Читать книгу Practitioner's Guide to Using Research for Evidence-Informed Practice - Allen Rubin - Страница 14

1  1.1 Emergence of EIP

2  1.2 Defining EIP

3  1.3 Types of EIP Questions 1.3.1 What Factors Best Predict Desirable or Undesirable Outcomes? 1.3.2 What Can I Learn about Clients, Service Delivery, and Targets of Intervention from the Experiences of Others? 1.3.3 What Assessment Tool Should Be Used? 1.3.4 Which Intervention, Program, or Policy Has the Best Effects? 1.3.5 What Are the Costs of Interventions, Policies, and Tools? 1.3.6 What about Potential Harmful Effects?

4  1.4 EIP Practice Regarding Policy and Social Justice

5  1.5 EIP and Black Lives Matter

6  1.6 Developing an EIP Practice Process Outlook 1.6.1 Critical Thinking

7  1.7 EIP as a Client-Centered, Compassionate Means, Not an End unto Itself

8  1.8 EIP and Professional Ethics 1.8.1 What about Unethical Research? Key Chapter Concepts Review Exercises Additional Readings

You've started reading the third edition of a book about using scientific research evidence to inform your practice decisions that is being written at a time when the COVID-19 pandemic is on the verge of being conquered by vaccines that were developed and evaluated by means of research. So, despite the ambivalence – perhaps even disdain – that some might have about studying research or using it to inform their practice decisions, we must ask: Especially during this post-COVID era, why would any ethical, caring helping professional choose NOT to be informed by research?

If you approach this topic with an open mind, and if you actually look for research evidence that can enhance your practice, you'll find many scientific studies that can help you to become more effective in your practice and to avoid doing harm. Seeking those studies and critically appraising them are part of what is called evidence-informed practice(EIP).

The term evidence-informed practice was more commonly called evidence-based practice when it became fashionable near the end of the last century. The main ideas behind it, however, are really quite old. As early as 1917, for example, in her classic text on social casework, Mary Richmond discussed the use of research-generated facts to guide the provision of direct clinical services as well as social reform efforts.

Also quite old is the skepticism about the notion that your practice experience and expertise – that is, your practice wisdom – are by themselves a sufficient foundation for effective practice. That skepticism does not imply that your practice experience and expertise are irrelevant and unnecessary – just that they alone are not enough.

Perhaps you don't share that skepticism. In fact, it's understandable if you even resent it. Despite the existence of research studies showing that some intervention approaches are ineffective and perhaps harmful, students learning about clinical practice have long been taught that to be an effective practitioner, they must believe in their own effectiveness as well as the effectiveness of the interventions they employed. Chances are that you have learned this, too, either in your training or through your own practice experience. It stands to reason that clients will react differently depending on whether they are being served by practitioners who are skeptical about the effectiveness of the interventions they provide versus practitioners who believe in the effectiveness of the interventions and are enthusiastic about them.

But it's hard to maintain optimism about your effectiveness if influential sources – like research-oriented scholars or managed care companies – express skepticism about the services you provide. Such skepticism was catalyzed by a notorious research study by Eysenck (1952), which concluded that psychotherapy was not effective (at least not in those days). Although various critiques of Eysenck's analysis later emerged that supported the effectiveness of psychotherapy, maintaining optimism was not easy in the face of various subsequent research reviews that shared Eysenck's conclusions about different forms of human services (Fischer, 1973; Mullen & Dumpson, 1972). Those reviews, in part, helped usher in what was then called an age of accountability – a precursor of the current EIP era.

The main idea behind this so-called age was the need to evaluate the effectiveness of all human services. It was believed that doing so would help the public learn “what bang it was getting for its buck” and, in turn, lead to discontinued funding for ineffective programs and continued funding for effective ones. Thus, that era was also known as the program evaluation movement. It eventually became apparent, however, that many of the ensuing evaluations lacked credibility due to serious flaws in their research designs and methods – flaws that often stemmed from biases connected to the vested interests of program stakeholders. Nevertheless, many scientifically rigorous evaluations were conducted, and many had encouraging results supporting the effectiveness of certain types of interventions.

In addition to studies supporting the effectiveness of particular intervention modalities, perhaps most encouraging to clinicians were studies that found that one of the most important factors influencing service effectiveness is the quality of the practitioner-client relationship. Some studies even concluded that the quality of practitioners' clinical relationship skills has more influence on treatment outcome than the choices practitioners make about what particular interventions to employ. Although that conclusion continues to be debated, some studies show that practitioner effectiveness is influenced by both the type of intervention employed and certain common relationship factors (Cuijpers et al., 2019; Nathan, 2004).