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Social Work Evidence-based Social Work Practice: Issues, Controversies, and Debates
by
Edward J. Mullen

Introduction

This entry provides references to issues, controversies, and debates stimulated by the introduction into social work of evidence-based practice. These relate to differing views about meanings, limitations, values, and assumptions attributed to evidence-based practice. Issues, controversies, and debates have accompanied the introduction of evidence-based practice into medicine, psychology, nursing, and other professions. Many of these are found in nearly identical form in social work. However, perhaps because of social work’s complexity and history, these concerns have taken on a distinct character in social work, and other concerns are being expressed specific to social work. Accordingly this entry includes key publications in the social work literature as well as key relevant publications in the literature of related professions. A final section of this entry provides references to seminal discussions of issues in education for evidence-based practice. Readers not familiar with this form of practice should read the entry Evidence-Based Social Work Practice as background for this entry.

Introductory Works

For an overview of issues, controversies, and debates associated with evidence-based practice, review the Straus and McAlister 2000 essay and then the Mullen, et al. 2005 article. Begin with Straus and McAlister 2000 because it describes the most commonly debated issues in evidence-based medicine that apply equally well to social work. Because these issues are debated extensively in the following references, it is useful to make note of them here at the outset. The limitations cited are those stemming from a shortage of coherent, consistent scientific evidence; difficulties in applying evidence to the care of individuals; barriers to doing high-quality practice; the need to develop new skills; limited time and resources; and a paucity of evidence that evidence-based practice “works.” Straus and McAlister cite as common misperceptions that evidence-based practice denigrates clinical expertise, that it ignores patients’ values and preferences, that it promotes a cookbook approach to medicine, that it is simply a cost-cutting tool, that it is an ivory-tower concept, that it is limited to clinical research, and that it leads to therapeutic nihilism in the absence of evidence from randomized trials. After reading the Straus and McAlister 2000 essay, examine the Mullen, et al. 2005 article to deepen one’s understanding of the issues discussed by Straus and McAlister in the social work context. The Mullen, et al. article describes additional issues, controversies, and challenges that have emerged as evidence-based practice has been implemented in social work. Next peruse the Kirk and Reid 2002 essay to understand the philosophical, political, and practical issues associated with social work’s attempts to incorporate the fruits of scientific research into the profession’s knowledge base, of which evidence-based practice is a recent expression. Although it addresses issues associated with the introduction of evidence-based practices into psychology, the Norcross, et al. 2006 book provides an excellent introduction to the common issues found in the evidence-based practice debate argued by proponents of contrasting positions. The Norcross, et al. book can be read from beginning to end to gain a broad overview of all issues or, if one’s interest is in a specific area of debate, go to those of the nine chapters that correspond to that issue area. The Gray, et al. 2009 book provides a range of perspectives on issues associated with evidence-based social work practice and is the most comprehensive treatment available.

  • Gray, Mel, Debbie Plath, and Stephen Webb. 2009. Evidence-based social work: A critical stance. London: Routledge.

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    Provides a useful international perspective and a critical analysis of evidence-based social work practice. This is a good introduction to issues pertaining to what should be considered as social work knowledge, values and underpinning this form of practice and key issues regarding implementation. The views presented should be contrasted with perspectives presented in other key readings.

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  • Mullen, Edward J., Aron Shlonsky, Sarah E. Bledsoe, and Jennifer L. Bellamy. 2005. From concept to implementation: Challenges facing evidence-based social work. Evidence and Policy: A Journal of Debate, Research, and Practice 1.1: 61–84.

    DOI: 10.1332/1744264052703159Save Citation »Export Citation »E-mail Citation »

    Read this essay for a critical assessment of key challenges in adapting evidence-based practice to the social work policy and practice contexts. This paper outlines the origins of evidence-based social work and current thoughts about its definition and application and includes a discussion of key challenges to the application of evidence-based practice and policy in social work.

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  • Norcross, John C., Larry E. Beutler, and Ronald F. Levant, eds. 2006. Evidence-based practices in mental health: Debate and dialogue on the fundamental questions. Washington, DC: American Psychological Association.

    DOI: 10.1037/11265-000Save Citation »Export Citation »E-mail Citation »

    This is a unique reference contrasting positions on key issues, controversies, and debates stimulated by evidence-based practice in the context of psychology and psychotherapy. This reference provides a range of contrasting perspectives and position papers on nine key questions. This book focuses primarily on issues pertaining to evidence-based practices, especially psychotherapy, rather than the process of evidence-based practice.

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  • Stuart A. Kirk, and William J. Reid. 2002. Knowledge, science, and the profession of social work. In Science and social work: A critical appraisal. Edited by Stuart A. Kirk and William J. Reid, 1–28. New York: Columbia University Press.

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    Review this critical essay to learn how, since its beginnings, social work has attempted to use scientific research to strengthen clinical practice. Evidence-based social work practice, including its strengths and limitations, can be better understood when viewed in this historical context.

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  • Straus, Sharon E., and Finlay A. McAlister. 2000. Evidence-based medicine: A commentary on common criticisms. Canadian Medical Association Journal 163.7: 837–841.

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    Begin with this essay because it presents a classification of criticisms of evidence-based medicine. It is recommended because of its relevance to social work and because many social work authors have adapted this classification as a basis for discussion. Straus and McAlister group the criticisms as pertaining to limitations common to medical practice in general, to limitations specific to evidence-based medicine, and to misperceptions.

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Journals

Whereas many journals have given some attention to evidence-based social work issues, controversies, and debates, the following are the best sources to follow the ongoing dialogue on this topic. The key journal in this area is Evidence and Policy because one of the purposes of this journal is to publish essays that debate topics pertaining to evidence-based policy and practice, including social work applications. Furthermore this journal provides an interdisciplinary perspective as well as an international perspective on the debates. Most professions adopting evidence-based practice have developed specialized journals that include conceptual articles debating important issues. In social work the Journal of Evidence-Based Social Work serves that purpose, and therefore it should be reviewed regularly to keep abreast of debates about evidence-based practice. Research on Social Work Practice includes periodic conceptual essays and articles on important evidence-based practice issues, especially dealing with research applications in practice.

Issues, Controversies, and Debates in Social Work

The Gambrill 2003 editorial provides a provocative critique of how evidence-based health care is being adapted in social work, with Gambrill arguing that much of what is being labeled as evidence-based practice is a distortion and not in keeping with the paradigm shift required. To understand important counterarguments to issues raised in social work about evidence-based practice, review the Gibbs and Gambrill 2002 article, in which the authors classify the arguments against evidence-based practice as those coming from ignorance about the nature of this form of practice, misinterpreted professional standards, arguments appealing to tradition, ad hominem arguments, arguments on ethical grounds, and philosophical arguments. Review the Gilgun 2005 article for a summary of lessons learned from evidence-based medicine, nursing, and applications in the United Kingdom, especially pertaining to challenges and limitations needing to be addressed. Otto and Ziegler 2008, the introductory article to a special issue of Research on Social Work Practice, raises important questions about the fit between evidence-based practice and a view of social work valuing professional autonomy and reflexivity. The articles in this special issue provide a wide-ranging examination of evidence-based social work topics with emphasis on what should be considered valid types of knowledge as well as how knowledge can be used in practice. Read the Otto, et al. 2008 and the Sommerfeld 2005 texts for thoughtful analyses of evidence-based social work practice in the German context. Many are calling for “evidence-informed practice” as an alternative to “evidence-based practice.” For one such view, read the Nevo and Slonim-Nevo 2011 position.

  • Gambrill, Eileen. 2003. Evidence-based practice: Sea change or the emperor’s new clothes? Journal of Social Work Education 39.1: 3–23.

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    This critical essay takes a strong point of view about what evidence-based practice means, contrasting the author’s views, which emphasize the tenets of evidence-based medicine and health care, with alternative views presented in the social work literature, which the author argues do not reflect these basic tenets. Views expressed in original evidence-based medicine and health care writings are contrasted with contemporary social work views.

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  • Gibbs, Leonard, and Eileen Gambrill. 2002. Evidence-based practice: Counterarguments to objections. Research on Social Work Practice 12.3: 452–476.

    DOI: 10.1177/1049731502012003007Save Citation »Export Citation »E-mail Citation »

    This is a good follow-up to the Straus and McAlister 2000 article in the Introductory Works section of this entry since it expands on the issues discussed by Straus and McAlister. Gibbs and Gambrill offer counterarguments to common criticisms. The authors think that understanding objections to evidence-based practice will help increase understanding of barriers to using practice-related research findings and honoring related ethical requirements.

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  • Gilgun, Jane F. 2005. The four cornerstones of evidence-based practice in social work. Research on Social Work Practice 15.1: 52–61.

    DOI: 10.1177/1049731504269581Save Citation »Export Citation »E-mail Citation »

    For those interested in comparing challenges to evidence-based medicine, evidence-based nursing, and evidence-based social work as developed in the United Kingdom, this is a good review. Gilgun draws out implications for evidence-based social work based on what has been learned from these three areas of application, discussing key emerging limitations and challenges.

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  • Nevo, Isaac, and Vered Slonim-Nevo. 2011. The myth of evidence-based practice: Towards evidence-informed practice. British Journal of Social Work 41.6: 1176–1197.

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    Many advocate replacing the term “evidence-based practice” with the term “evidence-informed practice.” Nevo and Slonim-Nevo offer a radical proposal, rejecting the standard five-step, evidence-based medicine process and placing evidence derived from research on equal footing with practitioner experience and client perspectives.

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  • Otto, Hans-Uwe, and Holger Ziegler. 2008. The notion of causal impact in evidence-based social work: An introduction to the special issue on What Works? Research on Social Work Practice 18.4: 273–277.

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    This is a special issue with nine articles prepared for the international conference “What Works? Modernizing the Knowledge-Base of Social Work; Evidence-Based Knowledge as Capability and Promise of Efficiency for a Better Practice.” Reviewing these articles will provide an appreciation of issues pertaining to the relationship between research and practice in social work.

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  • Otto, Hans-Uwe, Andreas Polutta, and Holger Ziegler, eds. 2008. Evidence-based practice: Modernising the knowledge base of social work?. Farmington Hills, MI: Barbara Budrich.

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    Published in German as What Works: Welches Wissen braucht die Soziale Arbeit? Zum Konzept evidenzbasierter Praxis (Opladen, Germany: Barbara Budrich, 2009), this is one of two texts now available dealing with evidence-based practice in the German context (for the other, see Sommerfeld and Huttemann 2007). This text presents a timely discussion of the pros and cons of evidence-based social work, proposing important modifications of the more established views.

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  • Sommerfeld, Peter, ed. 2005. Evidence-based social work: Towards a new professionalism? Bern, Switzerland: Peter Lang.

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    As the subtitle of this book indicates, some contributors to this volume wonder if evidence-based practice marks the end of professional social work or whether it is the beginning of a new professionalism. The first three chapters, by German-speaking authors (Peter Sommerfeld, Holger Ziegler, and Mark Schrodter), provide insight into the issues and challenges some European scholars see with evidence-based practice.

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  • Sommerfeld, Peter, and Martin Huttemann, eds. 2007. Evidenzbasierte Soziale Arbeit: Nutzung von Forschung in der Praxis. Baltmannsweiler, Germany: Schneider Verlag Hohengehren.

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    Published in German, this is the first text to deal with evidence-based social work practice (Evidenzbasierte Soziale Arbeit) and one of only two texts now available dealing with evidence-based social work practice in the German context. Chapters are authored by Swiss, German, British, and U.S. experts.

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Issues, Controversies, and Debates in Allied Professions

The introduction of evidence-based forms of practice into medicine, psychology, nursing, and allied health professions has resulted in identification of issues, areas of controversy, and ensuing debate just as has occurred in social work (see the section Issues, Controversies, and Debates in Social Work). Many of the issues are common across professions, but some are specific to the character of each respective profession. Notably, because this form of practice originated in medicine and in its original form reflects a medical model of practice, other professions have debated how best to adapt the basic principles without stifling each profession’s own identity. The Norcross, et al. 2006 book is a clear example of this struggle as it is being expressed in psychology. This text provides a stimulating expression of the debates in psychology, and it is a good point to begin reading. To gain insight into arguments for and against evidence-based practice from a broad interdisciplinary framework, read the Mullen and Streiner 2004 introductory essay to the special issue of Brief Treatment and Crisis Intervention. One of the most debated issues across professions has been how practices are to be judged to qualify as evidence-based. The Chambless and Hollon 1998, American Psychological Association Presidential Task Force on Evidence-Based Practice 2006, Roth and Fonagy 2005, and Mueser and Drake 2005 references provide contrasting positions and approaches to this question. Philosophical issues cut across many of the critiques of evidence-based practice. Review Kelly and Moore 2012 for an application of ideas derived from David Hume and Immanuel Kant to the judgment process. Additional issues are examined in Nathan 2004, including the question about the extent to which psychotherapeutic intervention should be considered art or science. J. A. Muir Gray’s brief epilogue to his classic text (Gray 2001) is a good place to end these readings since he elevates the debate to possible consequences at the societal level. Evidence-based practice is dependent on the availability of quality evidence reviews, yet such reviews are frequently criticized on a number of grounds. Moat, et al. presents strong counterarguments to twelve frequently cited criticisms.

  • American Psychological Association Presidential Task Force on Evidence-Based Practice. 2006. Evidence-based practice in psychology. American Psychologist 6.4: 271–285.

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    The American Psychological Association (APA) has worked on defining criteria for determining evidence-based policies and practices (EBPPs) since 1995. The 2005 report of the task force published in this article provides a good idea of how evidence-based practices are assessed and identified within the context of evidence-based psychological practice.

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  • Chambless, Dianne L., and Steven D. Hollon. 1998. Defining empirically supported therapies. Journal of Consulting and Clinical Psychology 66.1: 7–18.

    DOI: 10.1037/0022-006X.66.1.7Save Citation »Export Citation »E-mail Citation »

    This is an essential article to read for those interested in how psychological treatments have been determined to be empirically supported. These authors present an influential scheme for determining when a psychological treatment for a specific psychological problem or disorder may be considered to be established in efficacy or to be possibly efficacious.

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  • Gray, J. A. Muir. 2001. Evidence-based healthcare in the post-modern era. In Evidence-based healthcare. 2d ed. By J. A. Muir Gray, 371–380. New York: Churchill Livingstone.

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    In the second edition of Gray’s influential book, he points out that evidence-based practice can increase uncertainties as providers and consumers of services come to understand the limits of science when applied to human problems. Gray asserts that in the postmodern era, marked by increasing uncertainties, evidence-based practice may drive consumers away from science-based practices to nonscientific forms of practice because of the latter’s promise of certain results.

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  • Kelly, Michael P., and Tessa A. Moore. 2012. The judgement process in evidence-based medicine and health technology assessment. Social Theory and Health 10.1: 1–19.

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    Kelly and Moore set out to examine how the judgment process is used to interpret evidence and make decisions in both evidence-based medicine and health technology assessment. For those seeking a philosophical perspective on this judgment process, Kelly and Moore open the door by looking at applications of rationalism and empiricism derived from Hume and Kant. While most practitioners of evidence-based practice and technology assessment pay little attention to the philosophical issues, Kelly and Moore show how the uncertainties encountered can be explained through philosophical lenses.

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  • Moat, Kaelan A., John N. Lavis, Mike G. Wilson, John-Arne Røttingen, and Till Bärnighausen. 2013. Twelve myths about systematic reviews for health system policymaking rebutted. Journal of Health Services Research and Policy 18.1: 44–50.

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    Fundamental to evidence-based practice is the generation and dissemination of systematic evidence reviews, yet some cite constraints impeding their use for health system policymaking. Moat and colleagues suggest that most of these so-called constraints are myths, and they present strong counterarguments, using evidence from Health Systems Evidence, a continuously updated repository of syntheses of health systems research.

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  • Mueser, K. T., and Robert E. Drake. 2005. How does a practice become evidence-based? In Evidence-based mental health practice: A textbook. Edited by Robert E. Drake, Matthew R. Merrens, and David W. Lynde, 217–241. New York: W. W. Norton.

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    This is key reading for social workers practicing in a community mental health context. In community-based mental health practice, considerable attention has been given in the United States to identification of evidence-based programs that have been found to be effective with individuals who have been diagnosed as having one or more mental disorders. This chapter provides a succinct discussion of evidence, criteria for establishing evidence-based policies and practices (EBPPs), and steps in developing evidence-based policies and practices with specific reference to community-based mental health practices.

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  • Mullen, Edward J., and David L. Streiner. 2004. The evidence for and against evidence-based practice. Brief Treatment and Crisis Intervention: A Journal of Evidence-Based Practice 4.2: 111–121.

    DOI: 10.1093/brief-treatment/mhh009Save Citation »Export Citation »E-mail Citation »

    This editorial introduces readers to a special issue of Brief Treatment and Crisis Intervention (vol. 4, nos. 2 and 3) on evidence-based practice (EBP) in health and mental health, including social work. The authors identify and critically discuss key arguments for and against evidence-based practice.

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  • Nathan, Peter E. 2004. The evidence base for evidence-based mental health treatments: Four continuing controversies. Brief Treatment and Crisis Intervention: A Journal of Evidence-Based Practice 4.3: 243–254.

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    This article provides insight into key issues underpinning debates about the evidentiary basis of evidence-based psychotherapy. Nathan examines four issues: Does the efficacy model or the effectiveness model yield the most valid picture of psychotherapy outcomes? Which contributes the most variance to psychotherapy outcomes, common factors or treatment factors? Are most psychosocial treatments equally effective? Is teaching, learning, and doing therapy an art or a science?

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  • Norcross, John C., Larry E. Beutler, and Ronald F. Levant, eds. 2006. Evidence-based practices in mental health: Debate and dialogue on fundamental questions. Washington, DC: American Psychological Association.

    DOI: 10.1037/11265-000Save Citation »Export Citation »E-mail Citation »

    This reference provides a range of contrasting perspectives and position papers on nine key questions in the debate on evidence-based practices. This book focuses primarily on issues pertaining to evidence-based practices, especially psychotherapy, rather than the process of evidence-based practice, yet the debates have direct relevance to evidence-based practice in mental health and the range of professions providing mental health services.

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  • Roth, Anthony, and Peter Fonagy. 2005. What works for whom? A critical review of psychotherapy research, Chap. 3. New York: Guilford.

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    Chapter 3 presents an important contrasting position from that proposed in the Chambless and Hollon 1998 article. Roth and Fonagy argue that a narrow focus on empirically supported treatments as technologies detached from the treatment context will not improve services and that the effective use of evidence-based practices requires consideration of other components, such as professional consensus, the preparation and implementation of good practice guidelines, and service-based evaluation methods.

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Educational Issues

Education for evidence-based social work has its own set of issues, controversies, and areas of debate. Since evidence-based practice is a relatively new form of social work practice, it is not surprising that educators are only now beginning to turn to questions about how to teach social work students and practitioners to effectively engage in this form of practice. Teaching methods have been central to the evolution of evidence-based medicine and evidence-based nursing, however, even in these professions controversies and uncertainties remain. Begin reading with chapter 8 in Straus, et al. 2011 since these authors collectively have considerable experience with teaching issues. Extending this discussion and building on their personal experience, Bilsker and Goldner 2004 discuss key issues and methods for dealing with those issues in teaching psychiatric residents. While there are important issues debated about teaching methods and strategies at the level of accreditation policies, even larger policy issues seem to loom. For insight into accreditation policy issues, review the Gambrill 2007 article. The Walker, et al. 2007 editorial and the Rubin 2007 article provide excellent overviews of educational issues as these are being encountered and addressed in social work education. Both of these are written as introductions to special journal issues on this topic, so peruse articles within these two issues for further development of topics discussed.

  • Bilsker, Dan, and Elliot Goldner. 2004. Teaching evidence-based practice: Overcoming barriers. Brief Treat and Crisis Intervention: A Journal of Evidence-Based Practice 4.3: 271–275.

    DOI: 10.1093/brief-treatment/mhh023Save Citation »Export Citation »E-mail Citation »

    Evidence-based medicine (EBM) evolved out of attempts to develop a new way of teaching residents in internal medicine. Bilsker and Goldner discuss issues and barriers they have encountered in teaching evidence-based medicine to psychiatric residents. While their experiences are based on psychiatric training, the issues and barriers identified can be instructive for those considering teaching in other professions and specialties.

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  • Gambrill, Eileen. 2007. Views of evidence-based practice: Social workers’ code of ethics and accreditation standards as guides for choice. Journal of Social Work Education 43.3: 447–462.

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    Readers will find this reference to be a clear analysis of differing views about evidence-based practice (EBP). Especially useful is the author’s assessment of the merits of alternative views relative to social work ethical mandates as well as accreditation standards for social work educational programs.

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  • Rubin, Allen. 2007. Improving the teaching of evidence-based practice: Introduction to the special issue. Research on Social Work Practice 17.5: 541–547.

    DOI: 10.1177/1049731507300145Save Citation »Export Citation »E-mail Citation »

    This introductory article to a special issue of Research on Social Work Practice on teaching evidence-based practice provides an excellent overview of issues, challenges, and recommendations pertaining to how to organize and present evidence-based practice content in social work education curricula. Review other articles in this special issue for further in-depth examination.

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  • Straus, Sharon E., W. S. Richardson, Paul Glasziou, and R. Brian Haynes. 2011. Evidence-based medicine: How to practice and teach it, 4th ed. Chap. 8, 205–220. Edinburgh: Churchill Livingstone.

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    This text provides the most developed discussion of methods and issues in teaching evidence-based medicine and can be instructive for those dealing with related issues in other professions. These authors, building on the work of the originators of evidence-based medicine education, provide useful insights into how important methodological issues can be addressed.

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  • Walker, Janet S., Harold E. Briggs, Nancy Koroloff, and Barbara J. Friesen. 2007. Implementing and sustaining evidence-based practice in social work. Journal of Social Work Education 43.3: 361–375.

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    This editorial provides a succinct assessment of six articles on evidence-based social work practice comprising a special issue of the Journal of Social Work Education. Various meanings attributed to this form of practice are described, along with associated controversies and challenges for infusing it into practice and education. Readers can gain a good understanding of controversies and challenges by reviewing this summary editorial and, as interest dictates, accompanying articles.

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LAST MODIFIED: 11/27/2013

DOI: 10.1093/OBO/9780195389678-0044

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