1.3.6 What about Potential Harmful Effects?
In addition to cost considerations, as you search for the approach with the best effects, you should also bear in mind the possibility of harmful effects. There are two reasons for this. One is that some programs and interventions that were once widely embraced by helping professionals were found to be not only ineffective but actually harmful. Examples include Scared Straight programs; critical incidents stress debriefing; psychodynamic, in-depth insight-oriented psychotherapy for schizophrenia; and treating dysfunctional family dynamics as the cause of schizophrenia. (For a discussion of these approaches, see Rubin, 2012; and Rubin & Babbie, 2011.)
Some approaches that are effective overall can be harmful – or contraindicated – for certain types of clients. For example, consider two empirically supported treatment approaches for posttraumatic stress disorder (PTSD). In the early 1990s, trainees in one of these treatment approaches – eye movement desensitization and reprocessing (EMDR) – were cautioned to check for whether the client had a dissociative order or physical eye ailments before providing it because it could be harmful for such clients. The other empirically supported treatment approach – prolonged exposure therapy – can have unintended harmful effects for people whose PTSD is comorbid with suicidality or substance abuse, in that recalling and retelling in minute detail their traumatic events before their substance abuse or suicide risk is resolved can exacerbate both of those conditions (Courtois & Ford, 2009; Rubin & Springer, 2009). Even if a client doesn't have any characteristics that are a risk for harm from interventions, every client is different. In some cases, clients may experience an intervention negatively or may have a mix of both positive and negative outcomes – even if research suggests that the intervention on the whole works well for many people. The need to consider such harmful effects pertains to the aspect of EIP discussed earlier in this chapter – regarding the importance of integrating the best research evidence with your practice expertise and knowledge of client attributes, including the assessment intervention outcomes for each client individually.
1.4 EIP Practice Regarding Policy and Social Justice
Although much of the literature on EIP focuses on effectiveness questions and on the clinical level of practice, EIP also pertains to decisions made at other levels of practice, including decisions about community interventions and social policies.
1.5 EIP and Black Lives Matter
Regarding social justice, for example, in the aftermath of the murder of George Floyd and various other incidents of Black people being killed by police in 2020, policy questions arose in connection to the Black Lives Matter (BLM) movement and the prevention of future such incidents. At one extreme of the policy debate were those calling for defunding or abolishing police. Less extreme voices expressed fears that those extreme positions had no chance of being adopted and that those advocating such policies risked creating a backlash against the BLM movement and perhaps increasing the chances that Donald Trump would be reelected. Instead of abolishing the police, therefore, they advocated developing policies that would reform the police and policy-level interventions that would prevent or dramatically reduce future incidents of racist police brutality.
Taking an evidence-informed approach toward discovering such policies and interventions that would have the best chance of being effective, you might enter terms like Black Lives Matter, police violence, or similar terms in a search engine like Google. If you do, you might come up with a list of links such as the following:
Campaign zero.
Research shows there are at least six proven ways to reduce police brutality – and two strategies that don't work, A. Woodward & M. Mark, businessinsider.com.
Lum, C. et al. (2019). Research on body-worn cameras. Criminology & Public Policy, 18, 93–118.
At the Campaign Zero link, you might read the following quote from former President Barrack Obama:
We have more information and more data as to what works, and there are organizations like Campaign Zero, Color of Change and others that are out there, highlighting what the data show what works and what doesn't in terms of reducing incidents of police misconduct and violence. Let's go ahead and start implementing those.
Thus, President Obama took an evidence-informed approach and considered research findings when formulating his position on this issue. If you do not take such an EIP approach, you might recommend policies or interventions that the research that he cited showed to be ineffective or insufficient, such as relying solely on requiring police to wear body cameras or engaging them in interventions to reduce implicit bias.
Another example of EIP at the policy level pertains to the impact of managed care – a term referring to various approaches that try to control the costs of health care. The main idea is for a large organization (such as a health insurance company or a health maintenance organization) to contract with service providers who agree to provide health care at reduced costs. Health care providers are willing to meet the reduced cost demands so that more clients covered under the managed care plan will use their services.
Managed care companies also attempt to reduce costs by agreeing to pay only for the type and amount of services that they consider necessary and effective. Consequently, health care providers may feel pressured to provide briefer and less costly forms of treatment. Trujillo (2004, p. 116), for example, reviewed research on the question: “Do for-profit health plans restrict access to high-cost procedures?” The study found no evidence to indicate that patients covered by for-profit managed care plans are less likely to be treated with high-cost procedures than patients covered by nonprofit managed care plans. An excellent book on EIP and managed care, by Muir Gray (2001), is Evidence-Based Healthcare: How to Make Health Policy and Management Decisions.
A final example of EIP at the level of policy pertains to concerns about social justice for the LGBTQ (lesbian, gay, bisexual, and transgender, and queer) population. Taking an EIP approach to that issue, you might enter a term like LGBTQ POLICY RESEARCH on your search engine. If you do, you might come up with a list of links such as the following:
LGBT Policy Research - LGBTQ/Gender & Sexuality Studies …https://libguides.gc.cuny.edu › c.php
Public Policy Institute Uses Research to Advocate for LGBTQ …www.insightintodiversity.com › public-policy-in … .
LGBTQ Youth | American Institutes for Researchwww.air.org › topic › health › lgbtq-youth.
At the latter site you could find a review of research on the effectiveness of mentoring in improving the well-being of LGBTQ youth. That review identifies what kinds of mentoring support are most associated with desirable outcomes. You could also read about another study about the effectiveness of violence prevention programs targeted at urban LGBTQ youth.
1.6 Developing an EIP Practice Process Outlook
Becoming an evidence-informed practitioner does not begin just by implementing the phases of the EIP process, phases that we examine more thoroughly in Chapter 2. To implement the process successfully, practitioners might have to change the way they have been influenced to think about practice knowledge. For example, relatively inexperienced practitioners might work in settings where more experienced practitioners and supervisors generally do not value