This article was downloaded by: [Flinders University of South Australia]On: 04 October 2014, At: 05:29Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Australian Social WorkPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/rasw20

Evidence-Based Practice: CurrentIssues and Future DirectionsDebbie PlathPublished online: 19 Aug 2006.

To cite this article: Debbie Plath (2006) Evidence-Based Practice: Current Issues and FutureDirections, Australian Social Work, 59:1, 56-72, DOI: 10.1080/03124070500449788

To link to this article: http://dx.doi.org/10.1080/03124070500449788

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, in relation to orarising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Evidence-Based Practice: Current Issuesand Future DirectionsDebbie Plath

Evidence-based practice approaches continue to increase in popularity in health and

human service contexts in Australia and internationally. As social workers face

pressures to evidence practice and justify outcomes, the limitations in applying an

evidence-based practice approach to social work are confronted. The present paper

identifies the features of evidence-based practice and notes the potential benefits and

limitations of this approach in social work. Debates surrounding the nature of social

work interventions, effectiveness and evidence are reviewed. The current context and

climate influencing the use of research and other evidence in social work are discussed.

The paper also considers the position of qualitative, interpretive and critical reflective

approaches in relation to evidence-based practice. Issues for the future of evidence-

based practice in social work are identified, including the need for the profession to

examine more closely the relationship between critical reflective and evidence-based

approaches to practice.

Keywords: Evidence-based Practice; Practice Research; Reflective Practice

Introduction

Basing social work practice on methodologically sound research evidence is an

appealing prospect for the profession. However, the evidence-based practice

movement has been criticised for the values and goals it promotes and the

limitations it faces in the context of social work practice. There is a fear of

managerial intentions disguised by rhetoric about ‘evidence’ and ‘effectiveness’

(Gibbs, 2001, p. 693; Webb, 2001). There is concern that social work will be

‘. . . drawn into a detached, number crunching, dehumanizing style of practice’

(Bilsker & Goldner, 2000, p. 665). The appropriateness of the scientific paradigm,

associated with evidence-based practice, to the types of practice questions faced by

social workers continues to be questioned (Witkin, 1991; Epstein, 1996; Shaw, 1999;

Correspondence to: Debbie Plath, School of Humanities and Social Sciences, University of Newcastle,

NSW 2308, Australia. Email: Debbie.Plath@newcastle.edu.au

ISSN 0312-407X (print)/ISSN 1447-0748 (online) # 2006 Australian Association of Social Workers

DOI: 10.1080/03124070500449788

Australian Social Work

Vol. 59, No. 1, March 2006, pp. 56�/72

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

Gibbs, 2001; Scott, 2002; Murphy & McDonald, 2004). Despite such concerns,

popularity of the evidence-based practice movement is growing internationally,

particularly within the health professions (Upshur et al. , 2001; Webb, 2001, 2002;

Mullen, 2002; Wodarski, 2004).

Although evidence-based practice terminology is reasonably new to social work,

the use of research to determine the effectiveness of social work interventions has

been an aspect of the profession since it began (Gibbons, 2001). Social workers have

engaged in research to evaluate programmes and to assess the effectiveness of practice

with individuals, groups, communities and organisations. This research has entailed

varied methodological designs, including both positivist and interpretive approaches.

What is distinctive about the evidence-based practice movement in social work is the

emphasis on positivist, scientific research. This emphasis has similarities to the

‘empirical clinical practice’ movement of the 1970s, which advocated behaviourist

and single-system designs to determine the effectiveness of social work interventions

(Witkin, 1996; McNeece & Thyer, 2004). Although the positivist paradigm is strong

in the evidence-based practice movement in social work, particularly in the US

(Wodarski, 2004), recent literature demonstrates that the social work profession is

beginning to challenge and reshape evidence-based practice beyond a strictly

positivist approach (Smith, 2004).

Social work practitioners are being required to provide evidence for their practice

and to engage in debates about evidence-based practice, but are struggling to

understand what evidence-based practice actually means for social work (Murphy &

McDonald, 2004). The present article examines current issues and debates

surrounding evidence-based practice in social work. These include definitions of

evidence-based practice, the potential benefits of evidence-based practice for social

work, the nature of interventions in social work, how effectiveness is determined and

what may be regarded as strong or useful evidence for social work interventions. The

paper locates evidence-based practice within a political and organisational context,

identifying issues for the future as the social work profession addresses the challenges

of evidence-based practice.

The association of evidence-based practice with a scientific or positivist paradigm

can produce tension for social workers who recognise the importance of reflective,

interpretive and humanist responses to the personal and social conditions

encountered in practice. Social workers may question whether it is research findings

or critical reflection that should guide their practice. Evidence-based practice and

critical reflective practice have been regarded as alternative and somewhat conflicting

approaches in social work (Payne, 2002). While an evidence-based approach supports

technical rationale for particular practices, critical reflection emphasises reframing,

imagination, experiences and feelings as each unique and complex practice situation

is responded to in practice (Fook, 2002; Payne, 2002).

The potential to blend both evidence-based and critical reflective approaches

is given consideration in the latter part of the present paper as a way forward for

the social work profession. Social workers can and do use both research evidence

Australian Social Work 57

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

and critical reflection to inform practice and need not choose between the two.

Because social workers are increasingly pressured to provide evidence for their

practice, the present paper considers the common ground between evidence-based

and critical reflective approaches. A framework is provided that identifies the broad

range of evidence that can be used in a critically reflective way in social work decision

making.

What is Evidence-Based Practice?

Sackett, Richardson, Rosenberg and Haynes’ (1997) writing on evidence-based

medicine has been drawn upon in defining evidence-based practice for social work,

which is generally agreed upon as follows:

Evidence-based practice is the conscientious, explicit and judicious use of current

best evidence in making decisions regarding the welfare or care of individuals,

service-users, clients and/or carers (synthesised from Gambrill, 1999; Gibbs &

Gambrill, 2002, p. 452; Mullen, 2002; Centre for Evidence Based Social Services

(CEBSS, 2003).

Informed decision making by the practitioner is central to this definition of evidence-

based practice. A process of decision making suggests consideration of a range of

factors and leaves room for more than ‘one right answer’ (Newman, 2002).

Macdonald (2001), p. xviii) states that:

‘Evidence-based practice indicates an approach to decision-making which is

transparent, accountable and based on a careful consideration of the most

compelling evidence we have about the effects of particular interventions on the

welfare of individuals, groups and communities.’

Definitions in the literature do not always equate with the ways in which concepts are

applied in practice. The emphasis in the above definitions is on carefully considered

decision making in the light of best evidence. However, the pressures of time and

resources can result in an evidence-based practice approach that is reduced to a ‘What

works?’ or ‘What works best?’ approach. The use of research to establish ‘best

practice’ in a given field may be organisationally driven and can result in a

mechanistic and limited approach to evidence-based practice, rather than a careful

consideration by practitioners of the available evidence and best practice responses to

particular practice scenarios (Smith, 2004).

What are the Benefits of Evidence-Based Practice for Social Work?

Much has been written on the potential benefits of evidence-based practice for the

social work profession. A brief summary of the arguments for pursuing an evidence-

based practice approach in social work are provided here. Debates surrounding these

claims will be considered later in the paper.

58 D. Plath

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

Professional Reputation and Legitimacy

The social work profession has been charged with doing harm as well as good and is

in a position where good intentions and commitment are insufficient to maintain

standards. In an environment valuing outcomes and efficiency, professional

legitimacy will be enhanced by good effectiveness research (Sheldon, 1986; Witkin,

1991, 1996; Cheetham, 1992; Macdonald & Sheldon, 1992; Gambrill, 1999;

Macdonald, 2001; Gibbs & Gambrill, 2002).

Knowledge Base for Practice

Although studies of social work effectiveness have yielded some negative results in the

past, more recent appraisals of social work effectiveness studies suggest generally

positive outcomes (Sheldon, 1986; Macdonald & Sheldon, 1992; Reid, 2001). As

research becomes more refined and focused, practitioners are able to utilise

knowledge from research to improve practice effectiveness both in terms of client

outcomes and cost. The vision for evidence-based practice is that the practitioner has

access to reliable information about the impact of interventions, makes informed

choices between approaches and has more certainty about the outcomes that will

result (Hausman, 2002; Newman, 2002).

Ethical Responsibility

The need for stronger evidence in social work can be argued in terms of ethical

responsibility to ensure that interventions and outcomes are as beneficial as possible

for the individuals and groups social workers engage with (Cheetham, 1992; Sheldon,

1986).

Critical Approach to Practice

Evidence-based practice involves ‘. . . questioning of unfounded beliefs, rigorous

scrutiny of methodology and critical appraisal of proposed treatments’ (Bilsker &

Goldner, 2000, p. 664). Such an approach fosters a climate of critical analysis,

reflection and enquiry within the profession, with the aim of improving the quality of

practice (Macdonald, 2001).

Social Work Research Culture

There is an impetus in evidence-based practice for social work practitioners and

researchers to work together to establish research priorities, develop appropriate

methodologies and produce useful and relevant research findings. This trend towards

increased practitioner/researcher alliances has been observed in both Britain and the

US (Cheetham, 1992, 1997; Mullen, 2002; Webb, 2002).

Australian Social Work 59

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

Despite these potential benefits, evidence-based practice in social work faces several

conceptual and practical difficulties. These are discussed in the following sections.

Interventions, Effectiveness and Evidence: Vital but Vague Concepts

The evidence-based practice movement is based on the idea that evidence needs to be

found about the effectiveness of interventions. Each of these three central concepts is

examined here to reveal the difficulties encountered when applied in social work.

What is an ‘Intervention’?

Much of what social workers do is difficult to define in terms of discrete

interventions. The work of a social worker in a hospital surgical ward serves as an

example of the difficulties entailed in defining interventions. The social worker

receives a referral from the ward to see a patient whose discharge is imminent. The

patient is facing some social or emotional issues that complicate the discharge. Does

the social worker make a decision between intervention A and intervention B based

on knowledge of what is most effective? Practice is generally not so straight forward.

The social worker engages with the person, assesses the situation and makes a range

of practice decisions relating to the presenting issues. At times, the goals of

interventions are clear at the outset; at other times, goals and processes emerge as the

interaction progresses. The nature of the intervention will vary according to the issues

and goals that emerge, the skills of the worker, the quality of the relationship between

the patient and the social worker and the social and service provision context. In

making these practice decisions, the social worker is likely to draw on a range of

information, values, theories, models, procedures and techniques. Interventions are

rarely discretely defined and labelled.

Thus, evidence-based practice is not always compatible with the ways social

workers typically approach practice. There is a concern that within an evidence-based

practice approach the more discrete, treatment-oriented approaches will be given

higher status and a rationalist, reductionist, mechanistic approach to practice will be

fuelled (Hollway, 2001; Scott, 2002; Webb, 2001). When evidence is presented for

discrete, standard interventions, will the importance of other social work tasks and

processes be overlooked? The multi-dimensional nature of social and emotional

problems can be ignored within a framework focusing on strictly defined

interventions and outcomes (Hausman, 2002). The impact of the medical model is

apparent and, given the roots of evidence-based practice in medicine, this is

understandable. There is, however, the potential for the evidence-based practice

movement to overemphasise the importance of individual treatment models in social

work practice. Concerns about the tendency of evidence-based practice to ignore

important interactional and interpretive elements of clinical practice have also been

expressed in the medical context (Malterud, 2001).

60 D. Plath

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

Having noted these concerns about the values and priorities that evidence-based

practice may promote, it should be acknowledged that evidence-based practice in

social work need not move down this road. For example, Macdonald’s (2001) work

on child protection integrates a critical examination of the findings of outcome

research with an understanding of the complex and value-laden context in which

social work with children takes place.

Social work interventions are shaped by interpersonal relationships, social context

and political/organisational dynamics. Unlike the administration of a particular

medication, it is unusual to have standard and discrete interventions in social work.

For social work interventions that can be clearly and discretely defined, an evidence-

based practice approach would be useful in guiding and improving practice. There

are, however, many challenges associated with applying an evidence-based practice

approach more generally in social work.

What is Effectiveness?

The second central concept in evidence-based practice is effectiveness. ‘Does it work?’

is very rarely an adequate question to ask of social work practice. Social workers need

to know ‘what aspects worked well?’, ‘what aspects did not work well?’, ‘why?’, ‘for

whom?’, ‘from whose perspective?’, ‘what were the relevant factors impacting on the

situation?’ and so on.

Some social work practice has very specific goals or outcomes, such as stopping or

reducing a particular behaviour or symptom. When a clearly defined and observable

outcome is the social worker’s goal, then effectiveness can be more easily determined.

However, for most social work practice, this is not the case. Social work is generally

concerned with improving ‘well being’ and promoting ‘fairness’ and ‘social justice’.

These concepts are open to a broad range of interpretations because they are

dependent upon values, personal experiences and social context. They are, none-

theless, vital goals, central to the moral and ethical practice of social work.

What is deemed to be an ‘effective’ outcome of a social worker’s intervention may

vary according to the standpoint of the person evaluating the practice and the

particular context. The goals against which effectiveness is judged are essentially

linked to the values guiding the assessment of the presenting issues. Cheetham (1992)

draws the distinction between the service provider perspective ‘quality of care’ and

the client experience ‘quality of life’. A successful outcome may look quite different

from these two perspectives. For much social work practice there are multiple

desirable outcomes possible. This is not peculiar to social work, but has also been

identified in health care more generally (Hausman, 2002).

Returning to the example of the hospital social worker’s intervention with the

patient facing discharge, effectiveness could be evaluated in terms of the patient’s

length of stay in hospital or the provision of community services to match identified

needs or the experience of well-being of the patient on discharge home. The

‘effectiveness’ of the social worker’s intervention is seen differently from each of these

Australian Social Work 61

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

angles. Hospital social workers assist clients to deal with crises, change, loss and the

impact of hospitalisation and to negotiate the systems of services and supports. The

complexity of this work suggests that the question ‘is it effective?’ is too simplistic.

Assessment of effectiveness needs to include questions about ‘whose perspective?’,

‘what context?’ and ‘in relation to what?’.

The complex ways in which effectiveness is understood in social work is generally

recognised in the evidence-based practice literature (Sheldon 1986; Cheetham, 1992,

1997; Gibbs & Gambrill, 2002). For Sheldon (1986, p. 224) the concept of

effectiveness in social work implies:

‘. . . describing carefully the nature, extent and implications of any problems prior

to intervention; saying what it is you might do to alter these and why it would be

beneficial to try; describing how best this might be brought about; saying in

advance what kinds of public test might be applied to support the view that

something worthwhile has been achieved; pursuing a solution and then defending

the results against criticism from peers.’

Within the organisational context in which social work services are provided, there

may be conflicting definitions of effectiveness, particularly if there is a preoccupation

with costs and efficiency. Social workers need to actively engage in debates to ensure

that social work values are present in the definitions of effectiveness in outcome

research and that client experiences remain central in this. Gibbs (2001) argues that

the trend towards short-term, outcome-based, ‘good-enough’ information for

agencies is likely to ignore the importance of in-depth information from service

users. In line with Sheldon’s definition above, social workers require a strong

understanding of the goals and client outcomes they are aiming towards, how the

achievement of these outcomes may be tested and how to defend these. Otherwise,

there is a risk that the cost efficiency goals of management will prevail in the

definitions of effectiveness. Cheetham (1992) points out that when effectiveness is

convincingly argued, it is not necessarily the case that policy makers will choose the

cheapest option.

What is ‘Evidence’?

‘Evidence’ is a term that suggests authority, legitimacy and statement of fact.

However, the way that evidence is used in social work has been described as socially

constructed, value laden and culture laden (Gibbs, 2001; Webb, 2001). Social workers

do rely on ‘hard’ facts in the course of practice, but social work also involves assessing

and working with less-tangible principles and processes, generally in complex

environments. Social workers draw on a range of information, experiences and

knowledge in making practice decisions. What can then be included as evidence upon

which practice should be based?

Within the body of literature promoting a stronger evidence-base for social work

practice, there are differences regarding the nature of evidence deemed to be

62 D. Plath

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

legitimate or valuable. Although some argue that certain types of research

(experimental models in particular) yield stronger evidence for social work, others

argue that interpretive or multimethod approaches yield more useful and applicable

evidence for social work.

The notion of a hierarchy or levels of evidence has become accepted in medicine,

with systematic reviews and randomised control trials being regarded as the methods

yielding the strongest or most reliable evidence (Upshur et al ., 2001). The evidence-

based practice movement in social work has been strongly influenced by this

preference for experimental methods, randomised control trials, single-system

designs and systematic reviews of research (Sheldon 1986; Macdonald & Sheldon,

1992; Gambrill, 1999; Macdonald, 2001; Reid, 2001; Gibbs & Gambrill, 2002;

Mullen, 2002; Thyer, 2002). Reid (2001) states that although qualitative methods can

enrich understanding, they cannot be used to validate effectiveness and that

‘. . . scientific knowledge is the place to look when one is searching for definitive

answers to questions about phenomena, whether physical or psychosocial’ (Reid,

2001, p. 277).

Critics of this approach to social work research have argued that the types of

findings produced by experimental research are often not very useful ones for social

work. Experimental designs can produce reliable information about unrealistically

defined constructs and limited contexts that may not be more widely applicable in

social work practice. Experimental models tend to reduce multidimensional problems

into quantifiable variables that can be measured. Shaw (1999) states that although

randomised control trials lead to a greater certainty of results, there needs to be a

trade-off between certainty of outcomes and relevance of the research for social work

practice. It is better, he argues, to have less-dependable answers about a broader range

of questions. Hollway (2001) argues that experimental approaches isolate clients from

their contexts and that narrative interviews are a more appropriate approach to

investigating social work questions. Experimental approaches have also been

criticised on ethical grounds. Epstein (1996) argues that experimental designs are

in direct conflict with social work values because attention is limited to isolated

factors and outcomes, whereas other issues for the client are ignored.

In the face of this divide, there still exists much common ground. The common

ground is a general agreement in the literature that appropriate methods must be

chosen for the social work research questions being asked and that a range of different

research methods, both qualitative and quantitative, can contribute to the advance-

ment of social work knowledge. While promoting the explanatory role of controlled

experiments, Reid (2001), for example, states that the role of qualitative research

needs to be increased as a means of theory development, theory testing and in order

to better understand complex phenomena. There is a growing emphasis in social

work research literature on the need for mixed-method approaches (Sheldon 1986;

Cheetham, 1992, 1997; Shaw, 1999, 2003; Gibbs, 2001; Reid, 2001).

Cheetham (1992) argues that, in social work, there is little point to studying the

outcomes and effectiveness of interventions unless we also understand the processes

Australian Social Work 63

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

involved in these interventions. Thus, effectiveness research becomes more complex

than deciding between qualitative and quantitative approaches. A combination of

methods and enquiry from a variety of perspectives are required if the complex

practices of social work are to be investigated effectively.

Qualitative research can provide a different type of evidence to that generated by

experimental approaches. Qualitative research offers understanding of the impor-

tance and relevance of interventions in people’s lives (Shaw, 1999). The exploration of

the features of social work practice, how it works for whom and why, the standards of

practice and how practice varies between practitioners and circumstances are areas

appropriate to qualitative inquiry. It is interesting to note that these arguments for

the use of qualitative evidence in practice are not just occurring within social work.

The importance of qualitative research in describing the nature, quality and context

of interventions has been argued in public health, community health and medicine

(Malterud, 2001; Hausman, 2002; Warburton & Black, 2002; Bower et al. , 2003). The

Cochrane Collaboration is paying increasing attention to qualitative research as

evidence in health care and continues to work on identifying appropriate schemas for

evaluating the strength of qualitative research evidence (Cochrane Collaboration,

2004).

However, evidence for social work practice is not only a product of research.

Colgan and Cheers (2002) argue that the justification for social work practice lies in

the ‘. . . complex mix of moral, rational and pragmatic reasons’ (p. 115). Shaw and

Shaw (1997) found that social workers make use of a variety of ‘evidence’ in complex

and ambiguous ways to inform practice decisions. Webb (2001) draws a useful

distinction between evidence to ‘determine’ and evidence to ‘support’. It is possible to

determine the answers to some social work questions. Experimental designs and

systematic reviews will assist in doing this. Generally, however, social workers are

faced with questions where there are no definitive answers. What is needed is a varied

range of information in order to support and justify decision making in practice.

Reductionist approaches to evidence-based practice are less likely to yield useful

guidance for social workers than a broad view of evidence for practice.

Although the concept of evidence used in medicine and positivist science has

influenced social work and is useful in some contexts, social work also has a history of

association with legal settings where evidence must be gathered and presented to

support a judgement. Using this legal paradigm, gathering evidence involves lateral

thinking and active investigation to obtain information from a diverse range of

sources in order to support a judgement or decision. In social work, such evidence

may not be infallible and generally not even beyond reasonable doubt. The practice of

gathering and critically reviewing a range of information in order to inform decisions

generates a greater confidence among social workers and increases the capacity to

mount convincing arguments for practice interventions and decisions. However,

acceptance that practice questions will need to be made without definitive evidence

will remain the reality of much social work.

64 D. Plath

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

Finding and Using Research to Inform Practice

When the professional, organisational and political contexts of social work practice

are considered, barriers and limitations to the use of research are confronted. The first

barrier is the limited amount of high-quality social work research that can be drawn

upon as evidence for practice. There are repeated calls in the literature for more and

better-quality social work research (Sheldon 1986; Cheetham, 1992, 1997; Macdonald

& Sheldon, 1992; Gibbs & Gambrill, 2002; Scott, 2002; Shaw, 2003;). When the vast

array of social work contexts, client groups and interventions is considered, the goal

of providing comprehensive, high-quality research studies of use to more than a

handful of social workers is overwhelming. Who is expected to conduct and fund this

research? Searching for conclusive or applicable research evidence can be a frustrating

experience for social workers.

The second challenge is to make research findings accessible to practitioners.

Organisations such as the Cochrane Collaboration, Campbell Collaboration and the

Exeter Centre for Evidence Based Social Services review and disseminate research

findings. There are also other internet databases and search tools that make relevant

research findings accessible to social workers (Newman, 2002). However, reviewing

and compiling findings for access by social workers is a continuous and resource-

intensive process (Warburton & Black, 2002). Newman (2002) assessed databases

relevant to social work practice in terms of six criteria: easy to use, quick to access,

contain brief and focused abstracts, are screened for quality, have full search facilities

and contain links to relevant publication materials. He found the quality of databases

to be poor and none met all of criteria adequately.

The third challenge is for social workers to actually use research findings to inform

their practice. Reid (2001) claims that social workers make very little use of research

findings to guide practice and, when they do draw on research, there is a tendency to

alter the reported intervention to fit their own practice context. Webb (2001, 2002)

argues that the wider availability of research evidence is unlikely to cause social

workers to practice differently because time, inclination and ability influence social

workers’ reluctance to use research.

Macdonald (2001) states that the potential for evidence-based practice relies upon

five things:

. Investment in good-quality research;

. Access to summaries of research, good-quality systematic reviews and meta-

analyses;. The ability of practitioners to make use of evidence in practice;. The ability to use the skills and services indicated by the evidence; and. The ability to monitor, review and change practice.

The evidence-based practice movement in Australia and internationally still has a

long way to go before these conditions are met. Resources, organisational support,

Australian Social Work 65

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

training and encouragement are required before social workers can be expected to

rely on research findings in practice.

Political and Organisational Contexts for Evidence-Based Practice

The political context of social work shapes practices and priorities. Despite the

efforts of social workers and researchers to establish effectiveness, research findings

can be disregarded. The reality of service funding trends is that, despite an increased

interest in research by policy makers, policy and practice changes tend to be

incremental and take little account of research findings (Cheetham, 1992, 1997;

Harries et al. , 1999).

The language of evidence-based practice does fit well with managerial values of

optimising outputs and ensuring value for money (Gibbs, 2001; Webb, 2001). The

language of ‘evidence’ and ‘effectiveness’ can be used to justify service provision or

withdrawal. A particular service or policy direction may be given legitimacy as

‘evidence based’ if available research suggests that good outcomes will result.

Similarly, a service may be withdrawn if no such evidence is available or the only

available measure of effectiveness is in terms of cost. In light of the paucity of

available research, this is a concerning risk.

The principles of evidence-based practice may bring into question ‘bottom-up’

community development, participatory or empowerment practices where discrete

interventions and outcomes are hard to define (Hausman, 2002). Evidence-based

practice is likely to promote interventions that are limited and standardised, even

when local conditions require a diversity of responses (Hausman, 2002).

The position of clients’ rights, participation and self-determination has become an

area of debate in relation to evidence-based practice. An emphasis on experimental

approaches and outcome research has been associated with a negation of client input

and participatory styles of research (Gibbs, 2001). However, Sheldon (1986) argues

that client opinion research is highly valuable and can be undertaken in conjunction

with experimental research. Hausman (2002) points out that what is found in the

research to ‘work’ may not be what clients desire or see that they need. In such

situations, should the worker be ‘evidence based’ or ‘client centred’? Gambrill (1999)

argues that clients must become active participants in decision making by being

presented with intervention alternatives and given the research evidence on

effectiveness in order to make their decision. However, it is unlikely for a situation

with such clearly defined choices and corresponding research evidence to occur

frequently in practice.

Regardless of how strong the evidence for a particular intervention may be, social

workers are in a position where they need to critically reflect on their work in the

political, social, organisational and interpersonal contexts, engage in debates,

negotiate appropriate practices and, when necessary, argue convincingly for the

effectiveness of the work that is done.

66 D. Plath

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

Future Directions for Evidence-Based Practice in Social Work

The preceding discussion indicates that evidence-based practice cannot be adopted

easily within social work. Continued discussion, debate and inquiry on the

applicability of evidence-based practice to social work are needed within the

profession. Strategies and resources to support increased practice-based research

are also required. Those organisations expecting an evidence-based approach to

service provision need to support and train staff in the effective use of research

findings. More fundamentally, however, the future for evidence-based practice in

social work lies in the resolution of conceptual tensions surrounding notions of

‘evidence’. The principle of gathering evidence to inform practice needs to be

understood in the context of the relational and political dynamics impacting upon

social work practice.

While acknowledging the place of research in evaluating and informing practice,

the reflective use of self remains an important part of social work training and

practice (Gould & Taylor, 1996; Fook, 2002). A tension for social workers in the field

can be between producing scientific evidence for particular practices and engaging in

a critical reflective approach to practice, where each practice scenario is assessed as

unique. The evidence-based practice movement in social work would benefit from

closer examination of how a critical reflective approach can inform understanding of

evidence for practice.

Critical reflective practice, like evidence-based practice, is currently an influential

movement in social work practice (Gould & Taylor, 1996; Fook, 2002; Payne, 2002).

Based on the work of Schon (1983), critical reflective approaches in social work,

and other professions, emphasise the importance of continually analysing the

impact of values, relationships, context, past experiences and feelings in seeking to

understand individuals and society. Social workers are cautioned against applying

simplified rules or rigid theoretical frameworks in making assessments and

decisions (Payne, 2002). Critical reflection has been applied to the conduct and

use of research in social work and is central to action research approaches to

inquiry (Fook, 1996).

Evidence-based practice and critical reflective practice have been presented as

alternative approaches in social work (Payne, 2002). Evidence-based practice is

generally located within a positivist paradigm, whereas critical reflective practice fits

with an interpretive paradigm. Such a division is simplistic. From an evidence-based

practice perspective, there is acknowledgement that critical analysis is integral to the

effective use of research evidence in social work practice (Cheetham, 1997; Gambrill,

1999; Shaw, 1999; Gibbs & Gambrill, 2002). Evidence-based practitioners are being

asked to ‘. . . develop a sense of humility, a realisation that our hold on truth is

partial, tentative and open to revision’ (Bilsker & Goldner, 2000).

Social workers juggle the contradictions of positivist and interpretive paradigms

and draw on both in daily practice. A social work assessment will generally

incorporate concepts of fact and causation as well as acknowledgement of values

Australian Social Work 67

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

and personal interpretations. Although in abstract theoretical terms the positivist and

interpretive paradigms are distinct, in daily practice social workers draw on both

types of information.

The framework presented in Fig. 1 is a starting point for examining the notion of

‘evidence’ for social work, using critical reflective principles. The concept of evidence

is used to incorporate a broad range of information, including findings from

research. Research findings, it is argued, should not be used as rules for practice but,

rather, as part of a body of evidence used to inform reflective decision making.

The framework incorporates research findings as a source of evidence to inform

practice decisions in social work, but also includes other forms of evidence. Decision

making in social work draws on evidence derived from personal, interpersonal,

professional and political sources. Although definitive evidence for particular

practices is sometimes available, interpretive research findings and practice

experience are also of value in deciding the most appropriate practice in particular

circumstances. All types of evidence need to be reviewed critically in light of the

context in which the social worker is seeking to apply it. Although rational processes

are important in reviewing evidence, so too are reflective insights. These insights rely

on experience in and understanding of the complex personal, interpersonal, political

and professional contexts in which social work is carried out.

The use of the framework is illustrated by returning to the example of the hospital

social worker used above. The social worker may need to make practice decisions

such as, ‘How do I introduce myself?’, ‘How do I best establish rapport and get the

Practice Decision MakingCritical reflection on:Desirable outcomes

Availability, relevance and strength of evidenceImpacting factors

Intervention optionsLikely implications and outcomes

Ethical principles

Research findings (range of methods)

Theory

Literature

Worker’s Skills

Worker’s personal experiences and values

Worker’s past practice and training experience

Guidance of professional peers

Assessment of main issues in situation

Nature of worker-client relationship

Client views and requests

Resources available

Current fashions and trends

Policies

Organisational and interorganisational dynamics

Organisational/political priorities

Figure 1 Evidence for social work practice decision-making.

68 D. Plath

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

client to open up?’, ‘Do I use an interpreter?’, ‘How do I deal with gender, age and

cultural differences between the client and myself?’, ‘How will I address with ward

staff the delay in receiving the referral?’, ‘What are the central issues and priorities to

address with this client?’, ‘How do I balance the referral information with what the

client is saying are the central issues of concern?’, ‘Would it be better to extend my

intervention over several sessions, or can I be just as effective in a single session?’ and

‘What are the best avenues for accessing the community resources that the client

requests?’.

These practice decisions may be aided by a familiarity with research findings in

areas such as the use of interpreters and the outcomes of single-session interventions.

However, this knowledge must be reviewed for applicability in light of the particular

situation. In order to make effective practice decisions, knowledge of research

outcomes is considered in light of other factors, such as client wishes, organisational

dynamics, relationships (social worker and client, client and organisation, social

worker and other members of staff), social work skills, values and personal style and

familiarity with the politics and processes of community service networks. The social

worker may draw upon personal practice and training experience, experience of

peers, advice of supervisors, theories and value frameworks, as well as knowledge

of research findings in making practice responses to the questions above. Integration

of this diverse information in making daily practice decisions in individual situations

requires skills in critical analysis and reflection. Critical reflection on the personal,

interpersonal, political and professional aspects of the scenario is required by the

social worker in order to make appropriate practice decisions.

The critical reflective social worker will be interested to review research about

different practice approaches and how effective these have been. A critically reflective

approach to evidence-based practice would mean that findings from research would

not be accepted at face value and nor would they be automatically applied to a

different practice context. In reviewing research findings, the social worker needs to

ask questions about the context, processes, nature of client group, research

methodology, nature of client involvement, similarities and differences to own

practice context, ways in which the research findings may assist in dealing with

current practice questions and how the intervention would need to be adapted or

modified to suit their own practice setting. The actual research findings can provide a

starting point in this reflective process.

The effective integration of critical reflection with an evidence-based practice

approach requires curiosity, preparedness to question and willingness to explore

alternatives. It requires the ability to critique research methodology by assessing the

limitations and the results that can be claimed consequently. An ability to evaluate a

range of evidence from different sources and review applicability to the current

context and individuals involved is also needed. Although the available evidence sets

the stage, the processes of deliberation, problem solving and choice will be particular

to the context, individuals and situation (Webb, 2001).

Australian Social Work 69

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

Conclusions

The present paper has identified the central issues and debates surrounding evidence-

based practice in social work. It offers a framework for examining the notion of

evidence using a critical reflective approach. Adopting an approach similar to the

tradition of generic social work practice, it is proposed that evidence can be

understood in terms of personal, interpersonal, political and professional factors.

Although evidence-based practice and critical reflective practice are drawn from

different theoretical paradigms, facing the challenge of integrating the two offers an

approach to practice that is strongly grounded in the values, principles and traditions

of social work. A critical reflective approach to evidence-based practice in social work

seeks to value evidence gained from experience and understanding of contextual

factors, as well as research evidence. Such an approach fits more closely with the

ethics, values and traditions of social work than does a rule-based or prescriptive

approach to evidence-based practice. Although limited, the framework presented

herein is an initial step in developing a critical reflective approach to evidence-based

social work practice. A further step would be to evaluate the usefulness of the

framework for social workers requiring evidence in the field.

In order to analyse and use any evidence effectively, practitioners need critical

thinking skills, sensitive interpersonal skills, insights into personal and contextual

factors, awareness of political and power issues and a strong value base. Critical

reflection remains central as social workers engage with research and identify a range

of evidence to inform and justify effective practice.

References

Bilsker D & Goldner EM (2000), Teaching evidence based practice in mental health, Research on

Social Work Practice , 10 (5), 664�/669.

Bower P, Rowland N, Mellor Clark J, Heywood P, Godfrey C & Hardy R (2003), Effectiveness and

cost effectiveness of counselling in primary care (Cochrane Review), Cochrane Database Syst.

Rev. 2002; 1: CD001025.

Centre for Evidence Based Social Services (2003), www.cebss.org (accessed 2004).

Cheetham J (1992), Evaluating social work effectiveness, Research on Social Work Practice , 2 (3),

265�/287.

Cheetham J (1997), Evaluating social work: Progress and prospects, Research on Social Work

Practice , 7 (3), 291�/310.

Cochrane Collaboration (2004), www.co1chrane.org (accessed 2004).

Colgan C & Cheers B (2002), The problem of justification in social work, Australian Social Work , 55

(2), 109�/118.

Epstein I (1996), In quest of a research-based model for clinical practice: Or, why can’t a social

worker be more like a researcher?, Social Work Research , 20 (2), 97�/100.

Fook J (1996), The Reflective Researcher: Social Workers’ Theories of Practice Research , Allen and

Unwin, St Leonards.

Fook J (2002), Social Work: Critical Theory and Practice , Sage, London.

Gambrill E (1999), Evidence-based practice: An alternative to authority-based practice, Families in

Society, 80 (4), 341�/350.

70 D. Plath

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

Gibbons J (2001), Effective practice: Social work’s long history of concern about outcomes,

Australian Social Work , 54 (3), 3�/13.

Gibbs A (2001), The changing nature and context of social work research, British Journal of Social

Work , 31, 687�/704.

Gibbs L & Gambrill E (2002), Evidence-based practice: Counterarguments to objections, Research

on Social Work Practice , 12 (3), 452�/476.

Gould N & Taylor I (eds) (1996), Reflective Learning for Social Work: Research, Theory and Practice ,

Arena, Aldershot Hants.

Harries U, Elliot H & Higgins A (1999), Evidence-based policy-making in the NHS: Exploring the

interface between research and the commissioning process, Journal of Public Health Medicine ,

21 (1), 29�/36.

Hausman AJ (2002), Implications of evidence-based practice for community health, American

Journal of Community Psychology, 30 (3), 149�/166.

Hollway W (2001), The psycho-social subject in ‘evidence based practice’, Journal of Social Work

Practice , 15 (1), 10�/21.

Macdonald G (2001), Effective Interventions for Child Abuse and Neglect: An Evidence-Based

Approach to Planning and Evaluating Interventions , Wiley, Chichester.

Macdonald G & Sheldon B (1992), Contemporary studies of the effectiveness of social work, British

Journal of Social Work , 22 (6), 615�/643.

Malterud K (2001), The art and science of clinical knowledge: Evidence beyond measures and

numbers, The Lancet , 358, 397�/400.

McNeece CA & Thyer BA (2004), Evidence-based practice and social work, Journal of Evidence-

Based Social Work , 1 (1), 7�/25.

Mullen EJ (2002), Evidence-based social work theory and practice: historical and reflective

perspective. In XXX (ed.), Paper presented at the 4th International Conference on Evaluation for

Practice , University of Tampere, Finland, 4�/6 July 2002.

Murphy A & McDonald J (2004), Power, status and marginalisation: Rural social workers and

evidence-based practice in multi-disciplinary teams, Australian Social Work , 57 (2), 127�/136.

Newman T (2002), Developing Evidence Based Practice in Social Care: Locating, Appraising and Using

Research Findings on Effectiveness , Barnardos, Exeter.

Payne M (2002), Social work theories and reflective practice. In: Adams R, Dominelli L & Payne M

(eds), Social Work: Themes, Issues and Critical Debates , Palgrave, Basingstoke, Chapter 11.

Reid WJ (2001), The role of science in social work: The perennial debate, Journal of Social Work , 1

(3), 273�/293.

Sackett DL, Richardson WS, Rosenberg W & Haynes RB (1997), Evidence Based Medicine: How to

Practice and Teach EBM , Churchill Livingston, New York.

Schon D (1983), The Reflective Practitioner: How Professionals Think in Action , Basic Books, New

York.

Scott D (2002), Adding meaning to measurement: The value of qualitative methods in practice

research, British Journal of Social Work , 32, 923�/930.

Shaw I (1999), Evidence for practice. In Shaw I & Lishman J (eds), Evaluation and Social Work

Practice , Sage, London, Chapter 2.

Shaw I (2003), Cutting edge issues in social work research, British Journal of Social Work , 33, 107�/

120.

Shaw I & Shaw A (1997), Game plans, buzzes and sheer luck: Doing well in social work, Social Work

Research , 21 (2), 69�/79.

Sheldon B (1986), Social work effectiveness experiments: Review and implications, British Journal of

Social Work , 6, 223�/242.

Smith D (ed.) (2004), Social Work and Evidence-Based Practice , Jessica Kingsley Publishers, London.

Thyer BA (2002), Evidence-based practice and clinical social work, Evidence Based Mental Health , 5,

6�/7.

Australian Social Work 71

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4

Upshur REG, Van Den Kerkhof EG & Goel V (2001), Meaning and measurement: An inclusive

model of evidence in health care, Journal of Evaluation in Clinical Practice , 7 (2), 91�/99.

Warburton B & Black M (2002), Evaluating processes for evidence-based health care in the National

Health Service, British Journal of Clinical Governance , 7 (3), 158�/164.

Webb S (2001), Some considerations on the validity of evidence-based practice in social work,

British Journal of Social Work , 31, 57�/79.

Webb S (2002), Evidence-based practice and decision analysis in social work: An implementation

model, Journal of Social Work , 2 (1), 45�/63.

Witkin S (1991), Empirical clinical practice: A critical analysis, Social Work , 36 (2), 158�/163.

Witkin S (1996), If empirical practice is the answer, then what is the question? Social Work Research ,

20 (2), 69�/75.

Wodarski JS (2004), Introduction, Journal of Evidence-Based Social Work , 1 (1), 1�/5.

Accepted October 2005

72 D. Plath

Dow

nloa

ded

by [

Flin

ders

Uni

vers

ity o

f So

uth

Aus

tral

ia]

at 0

5:29

04

Oct

ober

201

4