy and administrative levels, however, EBP may conflict with client preferences and with professional autonomy. The methods of EBP may even be applied to evaluation of individual professionals. To understand EBP requires attention to the overall context in which it is embedded. From a third perspective, EBM and EBP have begun to alter research priorities in ways that may restrict the variety of research approaches and methods used to understand and evaluate clinical practice. A key strength of EBM/EBP is its use of population level research results based on experimental (or RCT) research designs.
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