WK7 Part 2 Evidence based practice is essential to effective social work practice.

WK7 Part 2 Evidence based practice is essential to effective social work practice. You are required to (a) identify a current practice problem relevant in your current agency (LGBTQ+ Community Center) (i.e., working with resistant clients, engaging clients when they don’t talk much, having negative perceptions about your client, counter transference, etc.), (b) after identifying your practice problem, conduct an extensive literature search as it relates to your practice problem that provides you with a complete understanding of the practice problem.
Based on your findings in the literature, what did you discover that will help you address your practice problem? How might your research guide your work in your field agency? After reviewing the literature/research and comparing it to the practice problem, the student is expected to do the following:
By Day 7
Submit a 1-2 pages that:

Briefly discusses the literature
Briefly identifies the practice problem (The agency has been closed the past year due to COVID-19 AND clients are having a hard time opening up to counselors over the phone & zoom because they prefer in person sessions)
Briefly explains how the literature will be used to address the practice problem while engaging in the agency. 79

Families in society: the Journal of contemporary social services
©2013 alliance for children and Families
issn: Print 1044-3894; electronic 1945-1350

2013, 94(2), 79–84
Doi: 10.1606/1044-3894.4283

Evidence-based practice or Evidence-guided practice:
A Rose by Any Other Name would Smell as Sweet
[Invited Response to gitterman & knight’s “Evidence-
guided practice”]
Bruce a. thyer

Gitterman and Knight (2013) expand upon the original model of evidence-based practice (eBp) by proposing an

approach they label evidence-guided practice (eGp). they justify this by highlighting some supposed limitations of

the original eBp model and by presenting some additional features to amend eBp into eGp. i attempt to show that

the limitations they say characterize eBp are not actually a part of the real eBp model and are based upon either a

misreading of the eBp literature, or by overlooking some of the features of eBp. i also try to demonstrate that most

of the add-on elements to eBp they propose to label eGB are actually already present in the original model of eBp.

one of their add-ons, an increased reliance upon formal theory as evidence, in addition to empirical research, seems

to me a retrograde step and will perpetuate the harmful influence of some aspects of theory in social work practice.

However, i judge their eGp model to be an improvement upon current social work practice, which largely tends to

ignore empirical research findings to assist in decision making.

i
t is encouraging to see such distinguished social workers
as Alex Gitterman and Carolyn Knight (2013) address the
issue of evidence-based practice (EBP), try and identify

some of the shortcomings of EBP, and propose some con-
structive improvements for the model of EBP, resulting in
a related perspective they label “evidence-guided practice”
(EGP). In their article I find a number of points about EBP
and its supposed limitations that have appeared in the social
work literature, as well as a number of new ideas. Their goal
is admirable—to improve upon the practice models which
can promote social workers’ efforts to improve practice
outcomes. I share this goal and it is in this spirit that I will
try and address what I believe to be some misconceptions in
their presentation of EBP—misconceptions which, once cor-
rected, demonstrate that EBP already possesses most of the
features of their proposed alternative, evidence-guided prac-
tice. It goes without saying that I appreciate their willingness
to engage in this dialog, as well as the invitation from the
co-editors of Families in Society to author this response. It
is worth noting that the first article introducing the topic of
evidence-based practice to a social work audience appeared
in this journal (Gambrill, 1999).

to begin my response in a simplified manner, it seems
to me that gitterman and Knight (2013) make some
claims about the model of ebP and say it is associated
with certain limitations or undesirable features, which
i will generically call features abC. They propose their
alternative model, egP, which is said to possess the
more desirable attributes of features XYZ. What i will
try and do in this response is to demonstrate that the
undesired features abC said to characterize ebP, are
actually not a part of the ebP model. Moreover, i will try
and demonstrate that the desired features XYZ are ac-

tually already present in ebP. Thus, there is no need for
any modification or amplification of ebP as it is pres-
ently construed in the primary sources of information
about this practice model.

Undesired Features Said to be Associated
with Evidence-based practice

evidence-based proponents argue that social
workers should base their practice decisions on a
critical review of available intervention strategies
for particular client’s challenges and difficulties. the
intent is to identify and employ those techniques
that have been found to help an individual, family,
or group with a specified problem. the social
worker selects the most relevant, empirically verified
approach. (gitterman & Knight, 2013, p. 70)

This misrepresentation asserts that the social worker
selects the intervention based on the research evi-
dence. There is no apparent role for client input or
consideration of other factors, such as environmental
considerations. in reality, ebP is much more holistic
than that. so that the reader has a clear understand-
ing of what ebP really is, i provide the definition pub-
lished originally in Evidence-Based Medicine (now in
its fourth edition):

evidence-based medicine (ebM) requires the
integration of the best research evidence with our
clinical expertise and our patient’s unique values
and circumstances….by patient values we mean the
unique preferences, concerns and expectations each

http://crossmark.crossref.org/dialog/?doi=10.1606%2F1044-3894.4283&domain=pdf&date_stamp=2018-05-03

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patient brings to a clinical encounter and which
must be integrated into clinical decisions if they are
to serve the patient….by patient circumstances we
mean their individual clinical state and the clinical
setting. (straus, glasziou, richardson, & haynes,
2011, p. 1, emphasis in original)

understanding this definition of real ebP is cru-
cial to avoid any implication that ebP is only about
research evidence. it is equally about client values,
expectations, and circumstances. research does not
trump these other considerations—they are all equally
and compellingly important. This is largely ignored in
presentations on ebP which appear in the social work
literature and convey the impression that in ebP one
merely selects the best supported treatments. This is a
massive distortion and its repetition is likely respon-
sible for some of the resistance to this approach.

since the professions of social work and medicine
have different functions, social work’s renewed
reliance on medical tenets is puzzling. (gitterman &
Knight, 2013, p. 71)

This is the hoary canard that ebP is a medical model.
it is not. it originated in medicine, but is itself atheo-
retical with respect to etiology (biological or psychoso-
cial), neutral with respect to who provides the services
(physicians versus social workers), and neutral with
respect to what those services should be (e.g., biologi-
cal or psychosocial). in contrast, the medical model
asserts that a given condition has a biological etiology,
interventions are focused on biological interventions
such as drugs or surgery, and the service providers
should be physicians. ebP possesses none of these fea-
tures of the medical model. ebP is a broadly scientific
model but its origins in medicine need no more imply
adherence to a medical model than the use of split-plot
factorial studies in social work research means that
one is following an agricultural model (from whence
r. a. fisher derived this type of experimental design
in statistical science). The disciplinary backgrounds of
the founders of a model need have no direct bearing on
that model’s applicability to social work. ebP is being
widely adopted across all the health care and human
service professions because of its utility in operation-
alizing a more scientific approach to practice, not be-
cause it is somehow intrinsically medical.

evidence-based practice proposes that specific
interventions exist to solve most types of problems,
and social workers can find them and then use the
most effective—the “best”—intervention. (gitterman
& Knight, 2013, p. 71)

no, ebP requires one to search the current best litera-
ture to find out what methods of assessment and inter-
vention possess the greatest amount of scientific sup-
port. There is no a priori assumption that the answer
already exists, only the mandate that one seek out the
available evidence. and there is no assertion that one
must use the “best” evidence, if the most promising in-
terventions are somehow unsuitable. amputation of the
hands of convicted thieves might effectively deter na-
scent criminals from stealing, but the ethics and laws
of our country prohibit cruel and unusual punishment.
if a client is clinically depressed, the research might
well indicate that cognitive behavior therapy (Cbt) is
a well-supported treatment. if, however, the client was
intellectually disabled and unable to comply with the
self-monitoring and homework exercises required of
Cbt, the evidence-based social worker may suggest an
intervention less well-supported. a practitioner can still
adhere to the original ebP model while not offering the
best research-supported interventions if there are con-
flicting or counterproductive ethics, client preferences
and values, or environmental considerations present.
This flexibility is inherent in the approach.

Complex social problems do not lend themselves
to narrow and discrete interventions that are the
foundation of evidence-based practice. (gitterman &
Knight, 2013, p. 71)

it depends. sometimes complex social problems require
complex interventions, and sometimes they respond
well to simple interventions. ebP lends itself equally well
to simple as well as complex interventions. Witness the
large amount of work being undertaken in the field of
social policy using the traditional ebP model (boruch,
2012; bogenschneider & Corbett, 2010; Vanlandingham
& drake, 2012) and the fine work of the Coalition for ev-
idence-based Policy (see http://coalition4evidence.org).
a review of the completed systematic reviews available
on the websites of The Campbell Collaboration (http://
www.campbellcollaboration.org) and The Cochrane
Collaboration (http://www.cochrane.org) reveals many
examples of complex health and social problems (e.g.,
the effectiveness of welfare-to-work programs) which
have been extensively investigated using high-quality
research studies. What alternative to evidence-based
practice do we have to tackle complex social problems?
The status quo?

evidence-based social work practice emphasizes
studies that typically involve brief, cognitive, and
skill-focused interventions…less straightforward,
harder-to-measure problems and interventions are
excluded. (gitterman & Knight, 2013, p. 71)

http://coalition4evidence.org

http://www.campbellcollaboration.org

http://www.campbellcollaboration.org

http://www.cochrane.org

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similar complaints have been registered with respect
to the application of randomized controlled trials
(rCts) in general. if the advocates of longer term and
more complex interventions fail to undertake cred-
ible evaluations of their own methods, whose fault is
that? are we surprised that a new model such as ebP
is initially explored with simpler practice issues rath-
er than more complex ones? There is a natural pro-
gression to the types of intervention research studies
needed to investigate the effectiveness of treatments,
usually from simpler to more complex problems, in-
terventions, and environments. This can take many
years. but it is being done.

There is nothing with the original model of ebP to
preclude more complex studies. in any event, this sup-
posed limitation is being overtaken by events since
rCts, meta-analyses, and systematic reviews are being
conducted on complex problems and interventions. to
illustrate, the december 2011 issue of the Clinical Social
Work Journal contains a number of articles discussing a
widely cited meta-analysis of the effectiveness of long-
term psychodynamic psychotherapy. see also rosebor-
ough, Mcleod, and bradshaw (2012) for an innovative
social work outcome study on psychodynamic psycho-
therapy, and drisko & simmons (2012) for a compre-
hensive survey of the evidence base for psychodynamic
psychotherapy. ebP places no limitations on the types
of problems investigated or interventions tested. if an
intervention can be applied, its outcomes can be evalu-
ated. if client functioning can be validly measured, the
potential impacts of intervention can be assessed. More
complex interventions and problems increase the diffi-
culty of the task but they do not preclude it.

the realities of contemporary social work practice
work against a purely evidence-based orientation.
Most social workers simply do not have access
to bibliographic databases and the peer-reviewed
literature, both of which are required to practice
from an evidence-based foundation…practicing
social workers lack the skills and expertise necessary
to operate from an evidence-based foundation.
(gitterman & Knight, 2013, p. 72)

The increasing ease of access to these databases and
literature is rendering this point moot. Much useful
information is available via open-access electronic
sources (see, for example, gary holden’s wonderful
resource information for Practice, available at http://
ifp.nyu.edu/); government-maintained websites, such
as the national registry for evidence-based Programs
and Practices, supported by the substance abuse and
Mental health services administration (see http://
www.nrepp.samhsa.gov); and the national Coalition
for evidence-based Policy, cited above. greater num-

bers of colleges grant library access privileges to their
alumni. at one point, office computers were said to be
too expensive to be made widely available for use by
social workers. time took care of that problem. The
problem of limited access to the research literature is
similarly being taken care of. regardless, this limita-
tion is one that is shared with gitterman and Knight’s
alternative, egP, which also requires access to such da-
tabases and literature.

it is embarrassing and limiting for us to assert that
our graduates lack the skills and expertise necessary to
operate from an ebP perspective. again, if true, whose
fault is this? are social workers any less intelligent or re-
search-trained than, say, nurses, public health workers,
or other largely bachelor’s- and master’s-level profes-
sions which have widely adopted ebP? We have barely
begun focusing our professional training in the research
skills needed to effectively engage in ebP (shlonsky,
2009)—namely how to formulate answerable questions
(gambrill & gibbs, 2009), track down the best available
literature (rubin & Parrish, 2009), critically analyze it
(bronson, 2009), apply any lessons learned to our work
with our own clients, and evaluate our effectiveness in
carrying out ebP. instead, we teach a wide array of re-
search methods with little connection to those needed
to carry out ebP (e.g., how to conduct a survey study),
in lieu of how to conduct outcome research on our own
practice—a crucial skill needed for ebP.

Desired Features Said to be Associated with
Evidence-guided practice

We intentionally use the term evidence-guided to refer
to an approach to practice in which interventions
are suggested, rather than prescribed, by research
findings…it also recognizes the uniqueness of the
individual and the inherent dignity and worth of
the person. evidence-guided practice reinforces
client empowerment and clients’ right to self-
determination…it adopts an ecological view of client
problems and worker interventions. (gitterman &
Knight, 2013, p. 72–73, emphasis in original)

Yet, these features are also true of ebP. The evidence in
ebP is only used as a guide, and taken into account when
considering clients’ preferences and values, professional
ethics, and clinical and environmental circumstances.
it only takes a reading of the primary sources describ-
ing ebP to realize this. for example, here is what the
founder of the term evidence-based medicine, gordon
guyatt, asserted as central to this model:

as a distinctive approach to patient care, ebM
involves two fundamental principles. first, evidence
alone is never sufficient to make a clinical decision.

http://www.nrepp.samhsa.gov

http://www.nrepp.samhsa.gov

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decision makers must always trade the benefits
and risk, inconvenience and costs associated with
alternative management strategies, and in doing so
consider the patients values. (guyatt & rennie, 2002,
p. 8, emphasis added).

Knowing the tools of evidence-based practice
is necessary but not sufficient for delivering the
highest quality of patient care. In addition to clinical
expertise, the clinician requires compassion, sensitive
listening skills, and broad perspectives from the
humanities and social sciences. these attributes allow
understanding of patient’s illnesses in the context
of their experience, personalities and cultures…for
some of these patients and problems, this discussion
should involve the patient’s family. for other
problems-attempts to involve other family members
might violate strong cultural norms. (guyatt &
rennie, 2002, p. 15, emphasis added)

understanding and implementing the sort of
decision-making process patients desire and
effectively communicating the information they
need requires skills in understanding the patient’s
narrative and the person behind that narrative…
Most physicians see their role as focusing on health
care interventions for their patients….they focus on
individual patient behavior. However, we consider
this focus too narrow….Physicians concerned about
the health of their patients as a group, or about the
health of the community, should consider how they
might contribute to reducing poverty (guyatt &
rennie, 2002, p. 16, emphasis added)

any presentation of ebP that solely focuses on ap-
plying research evidence to make important practice
decisions and ignores the unique features of indi-
vidual clients or larger societal or contextual issues
is either a mischaracterization, a misunderstanding,
or uninformed.

unlike evidence-based practice, egP explicitly
recognizes relevant theory. theories, as well as
research, provide significant guidelines for practice….
evidence-guided practice reflects…a solid grounding
in theory. (gitterman & Knight, 2013, p. 74)

This is a legitimate observation, but i consider the
atheoretical nature of ebP to be a strength, not a limi-
tation to this approach. although nothing in the ebP
model precludes a judicious consideration of relevant
theory as possibly pertinent to one’s searching for evi-
dence, in terms of helping to make practice decisions
it posits a decided preference for relying on sound
data-based studies in lieu of theoretical conceptualiza-

tions. Though there is nothing as practical as a good
theory, there is also nothing as harmful as a bad one
(Thyer, 2012). Many theories in social work have been
and are actively injurious to practitioners and clients.
They waste our time, most are not well-supported
empirically, and many have led to the development
of interventions which do not work and in some cas-
es are harmful. give me a good empirical study over
theoretical speculation any time. given how academic
social work has traditionally prized theory develop-
ment and extension (Thyer, 2002), i suspect that the
relative lack of focused attention on theory in ebP is
a source of much resistance to this model, as it flies in
the face of some our most cherished views. Yet egP
provides no guidance on how to select theory—surely
all theories are not equally valid? ignoring this issue
leaves the field wide open to every wildly speculative
conceptualization proposed by someone. We now have
social workers being taught reiki (using one’s hands to
realign a client’s supposed invisible body energies) by
our academic programs (i am not making it up), as if it
were a legitimate model of practice for our field. Why?
because it is an appealing theory to some.

When social workers rigidly adhere to prescribed
interventions, they are unable to be authentically
present or actively listen to clients’ verbal and
nonverbal responses. [gitterman and Knight go on to
critique the use of practice manuals.] (gitterman &
Knight, 2013, p. 75)

first off, practice manuals and guidelines are an en-
tirely different model of practice than ebP, having pre-
ceded it by many years. There is nothing in the ebP
literature that elevates practice manuals above any
other form of evidence; rather, manuals would still
need to be located, critically reviewed, and used only if
the evidence is sufficiently supportive. ebP is actually
rather suspicious of practice guidelines, since so many
of them are of poor quality. for example, straus et al.
(2011) note:

While substantial advances have been made in the
science of guideline development, less work has been
done to enhance the implementability of guidelines.
often, recommendations lack sufficient information
or clarity to allow clinicians, patients, or other
decision-makers to implement them. and guidelines
are often complex and contain large numbers of
recommendations with varying evidential support,
health impact and feasibility of use in practice and
decision making…ideally, guidelines should include
some mentions of values, who assigned these values
(patient derived or author derived) and whether
they came from one source or many sources. the

Thyer | Evidence-Based Practice or Evidence-Guided Practice: A Rose by Any Other Name Would Smell as Sweet

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values assumed in a guideline, either explicitly or
implicitly, may not match those of our patient or our
community. (pp. 128–129)

are gitterman and Knight correct in their cautions
about the role of practice guidelines and treatment
protocols? indeed, and in doing so they share views
identical with those of ebP and reservations which i
have expressed elsewhere (Thyer, 2003).

Summary

it is very important that social workers who wish to
learn more about evidence-based practice take the
time to read the original sources on this innovative
and influential model. Much of the social work litera-
ture on ebP relies on second- and third-hand inter-
pretations. sackett, straus, richardson, rosenberg,
and haynes (2000); straus, glasziou, richardson, and
haynes (2011); and guyatt and rennie (2002) are good
places to begin.

it is particularly important to recognize that ebP is
independent from, and has nothing to do with, other
similar-sounding initiatives (Thyer & Myers, 2011),
such as the empirically supported treatment (est)
initiative of division 12 (society of Clinical Psychol-
ogy) of the american Psychological association, or
the empirical clinical practice model developed within
social work (Jayaratne & levy, 1979). Yet ebP is often
confused with the est model which does rely solely
on lists of “approved” treatments for various disorders,
or upon the earlier and continuing practice guideline
movement which describes intervention protocols for
clients with various conditions. ebP does not designate
any treatment as “evidence-based.” doing so would
elevate the research elements of the model above the
other equally important ones, such as clinical exper-
tise, client’s personal values, expectations, and situa-
tion. as i have written earlier, there are no such things
as evidence-based practices (Thyer & Pignotti, 2011).
nowhere in the primary ebP literature will you find
lists of approved treatments or practice guidelines, yet
this is the common conception of the model and one
seemingly shared by gitterman and Knight. abandon
this misconception, carefully read the real ebP liter-
ature, and you will find that it shares almost all the
features proposed by gitterman and Knight in their
evidence-guided practice model.

eileen gambrill, who introduced to the concept of
ebP into the social work literature (1999), has recently
used the phrase evidence-informed practice in lieu of
ebP, in part due to her concern that the phrase evi-
dence-based inadvertently perpetuates the misconcep-
tion that ebP ignores other nonresearch factors in ar-
riving at decisions (gambrill, 2010; gambrill & gibbs,

2009). now gitterman and Knight suggest the term
evidence-guided practice, in part for the same reason.
good luck with that. The ebP train has left the station
and it will prove very difficult to amend this crucial
phrase. however, it makes little difference to me, ebP
or egP, so long as the five steps of the original ebP
model (straus et al., 2011) are adhered to, perhaps with
some additions. i believe that this is the case with git-
terman and Knight’s practice model. With apologies
to William shakespeare, let me close by paraphrasing
Juliet from Romeo and Juliet:

o ebP, ebP! wherefore art thou ebP?
deny thy father and refuse thy name;
’tis but thy name that is my enemy;
thou art thyself, o, be some other name!
What’s in a name? that which we call a rose
by any other name would smell as sweet;
so ebP would, were he not ebP call’d,
retain that dear perfection which he owes
Without that title. ebP, doff thy name;
and for that name, which is no part of thee,
take all myself.

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bruce A. Thyer, phD, lCsW, professor, Florida state University. Cor-
respondence: Bthyer@fsu.edu; College of social Work, Florida state
University, 296 Champions Way, tallahassee, Fl 32306.

…