EBP Exchange – UMB School of Social Work

I was recently responding to an email sent to me by Harry Chaiklin, that included some snippets from a dance therapy list, in response to a query from AHRQ (the Agency for Healthcare Quality and Research) asking for information that might inform their attempt to identify practices that can be helpful for a range of health problems. [As an aside, the AHRQ list is organized by problems (e.g., ADHD) rather than by ESIs, as many lists are. The AHRQ website is at http://www.ahrq.gov/clinic/epcix.htm].

Anyway, although I won’t include all of that discussion, there are clearly issues related to the application of the EBP framework that apply to our curriculum decisions. I don’t have answers, but here are some of my reflections.  I hope others will chime in with their thoughts about using EBP processes and the available lists of ESI to guide our choice of courses and material taught within courses.  Here is my reply related to dance therapy–it could be about many other interventions.

This is a very important area for us, because we have lots of curriculum components that are similar to dance therapy—they have a long history of development with strong underpinnings that would argue for the logic of their success, but probably do not enough rigorous study to get into systematic reviews like those requested by AHRQ or get on the SAMHSA or NIJ or BLUEPRINT ESI lists.  (Without going to look for a systematic review on dance therapy, which is what I should do,  I’m going to proceed with this argument.) So, in the case of dance therapy, we know from basic scientific evidence that movement and exercise is related to changes in serotonin levels and in immune responses that are beneficial.  We know from basic scientific evidence that relaxation and concentration training—part of what is learned through dancing–help reduce impulsivity.  I am sure that there are many more pieces to the body of evidence that can help sustain a logic model that would serve to justify the use of dance therapy for at least some conditions.  Should we teach it, then? Should insurers pay for it, then?  Perhaps so.  Still, if the logic model is tight enough, and the basic science is good enough, then what prevents the accumulation of evidence to the point at which Dance Therapy can be added to the AHRQ list, for at least one of the conditions listed? The absence of such evidence surely cannot  mean that a topic shouldn’t be taught, but it makes the case for such a course harder to sustain when there is a competition of interventions.

 If we excluded all practices that are not approved by AHRQ or on one of the other governmental ESI lists, we would have a very short MSW program and do a lot of standing around in the field. So we only exclude interventions like Holding Therapy (based on attachment theory), that has killed children?  Or, do we have a higher standard and being to exclude interventions with minimal or no evidence and a weak logic model?  We haven’t begun this work, here, but it is a judgement we have to make every day in the MSW program and CPE—what should we continue to promulgate as important to know?

I have heard or read several comments suggesting that EBP is the flavor of the month or just a rehashed accountability or case evaluation or program evaluation strategy, from the past.  I know that this question has been addressed by Eileen Gambrill, a couple of years back, if anyone wants to find that work. (Gambrill E.D. (2003). Evidence-based practice: Sea change or the emperor’s new clothes? Journal of Social Work Education, 39, 3-23.  I am just lazy enough to want to write this short piece without going to find and read that piece  and will hope that my ideas are fresh. 

 In short, the major difference that I see is that this is a worldwide and transdisciplinary movement. We are not alone–or just working with psychologists, as we did in purusing single subject design and goal attainment scaling or some other innovations.  Whether we want it or not, we are part of a giant health services movement that we must be prepared to respond to.  My first major involvement with EBP was working with a county in CA that had folded Child Welfare Services under their Health Department and every program had to meet the same EBP-driven standards.  There are international resources (e..g, the Cochran Collaborative) which are very well funded and are having a significant impact. Certainly, some of the processes that Len Gibbs and others have developed for how to respond to cases within a EBP framework are very familiar and could be traced to many social workers who have built our capacity for scientific charity. What is VERY NEW, in my individual view, and is not going to lose or change flavor in a month, is the international infrascture in support of this direction of work, coupled with the IT infrastructure that makes the sharing of research information undeniably possible and, in some cases, very important.  Also beyond the tipping point is the collection of ESIs that has emerged after three decades+ of development–including a series of interventions that have evolved from social and cognitive theory, which began to emerge in the 1960s as an important and influential explanation for behavior with practical applications.  More generall, the explosion of health services research has called for a greater need to integrate findings to identify ESIs.  The combination of additional ESIs with the ability to synthesize them and make the findings known to providers (and clients) is reason for me to believe that this is going to be a productive area for a long time.

Below are PowerPoint presentations from the February 8, 2007 Research Brown Bag Seminar held at the UMB School of Social Work.  The presentations addressed the topic, “Conducting Research To Create Evidence for Social Work Practice.” 

Rick Barth, PhD:  Terms for Research Presentation  |  CDC Definition of Terms  (e-mail the presenter)

Diane DePanfilis, PhD:  Quantitative Methods for Developing Evidence for Social Work Practice   (e-mail the presenter)

Debbie Gioia, PhD:  Qualitative Methods for Developing Evidence for Social Work Practice  (e-mail the presenter)

Charles Smith, PhD: Synthesizing Research to Summarize the Evidence for Social Work Practice   (e-mail the presenter)

Joan Zlotnik, PhD:  Evidence Based Practice(s): A Response  (e-mail the presenter)