BACKGROUND

The Use of Evidence in Practice: Survey Data from a National Sample of Social WorkersTracy Wharton, PhD, LGSW ~ Ann Arbor VA Geriatric Research Education and Clinical Center

METHODS

RESULTS (N = 154)

WHAT WAS LEARNED

RESEARCH QUESTIONS• How do social workers make practice-related decisions and

how do they feel about EBP?• Where do social workers get evidence for practice?• How do social workers determine the utility of evidence and

the validity of expertise?• Are workplaces oriented towards EBP?• What are the barriers to the uptake of EBP, both actual and

perceived?

• Internet-based survey using Survey Monkey• 36 questions, including 4 open-ended and comment fields

throughout the survey• Based on extensive literature review• Preliminary pilot study of 84 mental health practitioners• Recruitment:

• direct emails from the NASW registry, • direct mail to 1,000 social workers randomly chosen from

census lists by a USPS researcher, • social network postings

• Anonymous, no IP addresses collected• Donation made to scholarship fund for every participant who

completed

Social workers read journal articles, attend conferences and continuing education, and consult with peers, mentors, and experts regularly. They do not, however, get regularly asked about evidence related to treatment planning in their workplaces, and they are more likely to seek a consult or use a common search engine or professional organization website for information seeking than they are to use a research database or MeSH-use search engine. Where we put information and who generates the information are key points in whether or not research information is used. There may be value in linking database information to common search engines and organizational websites. Barriers to the uptake of evidence based practice (EBP) may not be as straightforward as we currently think, and there appear to be decision points related to time management that call for additional research. There were both positive and negative responses to the idea of EBP, with concerns about power, control, and necessary flexibility evident, as well as concern about policies related to the regulation of practice.

Acknowledgements: This research was made possible by research support from The University of Alabama Graduate Council, The Center for Mental Health & Aging, Dr. Jamie DeCoster and the Institute for Social Science Research, & The University of Alabama School of Social Work. Please see handout for reference list.

Crawford, Brown, Anthony, & Hicks (2002):

“Questions remain unanswered about the barriers and implementation of EBP …, particularly in the ‘swampy lowlands’ of practice” (p. 289).

Addis & Krasnow (2000):

“Little is known about how social workers and master’s-level clinicians feel about… empirically supported interventions… in the current clinical practice context, master’s-level clinicians are responsible for more and more direct patient contact” (p.338).

Mullen & Bacon (2004):

“A review of the literature in social work journals indicates that little has been written about the practitioners’ views” (p.3).

Sheldon & Chilvers (2002):

There appears to be a disconnect between the endorsement of the idea of EBP and the realities of implementing it.

Where do they find evidence?50% go to professional org websites (NASW, AEA, APA, etc)45% use Google, Google Scholar, Ask.com, Yahoo, University-based engines (ie Extreme Search) or similar37% use WebMD26% use specialized search engines (EBSCOhost, PsychInfo, etc)11% use databases (ie SCIE, NREPP, What Works, etc)10% use other websites (gov’t and private sites)3% use Cochrane or Campbell databases

How do they make practice decisions?

Are workplaces oriented towards EBP?• No official policy related to the use of EBP (70%)• Not very likely to be asked about evidence-based or research-supported

treatment (50:50)• Only occasionally asked to justify treatment choices

27% are regularly asked; 38% have been asked 1x, 2x or a few times;

34% have never been asked• Consult with supervisors or experts at least monthly (68%)• Have internet access at work, access to databases and journal articles

So, there is access, but is there value placed on

integration of information into practice?

“Like anything, the EBP approach can be corrupted in use with clients and in how it is used to ‘sell’ social policy decisions.”

“Evidence based practice becomes a tool for reimbursement and people who want a cookbook to therapy. It creates a system of therapists who

can get by on good enough as long as they write the correct thing down on paper (insurance documentation)and agree with the system

(insurance/poorly trained supervisor). It rewards the task doer... The goal becomes the completion of treatment plans and treatment within the required amount of time. The needs of the client are made to fit in the box issued by the insurer and protected by the clinician and his/her agency. The client's needs have been shrunk to be made to fit the

evidence based criteria for their stated problem.”

Barriers (Paired sample t-test) How important do you feel these items to be for most people (Profession)? X In your personal experience, how important are each of these items (Personal)?

Barrier Mean N SD t-value Sig Time (Profession) Time (Personal)

1.54 1.76

113 .732 .928

-2.90 .004

Access to literature (Profession) Access to literature (Personal)

2.59 2.73

115 1.07 1.03

-1.44 .152

Cost of literature (Profession) Cost of literature (Personal)

2.18 2.54

115 .99 1.16

-3.92 .000

Lack of knowledge (Profession) Lack of knowledge (Personal)

2.63 3.21

112 .99 .88

-6.39 .000

Research is overwhelming (Professional) Research is overwhelming (Personal)

2.45 3.04

110 .97 .96

-6.21 .000

4-point scale, from 1(Very important) to 4(Definitely not important), so lower scores indicate greater importance.

Top 3 choices for decision making with an unfamiliar diagnosis:

Calling a supervisor, mentor or expert 21%

Calling a peer 22%- 2nd choice, 17%- 1st choice

Searching the internet 18%- 3rd choice, 13%- 2nd choice, 16%- 1st choice