Читать книгу Practitioner's Guide to Using Research for Evidence-Informed Practice - Allen Rubin - Страница 16

The foregoing, overly simplistic view of EBP probably emanated from the way it was defined originally in medicine in the 1980s (Barber, 2008; Rosenthal, 2006). Unfortunately, the list or cookbook approach to EBP has probably stuck around because it seemed like a straightforward approach to making good practice decisions. It's much simpler for funders and others to implement and monitor whether practitioners are using an approved intervention than it is to implement and monitor the complexities of the EIP process. For example, one study found that mental health authorities in six states mandated the use of specific children's mental health interventions (Cooper & Aratani, 2009).

Fortunately, the revised definition of EIP – and revised acronym – incorporates practitioner expertise and judgment as well as client values and preferences (Sackett et al., 2000). The more current and widely accepted definition shows that managed care companies or other influential sources are distorting the definition when they interpret it as merely a list of what intervention to use automatically for what diagnosis or problem, regardless of your professional expertise and special understanding of idiosyncratic client characteristics and circumstances.

The current and more comprehensive definition of EIP – one that is more consistent with definitions that are prominent in the current human service professions literature – views EIP as a process, as follows: EIP is a process for making practice decisions in which practitioners integrate the best research evidence available with their practice expertise and with client attributes, values, preferences, and circumstances. In other words, practice decisions should be informed by, and not necessarily based on, research evidence. Thus, opposing EIP essentially means opposing being informed by scientific evidence!

In the EIP process, practitioners locate and appraise credible evidence as an essential part, but not the only basis, for practice decisions. The evidence does not dictate the practice. Practitioner expertise such as knowledge of the local service context, agency capacity, and available resources, as well as experience with the communities and populations served, must be considered. In addition, clients are integral parts of the decision-making process in collaboration with the practitioner. Indeed, it's hard to imagine an intervention that would work if the client refuses to participate!

Moreover, although these decisions often pertain to choosing interventions and how to provide them, they also pertain to practice questions that do not directly address interventions. Practitioners might want to seek evidence to answer many other types of practice questions, as well. For example, they might seek evidence about client needs, what measures to use in assessment and diagnosis, when inpatient treatment or discharge is appropriate, understanding cultural influences on clients, determining whether a child should be placed in foster care, and so on. They might even want to seek evidence about what social justice causes to support. In that connection, there are six broad categories of EIP questions, as follows:

1 What factors best predict desirable or undesirable outcomes?

2 What can I learn about clients, service delivery, and targets of intervention from the experiences of others?

3 What assessment tool should be used?

4 Which intervention, program, or policy has the best effects?

5 What are the costs of interventions, policies, and tools?

6 What are the potential harmful effects of interventions, policies, and tools?