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2. Evidence Based Practices
Theme 2: Evidence based practices and their problematics
The questions of evidence and knowledge have a great currency in international debates concerning the area of human services (Sommerfeld 2005; Mullen et al. 2007; Gray et al. 2009).
Evidence based practices may refer to those practices which are proven to be effective. In connection to this, issues concerning how to get to know and prove effectiveness of practices are of great interest. A narrow view on evidence approves certain kinds of methods, such as RCT’s, but also needs for more inclusive understanding of evidence as the best available knowledge can be presented.
More broadly, evidence based practices are understood as practices within the complex situation, where a human service practitioner, such as a social worker, and a citizen or client encounter. This broader view conceives knowledge as a combination of different types of elements and also approves that in real life outcome measurement/EBP has different meanings for different stakeholders in the fields of human service organizations. From this point of view evidence based social services are seen as a socio-technical innovation, the implementation of which is not just a technical exercise, but also a social process with political, cultural, and value-driven dimensions (Gray et al 2009).
There are thus big challenges in implementing EBP, even though it represents in principle the latest and best available scientific knowledge, which fits well to the idea of profession and its logic of applying good quality knowledge. From the point of view of a practitioner the interpretation of outcome information concerning a specific intervention cannot be separated from many contingencies involved. A practitioner has to take into account the values of clients, analysis of the problem and assessment of possibilities of solving it, as well as, what is counted as knowledge in an organization or professional group, as local relevancies of knowledge (Gray et al 2009). The practitioner makes practice decisions through clinical expertise, integrating the assessment of evidence with assessment of client preferences and the contextual circumstances (Mullen, Shlonsky et al. 2005).
Studies discussing this broader view on EBP are welcomed, examining use of research information also in connection to organizational information management, organizational learning and practicalities of casework management. These, together with professional education, dissemination of practical resources and guidelines, available experts, and development of organizational cultures and professional strategies, are relevant conditions of research use (Mullen et al. 2007).
Theory and research identifying the important influence of organizational conditions and external contexts on practices provide frameworks for understanding how organizational contexts influence knowledge use. Qualitative and quantitative studies of how information is gained, produced and used in particular service settings may help us to understand the influence of both institutional and organizational contexts on organizational knowledge use.
Also research on system level or institutional level solutions or requirements of EBP are important. In England, for example, three distinct models of research use in social care system are delineated (Walter et al 2004). In the research-based practitioner model it is the role of the autonomous practitioner to stay current with and apply research findings. The embedded research model emphasizes the importance of comprehensive systems of care, where the responsibility for research informed practice is the task of managers, policy makers and research specialists. The organizational excellence model connects a research-oriented culture with promoting the research use as a local (contextual) process, which implies knowledge and a commitment by both formal organization and collegial professional group in integrating the assessment of evidence, client preferences and contextual circumstances (Gray et al 2009).
Eamonn Noonan, PhD, Norwegian Center for Social Affairs and Health; CEO, Campbell Collaboration
Prof. Pekka Kettunen, University of Jyväskylä
Prof. Ilmari Rostila, University of Tampere, Unit at UCPori
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