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EVIDENCE BASED
PRACTICE
Evidence Based
Practices: What are
they and how do you
use them?
Jody Brook, Ph.D.
MSW/LCSW, in
collaboration with Becci
Akin, Ph.D. MSW
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What is Evidence Based Practice (EBP)?
(Based on IOM, 2001 definition, with modifications and additions by author)
Best Available
Evidence
Client
Characteristics,
needs, values,
preferences,
and culture.
Evidence
Based
Practice
Organizational
Environment and
Resources
Clinical Wisdom
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What’s up with the name game of:
• Evidence Based Practice
• Evidence Informed Practice
• Best Practices
• Evidence Informed Intervention
• Empirically Supported Treatment
And the incredibly important and distinct
concept of :
Practice Based Evidence
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How do you find a “real” EBP?
• Depends on who you ask!
• Generally speaking:
o Rigorous evaluation shows positive results
o The results can be linked to the program intervention
o Subject to peer review and independent scrutiny by
independent experts
o Designation by a federal agency, or respected review
organization in the field
o Buyer beware-EBP can be a marketing buzzword!
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Why do we need EBP?
• Commitment to clients and their needs;
• We all have limited resources, so using them with something that
•
•
•
•
works is better use of resources;
Most EBP’s are fully developed (may need to modify);
Accountability to funders/stakeholders;
Existing evaluation resources for effectiveness and cost/benefit
analyses;
One stop shop for training, manualized
curriculums, support, etc…
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Preparing for Evidence Based Practice……..Ready, or Not?
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Assessing agency readiness
• What is the driving force behind the desire to implement change?
• Is your staff open to this?
• How does this fit with structure and day to day activities?
• What can you learn from past experience with implementing new practices?
• How does this fit with other stakeholders and collaborative agencies in the community?
• Bottom line: Implementing EBP’s requires organizational planning.
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What is the problem you are seeking to
address and with what population?
• These are critical questions answer before selecting an
•
•
•
•
•
•
EBP.
Understand your consumer and context
Review factors to consider (handout)
It must be evidence based for the population you intend to
serve;
It must work on a clinical and practical level;
It must ultimately be something that is sustainable if it
works.
You will not find a ‘perfect’ fit-so how can you adjust and
work with what is there?
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Considerations:
• Understand needs of your consumers - what do these individuals and/or
families look like? Are there unique struggles?
• Have realistic expectations of their ability to participate.
• What are the needs of the community? What are the strengths and
weaknesses?
• What are the challenges you believe you will face and how can you plan to
address them?
• The difference between availability of services and true access to services
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Factors to consider:
• Describe the problem
• Describe the co-occurring conditions
Outcome (what you want to
happen)
Client:
Agency Service:
Community:
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Client, Agency and Community Factors to Consider Before and
During EBP Selection
Target population
demographics and
characteristics-age,
gender, race/ethnicity,
household structure,
reason for seeking service.
Disability, physical or
other needs
Cultural, linguistic, or other
adaptations needed
Setting constraints
Training and logistical
capabilities
Strengths and natural
resources of population
Agency support (all levels)
Sustainability
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Accessing EBP Information
• Most commonly used registries in mental health:
• http://www.nrepp.samhsa.gov/.
• http://www.cebc4cw.org/.
• http://www.campbellcollaboration.org/resources/links/links
_social_welfare.php.
• http://www.cochrane.org/.
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Assessing the fit of an EBP to your
organization:
• Levels of Evidenceo Evidence-Based Practice Rating Scale
o 1 = Well-Supported by Research Evidence
o 2 = Supported by Research Evidence
o 3 = Promising Research Evidence
o 4 = Emerging Practice
Quality of Research
Readiness for Dissemination
Reviewer Selection and Training
• Non-Researcher’s Guide to EBP Evaluation
http://www.nrepp.samhsa.gov/Courses/ProgramEvaluation/NREPP_0401
_0010.html.
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Sample structure for EBP Assessment
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Evaluating the credibility of sources of information:
(Based on Krysik and Finn, 2010)
• Authority
• Intent & proprietary interest
• Currency
• Fairness
• Reliability
Assessing Evidence-Based
Programs
and Practices
Capacity to Implement
Staff meet minimum qualifications
Able to sustain Imp Drivers
• Financially
• Structurally
• Buy-in process operationalized
• Practitioners
• Families
• Agency
Intervention Readiness for
Replication
Qualified purveyor
Expert or TA available
Mature sites to observe
# of replications
How well is it operationalized?
Are Imp Drivers operationalized?
EBP:
Need in Agency, Setting
Socially Significant Issues
Parent & Community Perceptions
of Need
Data indicating Need
Fit with current •Initiatives
• State and Local Priorities
• Organizational structures
• Community Values
Need
Capacity to
Implement
Fit
Intervention
Readiness
for
Replication
Resource
Availability
Evidence
Resource Availability
IT
Staffing
Training
Data Systems
Coaching & Supervision
Administrative & system
supports needed
5 Point Rating Scale: High = 5; Medium =
3; Low = 1. Midpoints can be used and
scored as a 2 or 4.
High
Medium
Need
Fit
Resources Availability
Evidence
Low
Evidence
Outcomes – Is it worth it?
Fidelity data
Cost – effectiveness data
Number of studies
Population similarities
Diverse cultural groups
Efficacy or Effectiveness
Readiness for Replication
Capacity to Implement
Total Score:
© National Implementation Research Network 2009
Adapted from work by Laurel J. Kiser, Michelle Zabel,
Albert A. Zachik, and Joan Smith at the University of Maryland
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Critical Steps in Quality Implementation
(Reference: Meyers, D. C., Durlak, J. A., & Wandersman, A. (2012). The Quality
Implementation Framework: A Synthesis of Critical Steps in the Implementation
Process).
Initial
Considerations
Creating a
Structure for
Implementation
Ongoing
structure once
EBP is
implemented
Improving
future
applications
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Common concerns about EBP
implementation:
• Costs
• Status quo
• Different values and beliefs
• Limits practitioner flexibility
• We (or our clients) are too different!
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Selecting the right EBP is a victory!