Bellamy, J. L., Mullen, E. J., Satterfield, J. M., Newhouse, R. P., Ferguson, M., Brownson, R. C., & Spring, B. (2013). Implementing evidence-based practice education in social work: a transdisciplinary approach. Research on Social Work Practice, 23(4), 426-436. doi: 10.1177/1049731513480528

Implementing Evidence-Based Practice Education in Social Work: A Trans-disciplinary Approach

JENNIFER L. BELLAMY

University of Chicago

BONNIE SPRING

Northwestern University

EDWARD J. MULLEN

Columbia University

JASON M. SATTERFIELD

University of California, San Francisco

ROBIN P. NEWHOUSE

University of Maryland

MOLLY FERGUSON

Northwestern University

Acknowledgments:

Supported in part by contract N01-LM-6-3512, Resources for Training in Evidence-Based

Behavioral Practice, awarded by the National Institutes of Health Office of Behavioral and

Social Science Research to Dr. Spring, Northwestern University.


Abstract

Evidence based practice (EBP) is reflected in social work publications, accreditation standards, research, and funding opportunities. However, implementing EBP in social work practice and education has proven challenging, highlighting the need for additional resources. This paper describes the Transdisciplinary Model of EBP, a model based on advances in EBP across health disciplines including and its application to the development of an online EBP training portal. Utility of the Transdiciplinary Model and a training portal for social work education is discussed. Also included is a description of the training modules, the Council on Social Work Education Educational Policy and Accreditation Standards competencies reflected in the modules, and a case example using the modules in a master’s of social work course.


Introduction

The influence of evidence-based practice (EBP) is increasingly reflected in social service funding mandates and policies as well as social work educational standards and scholarship. The demand for EBP from social workers is particularly strong for those working in health and behavioral health services. Social workers provide a large proportion of mental health, substance abuse, medical and public health services in the United States (Bureau of Labor Statistics, U.S. Department of Labor, 2011), and there is an ever-growing arsenal of effective behavioral health interventions available in these areas of practice (The Campbell Collaboration, 2011; The Cochrane Collaboration, 2011). Furthermore, technological advances have facilitated the identification, synthesis, and dissemination of information about effective interventions.

Despite these pressures, opportunities and advances the implementation of EBP in usual practice has proved challenging. One valuable strategy to advance the use of EBP in the social work profession is to equip new and practicing social workers with the knowledge and skills to identify, assess, and apply research in practice. Unfortunately, studies of EBP education in social work highlight the limited and inconsistent integration of EBP content in social work education and the challenges associated with preparing social workers to use EBP in the field (Rubin, 2011; Rubin & Parrish, 2007; Woody, D’Souza & Dartman, 2006; Weissman et al., 2006 & Wike, Bledsoe, Bellamy & Grady, in press).

In this paper we present the Transdisciplinary Model (TM) of Evidence-Based Behavioral Practice (EBBP) and its potential to support EBP training and education in social work education (Satterfield et al., 2009). The Transdisciplinary Model was designed to increase the coordination of evidence-based behavioral health training, communication, research, and practice across allied health disciplines including: social work, psychology, medicine, nursing, public health. Toward that end, this model has been applied to develop a flexible web-based training portal (EBBP.org) that can be used as a tool to advance EBP training in social work. We describe the Transdisciplinary Model and the EBBP.org training portal as well as the correspondence between the training content provided by this portal and the competencies required by the Council on Social Work Education (CSWE) Educational Policy and Accreditation Standards (EPAS) (2008). Finally, we provide an example and an assessment of the use of this web-based training portal in a master’s level social work research course and discuss other possible applications in social work education.

Background and Significance to the Field

EBP Training in Social Work Education

EBP for social work involves the integration of science-based assessments and interventions while taking into account client and community preferences and available resources in order to improve the health of individuals and populations. Efforts to use research to inform social work practice have a long history. EBP represents a contemporary effort to bridge the long standing research practice gap (Howard, McMillen & Pollio, 2003; Rubin, 2007; Rubin & Parrish, 2007). Efforts to integrate EBP content into social work education are reflected in recent changes to CSWE accreditation standards, which place greater emphasis on training in the use of research in practice (CSWE, 2008). Numerous presentations on EBP are delivered at the CSWE Annual Program Meeting and the Annual Conference of the Society for Social Work and Research (SSWR), and a growing number of EBP textbooks and other training materials have been created for social work educators (e.g. Council on Social Work Education, 2011; Danya International Inc., 2008, Rubin, 2007, Mullen, 2010a; Shlonsky & Gibbs, 2004).

Despite efforts to infuse social work education with EBP training, existing research suggests that the integration of EBP and evidence-supported interventions into classroom and field instruction has been limited and varied (Rubin, 2011; Rubin & Parrish, 2007; Woody, et al., 2006; Weissman et al., 2006 & Wike et al., in press). These studies suggest that few schools of social work formally endorse, emphasize, or require training in interventions with a strong evidence-base. Although research courses are part of the core social work curriculum, the EBP process does not appear to be prominent in social work training programs (Wike et al., in press).

One of the reasons for this lack of emphasis on EBP may be social work educators’ attitudes toward EBP. Scholarship in the field has reflected debates and doubts as to the use of EBP in social work practice (e.g. Mullen & Streiner, 2004; Mullen, E. J., 2010b). Frequently discussed concerns include a loss of provider autonomy, lack of respect for clinical judgment in practice, use of EBP language to deny needed services and reduce costs, and limited research evidence for intervening with some social work problems and populations. Even some proponents of EBP express doubt that social work educators can accept EBP as an approach to practice, given these negative perceptions (Roberts & Yeager, 2006; Walker, Briggs, Koroloff, & Friesen. 2007). However, recent studies suggest that social work faculty and administrators have generally positive attitudes toward EBP (Rubin, 2007; Bledsoe et al., in press). The limited uptake of EBP into social work education suggests the presence of other barriers, many of which also impede the teaching of EBP in allied disciplines (Bilsker & Goldner. 2004; Straus, Richardson, Glasziou, & Haynes, 2005).

One barrier to the integration of EBP into social work education is the existing faculty’s lack of knowledge and skills necessary to teach EBP. For example, a 2007 survey of social work faculty revealed that respondents had varied definitions of EBP and uncertainties about how to use evidentiary hierarchies to judge the quality of research evidence (Rubin, 2007). EBP is a relatively new framework for social work practice and education. Because EBP is a relatively new approach to practice, many faculty and instructors who teach at schools of social work may not have had formal training in EBP. Others do not have doctoral level research training. A dearth of expertise in EBP may particularly characterize relatively small schools that lack doctoral programs or a strong research focus (Bledsoe et al., in press). Moreover, many schools of social work employ adjunct faculty instructors to teach courses in social work practice; and very likely these instructors have even more varied training in EBP and research than faculty. Furthermore, social work education extends beyond the classroom and into the field. Field supervisors and social service agencies that provide an essential and large component of social work training may not have the necessary resources and knowledge to support students’ training in the application of EBP in social service contexts (Edmond, Rochman, Megivern, Howard, & Williams, 2006; Mullen, Bellamy, Bledsoe, & Francois, 2007). The nature of field placement training received by social work students reflects the range of EBP-related attitudes, resources, and behaviors of their supervisors (Edmond, et al., 2006). Given the variation across faculty, instructors’, and field supervisors’ attitudes, knowledge, skills and comfort with EBP, the EBP training experiences that students receive are likewise widely variable.

EBP Training Models in Social Work

Promising training models have emerged to increase social work practitioners’ positive attitudes, knowledge, and ability to implement EBP (Bellamy, Bledsoe, Mullen, Fang, & Manuel, 2008; Bledsoe, et al., in press; Coomarasamy & Khan, 2004; Glisson, Dukes, & Green, 2006; Manuel, Mullen, Fang, Bellamy, & Bledsoe, 2009; Parrish & Rubin, 2011). Many models were created chiefly for practicing professionals and involve partnerships with social work researchers or continuing education classes. In general, studies of these training models suggest that social work practitioners can be motivated to engage in EBP and can learn the basic steps of the EBP process (Bellamy, et al., 2008; Parrish & Rubin, 2011). Less research is available to inform the integration of EBP education models into undergraduate and graduate social work training programs (Edmond, et al., 2006; Howard, et al., 2003; Rubin, 2011; Rubin & Parrish, 2007).

EBP Training Across Disciplines

Although existing training models in social work are promising, they are also limited because they are discipline-specific. Social workers employed in multi-disciplinary environments may find that the language, models, and approaches to EBP in which they are trained differ from that of their colleagues in other health disciplines. These differences could lead to difficulties in coordination and communication efforts across disciplines. The demand for and the difficulty in implementing EBP in practice is not specific to social work. Allied professionals in behavioral health care are also facing demands to implement EBP. They are likewise striving to develop strategies to increase the use of EBP in their respective fields. Each major health profession (i.e., medicine, nursing, public health, psychology) has focused on building their evidence base for practice (APA, 2006; Brownson, Baker, Leet, & Gillespie 2010; Greiner & Knebel, 2003; Gray 1997; Mullen, Bledsoe, & Bellamy, 2008; Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996; Spring & Hitchcock, 2009; Spring & Neville, 2010; Stetler, 2001; Straus, et al., 2005; Titler et al., 2001). Unfortunately, advances in EBP are not easily shared across disciplines. Social work and allied professionals are collaborators in practice, but the development of research and training materials have historically remained profession-specific. Each discipline has specific knowledge and strengths that could contribute to other discipline’s training in EBP, but there has been an absence of interprofessional EBP education (Newhouse & Spring, 2010), thereby hampering efforts to move effective practices into team-based community care (Brekke, Ell & Palinkas, 2007). The development of a shared EBP vocabulary and conceptual foundation would facilitate collaboration in interprofessional research and practice. This more cohesive approach would be to the ultimate benefit of the broader field of behavioral health care and the clients served by it.

Existing barriers to interprofessional science and practice include dissimilar academic language,training, culture and knowledge formation, as well as profession-specific experiences. A common base of training and tools is needed to access, critically appraise, and iteratively apply the research evidence generated by each discipline. Establishing a common framework and forum to synergize the knowledge and perspectives of each discipline represents an important step toward facilitating interprofessional communication and understanding.

Development of the Transdisciplinary Model of EBBP and EBBP.org

In 2006, the National Institute of Health’s Office of Behavioral and Social Science Research (OBSSR) commissioned Bonnie Spring to create the Resources for Training in Evidence-Based Behavioral Practice (EBBP) project. The goal of the project is to bridge the gap between behavioral research and practice by harmonizing and upgrading the EBP approach across health professions. The EBBP Project team is comprised of a multidisciplinary Council, Scientific Advisory Board, Practitioner Advisory Council (PRAC), and a panel of expert consultants. The Council for Training in Evidence-Based Behavioral Practice includes representative experts from medicine, nursing, psychology, public health, and social work. Using a team science approach ( www.teamscience.net ), the EBBP Project identifies training gaps and creates learning resources to facilitate research to practice translation across disciplines. Professionals from the major health disciplines are collaborating to learn, teach, and implement EBP through the training project’s website ( www.ebbp.org ). In addition to training tools, the Council has collaborated to create the Three Circles of EBBP conceptual model as well as a description of competencies needed for EBBP, both of which are described next.

Conceptual Model

The Transdisciplinary EBBP Model integrates advances made within EBP models for social work, nursing, medicine, public health, and psychology while attempting to address remaining deficiencies (Figure 1).

[Insert Figure 1 Approximately Here]

Earlier discipline-specific EBP models upon which the Transdisciplinary Model builds as well as a full description of the model are described in a previous publication emanating from the EBBP.org project (Satterfield, et al, 2009). We use the term transdisciplinary (as opposed to multidisciplinary or interdisciplinary) to refer to an approach to EBP that moves beyond collaboration with or coordination between disciplines and reflects both a shared integrative conceptual framework of EBP and a common EBP skill set (Choi & Pak, 2006). The model is grounded in an ecological framework. As such it reflects an emphasis on shared decision-making among professionals and with clients, as well as the use of EBP across policy, public health, and direct client care decisions. This framework includes environmental and organizational factors, creating a cultural context that facilitates the acceptability of an intervention, its feasibility, and the balance between fidelity and adaptation needed for effective implementation. As part of the transdisciplinary approach, each discipline has contributed to important contextual lenses to the process – e. g. nursing practice with its focus on coordination of care, organization, governing policies, purchasing agreements and affiliations that modify the feasibility of practice recommendations; social work incorporating attributes of the client and community environment into the plan of care; and public health’s focus on policy enactment through organizations and communities. The best available scientific evidence is one of the three circles with evidence defined broadly so as to incorporate the various disciplinary perspectives and values.

Practitioner expertise features prominently in the model. Practitioner expertise includes four components: competence in performing the EBP process, assessment, communication and collaboration, as well as engagement and intervention (Spring & Neville, 2010). EBP process skills involve proficiency in the 5 steps of the EBP process, or the five “A’s”: 1) (Ask) formulate answerable practical questions, 2) (Acquire) acquire relevant evidence, 3) (Appraise) appraise evidence for quality and relevance, 4) (Apply) apply the evidence via shared decision-making that also integrates client characteristics and resource considerations, and 5) (Analyze and Adjust) analyze outcomes and make adjustments as appropriate. Assessment skills designate competency in the appraisal of clients and communities as well as the appraisal of one’s level of expertise to implement and evaluate the outcome of a needed behavioral health service. Communication and collaboration skills entail the ability to convey information clearly, and to listen, observe, and adjust to achieve understanding and agreement on a course of action. Engagement and intervention skills involve, at a minimum, proficiency at motivating interest, constructive involvement, and positive change from stakeholders.