Читать книгу Practitioner's Guide to Using Research for Evidence-Informed Practice - Allen Rubin - Страница 15

The accumulation of scientifically rigorous studies showing that some interventions appear to be more effective than others helped spawn the EIP movement. In simple terms, the EIP movement encourages and expects practitioners to make practice decisions – especially about the interventions they provide – in light of the best scientific evidence available. In other words, practitioners might be expected to provide interventions whose effectiveness has been most supported by rigorous research and perhaps to eschew interventions that lack such support – even if it means dropping favored interventions with which they have the most experience and skills.

The preceding paragraph used the words in light of the best scientific evidence, instead of implying that the decisions had to be dictated by that evidence. That distinction is noteworthy because some mistakenly view EIP in an overly simplistic cookbook fashion that seems to disregard practitioner expertise and practitioner understanding of client values and preferences. For example, the forerunner to EIP, EBP was commonly misconstrued to be a cost-cutting tool used by third-party payers that uses a rigid decision-tree approach to making intervention choices irrespective of practitioner judgment. Perhaps you have encountered that view in your own practice (or in your own healthcare) when dealing with managed care companies that have rigid rules about what interventions must be employed as well as the maximum number of sessions that will be reimbursed. If so, you might fervently resent the EBP concept, and who could blame you! Many practitioners share that resentment.

Managed care companies that interpret EBP in such overly simplistic terms can pressure you to do things that your professional expertise leads you to believe are not in your clients' best interests. Moreover, in a seeming disregard for the scientific evidence about the importance of relationship factors and other common factors that influence positive outcomes, managed care companies can foster self-doubt about your own practice effectiveness when you do not mechanically provide the interventions on their list of what they might call “evidence-based practices.” Such doubt can hinder your belief in what you are doing and in turn hinder the more generic relationship factors that can influence client progress as much as the interventions you employ. Another problem with the list approach is its potential to stifle innovations in practice. Limiting interventions to an approved list means that novel practices are less likely to be developed and tested in the field. As you read on, you will find that EIP is a much more expansive and nuanced process than simply choosing an intervention from a list of anointed programs and services.