Practitioner's Guide to Using Research for Evidence-Informed Practice. Allen Rubin

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      Needless to say, you have some self-compassion. What about the compassion of the two professionals? Suppose you make a preliminary visit to both to discuss what they do before you decide on a treatment. Suppose you ask them about the research evidence regarding the likelihood that their treatment will help you or harm you. Suppose one pooh-poohs the need for research studies and instead says he is too busy to pay attention to such studies – too busy providing a treatment that he has been trained in, has always done, and that he believes in. Suppose the other responds in a manner showing that she has taken the time to keep up on all the latest studies and explains clearly to you the likely benefits of the approaches she uses versus other treatment options that you might pursue. We suspect that because the latter professional took the time and effort to be informed by the evidence, and transparent about the reasons why she delivers the intervention that she does, you would perceive her to be more compassionate. You might therefore be more predisposed to choose her.

      But human service interventions, such as alternative forms of psychotherapy, don't involve poking people with needles, manipulating their bones, or zapping them with lasers. At least not yet! If you are familiar with such controversial treatments as touch field therapy or rebirthing therapy, you might wonder what's next. You might also have read about a child's death that resulted from rebirthing therapy (Crowder & Lowe, 2000). Human service interventions can be harmful without causing physical damage. For example, the studies we alluded to in discussing family therapy training found that certain intervention approaches for schizophrenia had unintended harmful effects. Instead of increasing the amount of time between relapses of schizophrenia, they decreased it (Anderson et al., 1986; Simon et al., 1991).

      Moreover, providing an ineffective intervention to people who are suffering – even if that intervention does not make matters worse – is harmful if we miss the opportunity to have alleviated their suffering with an available intervention that has been scientifically shown to be more effective.

1.8 EIP and Professional Ethics

      Thus, developing an EIP outlook is not just about science; it is about being more client centered, more compassionate, and even more ethical. Why ethical? Because, as you probably already have observed in your profession's code of ethics, ethical practice involves keeping up on the scientific evidence as part of trying to provide your clients with the most effective treatment possible. For example, the Code of Ethics of the National Association of Social Workers (1999) specifically requires social workers to include evidence-informed knowledge in guiding their practice. It further states that practitioners have an ethical obligation to “critically examine and keep current with emerging knowledge relevant to social work and fully use evaluation and research evidence in their professional practice” (5.02). Moreover, the Code of Ethics states that social workers have an ethical responsibility to provide services under informed consent. In other words, clients have a right to information about the purposes and risks of interventions so that they can engage in decisions about their own participation in interventions and exercise self-determination. The EIP process emphasizes transparency and information sharing with clients so that their preferences and values can be taken into account on balance with the research evidence and practitioner expertise. Clients who are educated about the research evidence can make better decisions about their own care – and can even advocate for funding or access to evidence-informed services.

1.8.1 What about Unethical Research?

      Some practitioners might find the idea of having research inform their practice distasteful due to their belief that research on human subjects is often unethical. Concern about research ethics is understandable in light of the times when research on human subjects could be carried out without scrutiny of their ethics. Such studies were not limited to the notoriously inhumane medical experiments conducted by Nazis during the Holocaust. For example, the Tuskegee syphilis study began in Alabama in 1932 and lasted several decades. In that study hundreds of poor Black male sharecroppers diagnosed with syphilis were not informed of the diagnosis. Instead, the researchers studied the progression of the disease without treating it, even after the discovery of penicillin as a cure (Jones, 1981).

      Later in the twentieth century additional research studies in America involving human subjects were criticized as unethical. The most notorious was Milgram's (1963, 1965) study of human obedience that examined people's willingness to harm others when following orders. Forty unwitting men were ordered to administer severe and potentially fatal electric shocks to unseen learners whenever the learner gave a wrong answer to a question. Although the shocks were not real, a danger sign and fake screams made the unwitting men think they were really hurting people. The men who followed the orders became extremely upset about what they had done, and some had seizures. Another, less notorious, study had its ethics criticized by the Dallas Morning News (1990). It was a federal welfare experiment that involved a control group of 800 employed poor people who were eligible to receive welfare. The study denied their benefits just to see how well they could live without the benefits.

In light of decades-old studies that have been criticized as unethical, is it reasonable for practitioners to want to avoid having unethical research studies inform their practice? You bet it is! Fortunately, these days it is very unlikely that the relevant studies that they would find would be unethical. That is due to the abundance of Institutional Review Boards (IRBs) that emerged in recent decades to approve or disapprove the ethics of proposed research studies involving human subjects. It is virtually impossible nowadays for a study involving human subjects to begin without first being approved by an IRB. The IRBs are virtually ubiquitous, and are affiliated with human service agencies, funding sources, and other organizations. IRB panelists can be zealous in meticulously scrutinizing the details of research proposals looking for ethically questionable procedures. Sometimes they might even be overzealous (Tufford et al., 2012). So, if you are vigilant in your concern about ethics, we applaud you. But we hope your vigilance will not prevent you from seeking research evidence to inform your practice.

      Having research evidence inform your practice decisions is a lot easier said than done. In Chapter 2, we examine various feasibility constraints practitioners face in trying to engage in the EIP process. We also examine the steps in the EIP process, and you will continue to see the importance of practice expertise and idiosyncratic client circumstances and preferences in that process. Nevertheless, you might be wondering whether engaging in the EIP process will have been a waste of time if your search finds no pertinent evidence. If so, consider the peace of mind you can feel knowing that at least you searched. Had you not searched, you would not know whether there is a better way to intervene with the people who need your help. Moreover, had you not searched, you would not know whether evidence exists implying that your intervention approach might be contraindicated, and perhaps even harmful, for those folks. Consider the pride you can feel as a compassionate professional who has left no stone unturned in trying to maximize your practice effectiveness.

KEY CHAPTER CONCEPTS

       Although the term evidence-informed practice (EIP) is new, its underlying ideas are quite old.

       One of the most important factors influencing service effectiveness is the quality of the practitioner-client relationship.

       EIP is a process for making practice decisions in which practitioners integrate the best research evidence available with their practice expertise and with client attributes, values, preferences, and circumstances.

       Some misconstrue EIP in an overly simplistic cookbook fashion that seems to disregard practitioner expertise and practitioner understanding of client values and preferences.

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