Читать книгу The Sage Handbook of Social Constructionist Practice - Группа авторов - Страница 161

The evidence-based practice (EBP) movement spans multiple professions, such as medicine, psychology, and social work. It has also spawned ‘cottage industries’, most notably organizations such as the Cochrane Collaboration that summarize the available evidence on different practices and provide recommendations to practitioners regarding the degree to which a practice is evidence-based.

Within social work, EBP has gained wide acceptance both in the academy and in practice. In academic circles the argument for EBP centers around the superiority of research-based knowledge and the ethical obligation of practitioners to draw upon this knowledge in their practice. This has led social service organizations to promote their services as evidence-based, resulting in the EBP label becoming a marketing tool used to communicate to potential clients that they will be receiving the best available services, backed by science.

From a social constructionist perspective, EBP's underlying assumptions, its widespread endorsement, claims, and politicization, generate some troubling issues. Although on the surface the idea of EBP seems laudable, to use the best available evidence in collaboration with the client to develop a treatment plan, its meaning in use and underlying philosophical foundation bears closer inspection.

Social construction encourages a problematizing orientation toward commonly held beliefs and concepts. Rather than accepting such concepts and beliefs as given or the way things are, social constructionists interrogate meanings, origins, use, and most important, benefits and harms. Social construction also encourages analysis from a relational perspective. When applied to EBP, a number of issues emerge. For example, I (Witkin, 2017) problematize the meanings of EBP, raising questions such as: Should early meanings of the concept – those attributed to the originators – be privileged? Is the meaning of EBP found in its definition or in how it is practiced? Is the concept of EBP static or does it change as social conditions change? Regarding application, I explore the difference between EBP use in practice versus its use in research, the latter being more circumscribed and uniform. Also related to application are the complexities of assessing whether an evidence-based treatment is appropriate for a particular client. EBP is a multidimensional concept derived from different kinds of inquiry with different research participants in different settings, presenting different problems, and using different measures. Ironically, when practitioners rely on summary evaluations from organizations like the Cochrane Collaboration, they are moving away from an evidence-based approach toward a more authority-based approach (Goldenberg, 2009). Consequently, applying the recommended procedure involves a leap of faith in the summarizing organization. The issue of what counts as evidence can also be viewed as a political issue. For example, Denzin (2009) asks,

[W]ho has the power to control the definition of evidence, who defines the kinds of materials that count as evidence, who determines what methods best produce the best forms of evidence, whose criteria and standards are used to evaluate quality evidence? (p. 142)

The response to these questions is inevitably political, subject to the vicissitudes of power relations within the context in which EBP is being applied.

From the EBP perspective, evidence is a form of knowledge. Such knowledge depends on the means by which it was generated. Therefore, research-based knowledge is most authoritative, trumping knowledge generated from other activities such as practice. From a social constructionist perspective, knowledge can be considered a status given to information. Its credibility will depend on the traditions of the knowledge community to which it is applied. Thus, for practitioners, knowledge generated within the context in which it will be used, and which is sensitive to client differences, is more relevant, robust, and useful. Moreover, it is generated within relationships and will reflect the dynamics of those relationships. Therefore from this standpoint, it is practice that should be the primary site of knowledge generation (Witkin, 2015).