Integrating Evidence-Based Practice and Implementation Science Into Academic and Field Curricula

We are experiencing an unusual moment in history.  Myths, misconceptions, opinion, and ideology are challenging science when findings suggest new approaches that may disrupt accustomed practice and belief. The resulting confusion is not limited to the divided politics of our time. For nearly two decades, administrators of behavioral health and academic programs have struggled to understand and embrace, to provide and teach evidence-based practice and implementation science.

This special issue emerged from a series of studies, subsequent webinars, and papers initiated by participants in the Child & Family Evidence-Based Practice Consortium (https://ebpconsortium.com), an international group of faculty, implementation specialists, program administrators, developers, practitioners, and researchers. A workforce readiness survey conducted by a Canadian consortium participant in 2011 precipitated these activities. In this study 589 North American behavioral health care administrators and clinical supervisors indicated that new master’s-level practitioners (most of whom were social workers) were not well prepared to deliver evidence- based practice. Respondents reported that practitioners frequently lacked the skills to search for and critically appraise literature to support a scientific approach to practice, as well as technical skills to deliver specific interventions, and that these skills had to be developed through agency training and coaching (Barwick, 2011).

These findings inspired a group of consortium researchers to examine the extent to which master’s-level programs in social work and in marriage and family therapy teach skill sets needed in a process of evidence-based practice as well as specific evidence-based intervention models. The first of these studies examined MSW programs (Bertram, Charnin, Kerns, & Long, 2015). In contrast with Barwick’s findings (2011), most responding MSW deans and directors believed their students thoroughly developed those skill sets. Faculty differences about evidence-based practice definitions, their lack of training and experience with specific evidence-based intervention models, and faculty with competing philosophical or theoretical orientations were the most frequently cited barriers to teaching evidence-based practice.

To address findings from that study, in 2016 the consortium assembled faculty from Fordham University; Washington University; the Universities of Washington, Missouri-Kansas City, and Toronto; and the vice president of the Wheeler Clinic of Connecticut to deliver a series of four webinars for social work faculty (available from https://ebpconsortium.com/webinars/). The webinars began with a review of social work’s prolonged debate about a process of evidence-based practice and the menagerie of different and sometimes confusing criteria, definitions, and names for evidence-based intervention models. EBP in North American MSW curricula (Bertram et al., 2015) was presented, and additional webinar content challenged common myths and misconceptions with evidence and facts, highlighted critical lessons from implementation science, and asserted that the time for social work’s prolonged debate about evidence-based practice had passed. The series concluded with several examples of how to integrate evidence-based practice and implementation science into academic and field curricula. Webinar participants urged us to propose a special issue of this journal with that same focus.

The call for papers produced an astounding number (n=55) of abstracts from the United States and Australia proposing manuscripts for this special issue. This response suggests important transformation in social work is well under way. We are grateful to Patricia Kohl, who before shifting her attention to other projects, helped us review this large number of abstracts and select those that most closely addressed the intent of the special issue. Twenty-one manuscripts were invited for submission. Four sets of authors chose not to submit.

By the end of 2017, page limitations allowed us to select only ten of the remaining manuscripts for special issue publication. The selected articles present a range of topics and approaches, from strategies to enhance the overall uptake of evidence-based practice and implementation science, to thoughtful, conceptual articles. These include examples of university–field partnerships and the use of centers of excellence. Some articles focus on specific evidence-based interventions and models (e.g., motivational interviewing; screening, brief interventions, and referral to treatment; managing and adapting practice [MAP]; and modular approach to therapy for children with anxiety, depression, trauma, or conduct problems).  Others provide basic orientation to evidence-based practice and tools that may be supportive for instruction (e.g., the California Evidence-Based Clearinghouse; Gambrill’s suggestions for encouraging deep dialogue in the classroom). Some articles provide data from quantitative, qualitative, and mixed-methods approaches to present classroom results. However, the Leathers and Strand study followed students post-graduation to demonstrate the impact of training on clinical practice.

The following brief descriptions offer a glimpse into each article in the special issue.

Graaf and Ratliff: “Preparing Social Workers for Evidence-Informed Community-Based Practice: An Integrative Framework”

This article shows how integration of evidence-based practice in the curriculum can be well aligned with the Council on Social Work Education’s accreditation standards.  Graaf and Ratliff describe an integrative model of evidence-informed social work to guide social work curriculum development while addressing constraints of time and resources and persisting translational concerns, and provide examples of how to apply it from a generalist and a specialist framework.

Bertram et al.: “Integrating Implementation Science and Evidence-Based Practice Into Academic and Field Curricula”

This article highlights the nexus between implementation science and evidence-based practice in transforming academic and field curricula, as well as their impact on students, instructors, and participating child welfare organizations. Field learning plans focus on implementation frameworks, and weekly field portfolios monitor field learning while requiring students’ selection of evidence-informed literature for discussion with their field instructor. Students conduct multimethod program implementation evaluations that inform field instructor and site development. Plan-do-study-act feedback loops integrate lessons for students, faculty, and participating organizations.

Nwabuzor Ogbonnaya et al.: “Using the California Evidence-Based Clearinghouse for Child Welfare as a Tool for Teaching Evidence-Based Practice”

The California Evidence-Based Clearinghouse (CEBC) has been a resource for communities and practitioners alike since 2004. Often described as a first-stop shop for information about effective programs for child welfare, the CEBC is a registry of more than 350 programs. This article provides a thorough overview of the CEBC and the relevance of the registry to social work education. The authors provide a framework for using the CEBC with a stage-based framework for implementation and provide a case example of how this registry can be used in a capstone class to encourage students to be lifelong learners knowledgeable about effective programs. A downloadable guide to help faculty incorporate the CEBC into course work is among the references.

Leathers and Strand: “Social Work Training in the Use of Evidence-Based Treatments for Children: What Works?”

This article describes an iterative approach toward the curriculum development that provides a blueprint of strategies for programs to overcome specific barriers. The formal training program is embedded in a specific concentration (mental health). This is the only article in this special issue in which students were studied postgraduation. One of the findings was that graduates were using an impressive variety and number of evidence-based treatments in their employment settings. Findings also demonstrate the impact of an iterative process of curriculum development, in that later cohorts were more likely to use evidence-based practices than were earlier cohorts.

Mennen et al.: “The Large-Scale Implementation of Evidence-Informed Practice Into a Specialized MSW Curriculum”

This article provides an in-depth examination of the MAP program and how training in this specific intervention was incorporated into curricula. This article provides a tangible example of how social work science can be operationalized in a curriculum. Interesting features include the opportunity to embed MAP training in a large-scale countywide implementation, providing students with ample opportunities for direct practice. Specific emphasis is on training faculty to deliver the intervention and to develop implementation teams to support the curriculum. As shown in this article and others in the special issue, curriculum development is an iterative process.

Shapiro: “Centers of Excellence: An Opportunity for Academic Training in Social Work”

Shapiro introduces readers to centers of excellence and how such centers can be facilitators of academic and service program partnerships that support evidence-based practice training and implementation supports. This conceptual article provides an example of how one center of excellence was able to include students in support of MAP and implementation of the modular approach to therapy for children with anxiety, depression, trauma, or conduct problems. This approach may represent a viable strategy to overcome previously described faculty-related barriers associated with a lack of training in evidence-based practice.

Rollo and Kleiner: “From Clinic to Classroom: Creating Evidence-Based Practice Champions in a Graduate Social Work Program”

This article tackles how a broad-based course focused on teaching the fundamentals of evidence-based practice can be incorporated into the curriculum. Strategies for directly addressing potential student concerns about evidence-based practice are provided. This is the only article in the special issue that specifically refers to inclusion of evidence-based assessment in a course context. The course addresses issues such as flexibility in fidelity, cultural considerations, and treatment disparities and provides an intriguing model for how course processes may affect agencies.

Smith et al.: “Teaching Empirically Supported Substance Use Interventions in Social Work: Navigating Instructional Methods and Accreditation Standards”

Smith et al. acknowledge the paucity of social work programs that teach gold-standard evidence-based substance abuse interventions. They describe a strategy of using existing practice adherence measures to benchmark student progress and clearly articulate course competencies. This article explores how evidence-based practice for substance use can be effectively taught with the undergraduate and graduate levels, and provides examples of how the course can be taught with varying levels of intensity. They include a brief protocol description for a randomized control trial of the curriculum. This type of research is needed to identify optimal strategies for instruction.

Iachini et al.: “Integrating Motivational Interviewing Into Social Work Education: A Practical Example”

This article focuses specifically on one evidence-based practice, motivational interviewing. The practical example provided in this article could be used as a template for programs whose administrators may not be ready for a curricular overhaul but are interested in starting with incorporating an intervention with broad applicability. The discussion section provides several practical examples of how motivational interviewing could be embedded in the social work curriculum.

Gambrill: “Contributions of the Process of Evidence-Based Practice to Implementation: Educational Opportunities”

Gambrill offers a critical discussion of ethical and controversial aspects of evidence-based practice in the social work curriculum. She begins with a differentiation of evidence-based practices, processes, treatments, and their relationship to implementation. Embedded in her discourse is a caution to not blindly embrace evidence-based practice and to ensure thoughtful and critical assessment of available literature and its associated limitations. Gambrill offers a helpful list of prompting questions faculty can use to encourage deep dialogue about evidence-based practices, processes, and implementation. Of particular note is a section in which we are challenged to involve clients as informed participants in the implementation of evidence-based practice.