The fourth step in the EIP process involves selecting and implementing the intervention. Rather than just automatically selecting and implementing the intervention with the best evidence, you need to consider the importance of the practice context. Also, you should inform the client about the evidence and involve the client in the decision of which intervention to use.
The fifth step in the EIP process involves monitoring client progress. Even the most effective interventions don't help everybody. Moreover, even if your client could benefit from the intervention, perhaps there is something about the way you are providing it – or something about your practice context – that is making it less effective than it was in the research studies.
In the real world of everyday practice, you may encounter some practical obstacles limiting your ability to implement the EIP process in an ideal fashion. Common obstacles include a lack of time, training, and access to Internet databases. You should always do the best you can, even if that involves taking some shortcuts. Not doing so, and thus practicing in disregard of the evidence, is not ethical or compassionate.
In order to leverage the best outcomes for clients it's important to both foster a strong working relationship with clients and carefully select the intervention through the EIP process.
REVIEW EXERCISES
1 Identify two different Internet-based search databases you might use for an online search. Find the help section and read about how the search engine uses Boolean operators, advanced search options, and other symbols or strategies that you might use to make your search more efficient. Make yourself a table with notes outlining these tools and tips for each of the search engines.
2 Formulate an EIP question to guide an intervention decision in a practice situation with which you are familiar. Using the Internet, search for studies providing evidence to inform that decision. In your search, see how the use of different search terms and different Boolean operators (and versus or) affect the range and types of studies that display. Just by examining titles, and perhaps reading some abstracts from some of the studies that seem most relevant to your question, determine whether some of the studies are reviews of studies. Briefly describe the different kinds of results you get using different search terms.
3 After examining some of the studies that you find in your review in Exercise 2, discuss how the practice context, including idiosyncratic client characteristics, might make one of the studies you find inapplicable to your practice decision even if that study might provide the best evidence from a research standpoint.
4 Go to the following website: http://www.lib.umich.edu/socwork/rescue/ebsw.html. Explore some of its links to additional sites relevant to EIP. Briefly describe one or two things you find that seem likely to be helpful to you in implementing the EIP process.
ADDITIONAL READINGS
1 Corcoran, J. (2003). Clinical applications of evidence-based family interventions. Oxford University Press.
2 Foa, E. B., Keane, T. M., & Friedman, M. J. (2000). Effective treatments for PTSD. Guilford Press.
3 Reddy, L. A., Files-Hall, T. M., & Shaefer, C. E.. (Eds.) (2005). Empirically based play interventions for children. American Psychological Association.
4 Roberts, A. R., & Yeager, K. R.. (Eds.) (2004). Evidence-based practice manual: Research and outcome measures in health and human services. Oxford University Press.
3 Research Hierarchies: Which Types of Research Are Best for Which Questions?
1 3.1 More than One Type of Hierarchy for More than One Type of EIP Question
2 3.2 Qualitative and Quantitative Studies
3 3.3 Which Types of Research Designs Apply to Which Types of EIP Questions? 3.3.1 What Factors Best Predict Desirable and Undesirable Outcomes? 3.3.2 What Can I Learn about Clients, Service Delivery, and Targets of Intervention from the Experiences of Others? 3.3.3 What Assessment Tool Should Be Used? 3.3.4 What Intervention, Program, or Policy Has the Best Effects? 3.3.5 Matrix of Research Designs by Research Questions 3.3.6 Philosophical Objections to the Foregoing Hierarchy: Fashionable Nonsense Key Chapter Concepts Review Exercises Additional Readings
Now that you understand the importance and nature of the evidence-informed practice (EIP) process, it's time to examine in more detail how to critically appraise the quality of the evidence you'll encounter when engaged in that process. We take a look at that in this chapter and in several chapters that follow. As we do that, you should keep in mind that our aim is not to learn how to find the perfect study. No such study exists. Every study has some limitations. Instead, we examine how to distinguish between evidence that, despite its relatively minor limitations, merits guiding our practice versus more seriously flawed evidence that should be viewed more cautiously.
Chapter 2 alludes to differentiating between studies with reasonable limitations versus studies with fatal flaws. If you appraise many studies, however, you'll soon realize that things aren't black and white. That is, the universe of practice-relevant studies contains not only exemplary studies and fatally flawed ones; there are many shades of gray. You'll want to exercise some degree of caution in being guided by any evidence you find, and the various types of evidence you find will reside along a continuum with regard to how much caution is warranted. Moreover, it will not always be easy to conclude that one intervention has the best evidence. You might encounter some ties for the best. Also, as is discussed in Chapter 2, your practice expertise and client attributes and preferences often will influence your course of action – sometimes even swaying you toward a course based on evidence that is less than best.
3.1 More than One Type of Hierarchy for More than One Type of EIP Question
If you've read much of the literature about EIP, or have discussed it with many colleagues, you probably have encountered some misconceptions about EIP. One misconception is that EIP implies an overly restrictive hierarchy of evidence – one that values evidence produced only by tightly controlled quantitative studies employing experimental designs. In those designs, clients are assigned randomly to different treatment conditions. In one treatment condition, some clients receive the intervention being tested and other clients are assigned