Evidence-Based Practice
A Stepwise Approach
Bruce D. Friedman, PhD, ACSW, CSWM
University of Texas – Pan American
Social Work Department
friedm52@panam.edu
October 27, 2006
www.socialworkmanager.org
Objectives
• Understand evidence-based practice & its
relationship to the professional, client system,
existing knowledge, and values & expectations.
• Develop an understanding on how to ask focused
clinical questions.
• Develop search strategies that include:
– Identifying appropriate search engines on the web.
(Various search engines may be used depending on
connectivity).
• Learn how to critically appraise literature for
validity and applicability.
Problems
• Suspected accuracy of assessment of treatment
protocols.
• Our textbooks are out of date.
• Our journals have slim pickings with too much
to read and too little time.
• Consequently, our knowledge and performance
deteriorate.
• Traditional instructional CE doesn’t improve
our performance or client outcomes.
Three Solutions
Clinical performance can keep up to date
by:
1. Learning how to practice EBP ourselves.
2. Seek and apply evidence-based
practice summaries generated by others.
3. Apply evidence-based strategies for
changing our clinical behavior.
“Evidence-Based Users”
• Efficiently track and use sources of pre-appraised
evidence (journals of secondary publication) 
provide immediately applicable conclusions.
• Master a set of skills to acquire up to date
information for delivering evidence-based care.
• More likely (than personal search and critical
appraisal) to be true.
• Saves precious (scarce!) time.
• Avoids error and duplication of effort.
What evidence-based practice is:
The practice of EBP is the integration of
• individual clinical expertise
with the
• best available external clinical evidence
from systematic research
and
• client’s values and expectations.
Best
Individual
Clinical
External
Expertise
Evidence
EBP
Client Values
& Expectations
What do we mean by EBP?
• A conscious decision to base clinical
decisions on the most objective evidence of
effectiveness available.
• Involves a fundamental acknowledgement
that our clinical convictions can be wrong.
Why is EBP necessary?
• Essential to the process of lifelong learning and
keeping up to date.
• Frees you up to do things that you want to do.
• It is egalitarian.
• Best way of being sure that we provide effective
care within the confines of our finite social service
resources.
The EBP Process
When caring for a client it creates the
need for information:
1. Ask a focused clinical question.
( “answerable question”)
Yogi Berra said….
"You got to be very careful if
you don't know where you're
going, because you might not
get there."
The EBP Process cont..
2. Efficiently track-down the best available
evidence.
3. Critically appraise the evidence for its
validity and clinical applicability.
4. Integrate the critical appraisal with your
clinical expertise and the client’s unique
values and expectations  Action.
5. Evaluate your performance (= Audit).
Tactics for efficiently tracking
down the best evidence
Carry out instant information searching
as soon as we need to know something
The advantages of instant
information searching
Answers found will be better remembered in the
context of needing to know.
 Will apply the information to similar patients in
future.
 Applying valid and relevant E-B information will
improve outcomes in a timely fashion.
 Answering questions that arise around problems we
commonly see will keep us up to date with a
minimum amount of work.

The usefulness of information
equation
Usefulness of information =
Applicability x Validity
Work
A stepwise approach to finding
the best evidence efficiently
• Step 1. Ask a focused clinical question.
• Step 2. Devise a search strategy.
• Step 3. For questions with a narrow focus concentrate
on information contained in Evidence Based
Journals of Secondary Publication
• Step 4. For EBP queries use sites like TRIP or Mental
Health
• Step 5. If previous steps fail then use broader search
engines like PubMed, or Google.
Internet
Resources
for
SEARCHING
TRIP (Turning Research Into Practice)
http://www.tripdatabase.com/
Mental Health Resources
http://www.mentalhealth.com
SUM Search
http://SumSearch.UTHSCSA.edu/cgi-bin/SUMSearch.exe
Cochrane Library
http://www.cochrane.org/
Drug Reference Site
www.rxlist.com
NASW - http://www.naswdc.org
Urban Institute www.urbaninstitute.org
Netting the Evidence: ScHARR
http://www.shef.ac.uk/~scharr/ir/netting/
Search Strategy
• Stick to “answerable questions”.
• Remember EBP databases will
predominantly have studies that satisfy the
highest levels of evidence  If an answer
to your question can’t be found in these
databases (e.g. TRIP) good evidence on this
topic probably does not exist.
• Restrict yourself to a handful of high quality
databases that you can implicitly trust and
know them well.
Literature Validity & Applicability
• Does the literature answer your question?
• Is the information useful in working with
your client system?
• How does the information relate to the
client system’s value orientation?
Summary
• What is evidence-based practice & its
relationship to the professional, client
system, existing knowledge, and values &
expectations?
• How do you ask focused clinical questions?
• Identify two search engines and how you
would use them.
• Identify criteria for critically appraising
literature for validity and applicability.