The Missing Link: The Role of Social Work Schools and Evidence-Based Practice

Abstract

The translation and adoption of evidence-based practice principles has proved to be more difficult than researchers anticipated. Schools of social work are in a unique position to support this process within their home communities. Using the evidence-based practice process steps outlined by previous researchers, this article identifies specific strategies that schools of social work can adopt to support their broader communities as they attempt to adopt and sustain empirically supported interventions.

KEYWORDS:

• Schools of Social Work
• evidence-based practice
• implementation

Introduction

There is growing consensus that if schools of social work are to remain competitive and relevant in the field of mental health then their courses of study must steep students in the principles of evidence-based practice (EBP; Gambrill, 2003; Howard, Allen-Meares, & Ruffolo, 2007; Thyer, 2004). Given this mandate, a growing number of scholars hold that schools of social work must take a more active role and become more effective in enhancing the EBP knowledge through intentional and targeted pedagogical strategies (Edmond, Rochman, Megivern, Howard, & Williams, 2006; Howard et al., 2007; Mullen, Bellamy, Bledsoe, & Francois, 2007; Manuel, Mullen, Fang, Bellamy, & Bledsoe, 2009; Shlonsky & Stern, 2007). These scholars argue that effective teaching of EBP principles will launch a new generation of social workers who are committed to practicing within an EBP framework. Such commitment to an EBP will not only strengthen practice at the individual- and agency-level but also will increase the social work profession's competency in EBP. However, targeting current students for EBP training addresses only one of many factors involved in this paradigm shift (Kuhn, 1962). In the case of current students, EBP training addresses only the factor of increasing practitioners' abilities to translate research into practice (Brekke, Ell, & Palinkas, 2007). If social work as a profession is committed to widespread adoption of EBP, then schools of social work must look outside their classroom walls and find additional methods of supporting the adoption of EBP in their home communities.

Scholars from academic institutions have given attention to what occurs within schools of social work and how to effectively teach EBP, yet little attention has been paid to how schools of social work can provide on-going support to their surrounding communities regarding EBP for alumni and for other practitioners within the school's base community. Schools of social work are an excellent vehicle through which the dissemination and translation of knowledge can be made available to individuals beyond their current student body. This article identifies specific strategies that schools of social work can adopt to support their broader communities as they attempt to adopt and sustain empirically-supported interventions.

Evidence-based practice has been defined as “a process of using research findings to aid clinical decision-making. EBP promotes the collection, interpretation, and utilization of evidence that has been derived from client reports, clinical observation, and empirical research” (McCracken & Marsh, 2008, p. 301). In addition to research, many other factors must be considered when determining the most effective course of treatment, including the clinicians' expertise (McCracken & Marsh, 2008; Pollio, 2006; Shlonsky & Stern, 2007; Thyer, 2004), and the client's wishes (Pollio, 2006; Thyer, 2004). Thyer (2004) has provided step-by-step guidelines for following the EBP process, and offers examples for clinicians regarding what actions should be accomplished in each step of the process. McCracken and Marsh (2008) have outlined the same five steps in the EBP process:

1. Convert the need for information into an answerable question;

2. Track down with maximum efficiency the best evidence with which to answer that question;

3. Critically appraise that evidence for its validity and usefulness;

4. Integrate the critical appraisal with practitioner clinical expertise … client values, preferences, and clinical circumstances and apply the results to practice; and

5. Evaluate the outcome. (p. 302)

Although this process may sound simple, adoption of EBP principles in practice settings has proved to be much more complex than many imagined (Bellamy, Bledsoe, Mullen, Fang, & Manuel, 2008; Brekke et al., 2007; Nelson, Steele, & Mize, 2006; Pollio, 2006; Rosen, 2003). Schools of social work can be integral players in supporting agencies and practitioners through the EBP adoption process utilizing the strengths of their faculty, increasing the potential to create wide gains in the quest to integrate EBP more firmly in community practice settings. The leadership within schools of social work should encourage faculty members' efforts to support this goal. For the remainder of the paper, specific suggestions will be provided regarding how schools of social work can play a constructive role in each of the steps outlined by Thyer (2004) and McCracken and Marsh (2008).

1. Convert the need for information into an answerable question

Given that Masters of Social Work (MSW) programs are only two years in length, it would be impossible for social work programs to adequately prepare their graduates for all possible contingencies that may arise in their practice settings. As such, practitioners regularly face dilemmas or scenarios they did not come across in their coursework. The first step in developing an intervention plan to address these unanticipated situations is to first know what your question is regarding the dilemma. “Is there a need for additional information in order to identify and apply the most effective intervention for my client (system), and if so, what information do I need?” (McCracken & Marsh, 2008, p. 303).

Schools of social work can help practitioners by simply being accessible to practitioners within their communities. When social workers ask questions such as “who, what, where, when, how, or why” (Thyer, 2004, p. 168), faculty members can help refine these questions and put them in a format where they can be more easily searched. In addition, if faculty members are a presence in community agencies, through field education (Edmond et al., 2006) and through community partnerships (Bellamy et al., 2008; Gioia & Dziadosz, 2008) as well as community training, faculty members can be used as a resource for practitioners that may not have had more than minimal training in research methodology.

2. Track down with maximum efficiency the best evidence with which to answer that question

This second step is a multi-tiered process, involving locating useful information, efficiently accessing the information, utilizing search terms within data base systems, and understanding what evidence would be useful to include in the search (McCracken & Marsh, 2008). In other words, “what is the best place to get this information, and how do I structure my search to efficiently get the information I need?” (McCracken & Marsh, 2008, p. 304). Within this second stage, schools of social work can play an active role and greatly assist local practitioners as they attempt to navigate this process.

Public Web sites: Most schools of social work now have Web sites for their programs that can be accessed by anyone with a computer and an Internet connection. Within those Web sites, schools could provide resources for the broader communities, such as links to public research sites with information on empirically supported interventions (ESI). Such public research sites include the National Institute of Mental Health's site (http://www.nimh.nih. gov) or the Substance Abuse and Mental Health Services Administration's site (http://www.samhsa.gov/). Although a quick Google search will produce these links, many community practitioners may not be familiar with their existence, the public access, or the type of research information available.

An additional resource that schools should make available to community practitioner is the research generated by the school's faculty. This information could be organized by topical areas and accessed by a practitioner via the school's Web site that provides links to faculty research according to faculty areas of interest and expertise. In other words, school Web sites should not only list faculty by name but also list areas of expertise represented in the faculty. With access to that level of information, a practitioner looking for interventions focused on reducing school violence or depression in adolescents, could easily identify faculty with expertise in those areas as well as some of their research and contact information.

One final use of the Web site could be to make all course syllabi available to the public. With the information, practitioners could search for courses that may address their practice area and find readings or other resources that they might be able to use in practice as well as stay current with new research, controversies, and changes that occur in those topic areas.

Hold Seminars for the Public: In addition to making research more available, schools could also provide community trainings on effective search methods to identify evidence. Practitioners who attended school when data-bases were less prominent, or nonexistent, may not have the skills, knowledge, or resources required for conducting searches via subscription-based services (e.g., PsychInfo or Social Work Abstracts) or open-access public databases (e.g., Google Scholar or Pub Med). Practitioners have reported that the process of searching for research is an intimidating and daunting endeavor because they are unfamiliar with using the research tools and resources that most researchers take for granted (Bellamy et al., 2008). By using/ relying on the expertise of the school's faculty regarding the “how to” of conducting searches for evidence, practitioners would likely be better equipped and more confident in their ability to find the best, most relevant evidence available to them.

Access to Libraries: Many colleges and universities must limit access to their collections and the services they pay for, such as electronic journals, to members of their college or university. As such, community members often do not have access to such materials, further limiting their ability to retrieve any evidence they may have found in a search (Bellamy et al., 2008; Proctor et al., 2007). However, for field advisors, research advisors, or other practitioners who play a role in students' education, it would behoove schools of social work to advocate for these individuals to have access to the resources available to most faculty members. With such access, these individuals (who may be based within community agencies) can help support the students' learning and utilization of ESIs in the field. An additional benefit is that through the students' familiarity and comfort with ESIs, they can help to infuse these interventions into the culture of the agency, which various studies have found to be a significant barrier to adopting ESIs in practice settings (Bellamy et al., 2008; Nelson et al., 2006).

Public Access for Journals: Finally, faculty who are members of editorial boards for various journals should encourage their publications to become open access. Through such access, individuals who are not within a close proximity to a university or college library would be able to find research and information on their area of interest from any computer with an Internet connection. This knowledge sharing is a very important global resource and would help to bridge the divide between the academic and practice worlds.

3. Critically appraise that evidence for its validity and usefulness

For many practitioners, the third step in the EBP process is the most daunting. The majority of empirical research articles reporting findings regarding a particular intervention are not written for clinicians but for other researchers (Yunong & Fengzhi, 2009). Therefore, non-researchers face numerous challenges in interpreting the results of the available evidence (Bellamy et al., 2008). For example, one research project involved a university-supported research team partnering with a community agency to work toward implementation of an ESI. Having access to the resources of the university through the research team was a critical part of the project because nearly all of the agency participants commented on “their struggle to understand the sophisticated aspects of research, whether that meant interpreting research methodology or calculating comparison statistics” (Bellamy et al., 2008, p. 63). One participant stated, “To me, the evaluations of the research, it's like really complicated, and the statistical stuff, to me, I start to zone out” (Bellamy et al., 2008, pp. 63–64), and another said, “I can't see myself going through 15 articles and calculating the effect size” (p. 64). Overall, the agency participants did not feel confident in their ability to understand the research well enough to confidently implement an EBP.

Schools of social work can play a vital role in helping practitioners interpret and translate the available research into their practice settings through several avenues.

Dissemination of Research for Practitioners: Faculty members at schools of social work who have expertise in particular areas of practice research should offer lectures or workshops for local practitioners that help to interpret the research and give practical guidelines on the application of such research to various practice settings. Although many research institutions do not value these trainings as highly as presentations at professional conferences, researchers, universities, and other stakeholders must make more effort to disseminate the information to the people the intervention researchers hope will use the intervention. Further, such dissemination efforts should include guidance regarding the extent to which an intervention can or cannot be adapted to a practice setting (Fraser, Richman, Galinsky, & Day, 2009). School administrators should therefore encourage more local training by their faculty, allowing those presentations to be included as part of the faculty member's service to the community and counted as part of their engaged scholarship activities. If it is not feasible for multiple trainings to take place, schools could record the trainings and then make them available through podcasts, online videos, or other formats to accommodate those individuals who are limited by time and financial constraints.

Summary or white papers on particular topics: There are some institutions that provide summaries of research, such as the Cochrane Collaboration (http://www.cochrane.org/) and the Campbell Collaboration (http://www.campbellcollaboration.org/). However, the summaries are quite technical and are not generally geared towards practitioners. In addition, these sites are not exhaustive as the number of ongoing research projects are too numerous to be tracked in present time by these institutions. Faculty members who have an expertise in a particular topic area should attempt to write one or two papers each year that are aimed at assisting practitioners by interpreting and summarizing their area of expertise. Such summaries would help practitioners better understand research findings and begin the process of discerning how to apply those findings to their practice setting and population (Bellamy et al., 2008; Nelson et al., 2006). These summary papers could then be made available on the school's Web site and used as a source of evidence by practitioners wanting to practice using EBP principles.

In addition to helping community practitioners, this information would communicate to prospective students the quality of education they would receive, and the emphasis a school places on supporting graduates once they become community practitioners. From a broader university or college perspective, providing this information would demonstrate community involved scholarship. Finally, by allowing others to see the available information in a digestible format, it might initiate more open dialogue between practitioners and research faculty on feasibility, cultural competence, and effectiveness of interventions in various settings.

Within Schools: As stated in the introduction, much has been written concerning the importance of teaching MSW students to be critical consumers of research and that social work students must be socialized to use EBP beginning in their MSW programs. As this topic is not the focus of this paper, readers are encouraged to read previous writers who have provided guidelines for educators regarding how to teach and incorporate EBP into the curriculum (see Howard et al., 2007; Jenson, 2007; Mullen et al., 2007; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000; Springer, 2007).

Integrate the critical appraisal with practitioner clinical expertise, client values, and preferences, and clinical circumstances and apply the results to practice

There are many steps involved in this fourth part of the EBP process. These include a practitioner's evaluating her or his own skill set in being able to provide the intervention supported by the evidence (McCracken & Marsh, 2008), considering client factors that may influence how the intervention is perceived by clients (Comas-Diaz, 2006; Nelson et al., 2006; Pollio, 2006), and what adaptations, if any, need to be made to the intervention to most effectively meet the needs of the client (Nelson et al., 2006; Proctor & Rosen, 2006). This fourth step in the process is one where practitioners must determine how to use an intervention given the complexities of their clients' circumstances. For many practitioners, this is often where ESIs are dismissed as the practitioner views the intervention as not being applicable to the particular needs of their client (Bellamy et al., 2008; Nelson et al., 2006; Pollio, 2006; Proctor et al., 2007; Rosen, 2003). One practitioner stated “In terms of the fit, so it almost would require another piece of training or knowledge around how do you judge evidence that's been produced out of a completely different population … we had difficulty finding research dedicated to the population that looks like [our clients]” (Bellamy et al., 2008, p. 67).

Given the complexities or the “messiness” of practice, it is often within this stage that many practitioners dismiss the applicability of ESIs to their population (Nelson et al., 2006; Pollio, 2006; Proctor et al., 2007; Rosen, 2003), saying that the usefulness of highly controlled studies are “irrelevant” and “absurd” (Nelson et al., 2006, p. 404), with another stating, “The research has to be with out-of-control kids, not control kids” (p. 404). To address this problem, many researchers are beginning to partner with community agencies in an attempt to help the intervention be sustainable within the community setting (Bellamy et al., 2008; Gioia & Dziadosz, 2008). However, these partnerships tend to be with singular agencies rather than supporting the broader social work community in which the school is based.

As this adoption and translational process is complex and must consider many individual elements, schools of social work can act as a resource regarding how to think critically about the application of interventions within the agency. Such support can be offered through direct consultation, or spending more time in the settings where the interventions will take place, as one practitioner invited researchers to “Come spend a day with us” (Nelson et al., 2006, p. 404). In social work programs where there is a great deal of emphasis on conducting research, there is the potential for those researchers to lose touch with the actual daily challenges that front-line workers are facing and the “messiness” of clinical practice (Pollio, 2006; Yunong & Fengzhi, 2009). Clinicians often feel that researchers do not understand clinical practice and need to be more informed about the nuances of actual practice (Brekke et al., 2007; Pollio, 2006) and may dismiss therefore the knowledge offered by social work researchers if they are not seen as understanding the specific challenges they face in practice (Brekke et al., 2007; Yunong & Fengzhi, 2009).

Given these critiques, administrators should encourage and support faculty members to participate more in practice-based research and/or to carry out some of the interventions they are recommending others adopt. Maintaining the clinician/researcher model is supported in other disciplines practice-based disciplines, such as medicine and nursing (Latter, Clark, Geddes, & Kitsell, 2009; Ley & Rosenberg, 2005). These experiences would not only increase the appreciation for the complexities associated with translating research into practice within community settings, but would model for social work students the importance of maintaining both hats within social work, the researcher and the practitioner (Stricker, 2007). Tenure or promotion standards should include and recognize the importance of maintaining practice activities for faculty members, as such practice experience has the potential to enhance their research as well as their teaching (Stricker, 2007).

5. Evaluate the outcome

“EBP also mandates that we systematically evaluate our own service outcomes” (Thyer, 2004, p. 175), as such, the evaluation of practice is an essential step in finding the best fit for a client's current situation. Similarly to step 4, schools of social work faculty can act as consultants to agencies who are interested in conducting efficacy or outcome studies. The extent to which faculty members can be involved could be limited to a brief consultation, or they could extend to a partnership role where they are involved more extensively with the evaluation process of an intervention (Bellamy et al., 2007; Gioia & Dziadosz, 2008). Many practitioners are eager to be involved from the ground-up in research projects and would welcome researchers to play a role in this aspect of the implementation process (Nelson et al., 2006; Pollio, 2006).

In addition, for those faculty members who have expertise in program evaluation or intervention research, offering brief seminars on various evaluation strategies that could be conducted in a cost effective way, both in regards to financial and time costs, would be a great service to practice agencies. Practitioners and agency directors have repeatedly cited that one of their struggles in adopting and maintaining the use of ESIs within their agencies is their lack of time to learn about the intervention and evaluate whether it was worth the time and effort to adopt it, as illustrated by one practitioner who stated, “You don't have time to sit there and read 20 articles. Time is very, very tight and this influences what evidence and research we access” (Murphy & McDonald, 2004, p. 130). One agency director stated that “Our clinicians don't have time to spend an hour in the library every day reading the literature, or to spend just once a week go in and spend the day in the library and catch up on what's going on in the field” (Proctor et al., 2007, p. 483). “How to” seminars could include information on new standardized instruments, outcome study designs, and instructions on how to conduct simple analyses using commonly available software, such as Microsoft's Excel or equivalent programs that are available without charge through Open Office .org (http://www.openoffice.org).

6. Provide a clearinghouse for practice-based research

In addition to the five steps outlined by Thyer (2004) and McCracken and Marsh (2008), social work should showcase their expertise in a user-friendly format on a national level. There are several national bodies that represent social work in various forms, such as the National Association of Social Workers (NASW), the Council for Social Work Education (CSWE), and the Society for Social Work Research. One of these organizations should take on a leadership role on behalf of the profession and act as a clearing house for practitioners from multiple disciplines where current evidence regarding practice research could be easily accessed and searched. Within the NASW WEBSite, there is a link to a Web page that summarizes the concepts of EBP and provides some resources for individuals (http://www.socialworkers.org/research/naswresearch/0108evidencebased/default.asp). However, none of these are social work specific, nor is there a link to evidence-based social work interventions or social work practice areas. As the social work profession works to demonstrate both internally and externally our scientific scholarship (Sowers & Dulmus, 2009; Stoesz & Karger, 2009), this service would also function to showcase the vast expertise housed within the social work profession. As such, the perception that social work is a less rigorous profession than others (Murphy & McDonald, 2004; Sowers & Dulmus, 2009; Stoesz & Karger, 2009) could be altered to one that encompasses high caliber research and rigorous scholarship, providing leadership in the translation and adoption of ESIs into various communities and settings.

CONCLUSION

For EBP to take hold with communities, changes must take place systemically that address issues beyond the education of the next wave of social work practitioners. Schools of social work should play an active role in supporting the adoption and the staying power of EBP principles by using the vast expertise within programs to disseminate not only content expertise of ESIs, but process expertise on how to carry out the various steps involved with the translation and adoption of EBP. School administrators should begin to consider how to reward some of the activities suggested in this article that are focused on community based efforts aimed at challenging schools of social work to take on a leadership role regarding EBP. Through their active and visible support of the wide-spread adoption of EBP on a broader community level, social work has the potential to take a prominent role in the reframing of EBP from a developmental phase only to one that includes both development and application.