What is Evidence-Based Practice?
Evidence-Based Practice in the child welfare sector has been defined as:
● Best Research Evidence
● Best Clinical Practice
● Consistency with Family and Client Values
The above components are those delineated by the California Evidence-Based Clearinghouse for Child Welfare. But what does this mean? What is evidence-based practice really? What is the evidence and how are these practices implemented?
Simply speaking, evidence-based practices (EBPs) are a reference to using research evidence to provide the best available services, whether we are referring to medical, behavioral, therapeutic or social services. Both the Institute of Medicine and the American Psychological Association refer to the integration of the best available research and clinical expertise.
How is this evidence obtained?
A practice or program is labeled “evidence-based” after a lengthy process of establishing, by scientific means and peer review, that a practice or program really works, i.e. that it makes a statistically significant difference in outcomes. National and international governmental organizations and practitioner associations develop the criteria ratings for determining that a practice is evidence-based or meets other high standards. Programs that are under study for being termed evidence-based are theory-based and rigorously experimentally tested, whenever possible with randomized control groups. The results of these studies are then reported in peer-reviewed journals where they are open for discussion, criticism and for attempts to reproduce the findings under similar conditions.
The most stringent criteria have been applied and met by programs that may be variously labeled as Model Programs, Evidence-Based Programs, Exemplary Programs. Practices or programs that have received these dseignations rise far above those achieved by less rigorous methods. These programs have been extensively researched, published and are yielding highly reproducible and excellent results.
Less stringent criteria may have established that an evolving program or practice appears to be successful. These practices may variously be labeledPromising Practices, Emerging or Evidence-Informed Practices or Supported Practices. Occasionally this class of programs may be termed as yielding “practice-based evidence.” Promising and Emerging or Evidence-Informed Practices may, in time and with sufficient supporting research and peer review, become Evidence-Based, Exemplary or Model Programs.
How is an Evidence-Based Practice implemented?
A central point in scientific methods that are subject to peer review is the reproducibility of results. This same concept applies to evidence-based practices in the social sciences and child welfare sector. In order to be sure of achieving the results seen in an evidence-based practice or program, the practice or program must be implemented precisely as it was studied. Changes to the practice or program, even changes such as language used in a program, or adaptations for specific cultures and ethnicities, will all have to be studied further in order to be sure they yield the same result as the actual evidence-based practice model. This is essential to understanding EBPs. You cannot alter the practice or program and expect the same results or even say that you are still practicing the same evidence-based practice. Thankfully, especially in the social welfare sector, many practices and programs may have already been adapted for different cultures, languages and circumstances. These adaptations may already be considered Promising Practices, or Evidence-Informed Practices, based on studies of the adapted material. You can find more information about Implementation of evidence-based practices at the National Implementation Research Network and the Colorado Implementation Collaborative.
What is Fidelity and How Does It Relate to EBPs?
One of the vital factors in continuing to achieve success when an evidence-based practice has been implemented is making sure that the practitioners remain true to the practice model. This is called fidelity. Drifting from the implemented practice model may occur naturally in any practice or clinical setting. This same drift or loss of fidelity, however, may cause a loss of efficacy, or the lack of achieving the expected or desired results. Most evidence-based practice models recommend that organizations practicing EBPs have regular assessments to make sure that they are adhering to the practice design and initial implementation. You can read more about fidelity in EBPs at ChildWelfare.gov
FAQs about Evidence-Based Practice
Is there a difference between Evidence-Based Practices and Evidence-Based Programs?
While the two terms are often used interchangeably, strictly speaking an evidence-based program is a multi-component program in which linked core components are associated with specific and clearly identifiable outcomes. An evidence-based practice, in contrast, might be a single core component of an evidence-based program. In this light, the term practice may refer to a core group of techniques that have been studied, peer-reviewed and shown to yield desired outcomes, hence evidence-based practice.
Can you take interesting components of an Evidence-Based Model Program combine them into a different practice and still say your program is Evidence-Based?
No, you cannot. Again, for a program or practice to be truly evidence-based, it is being implemented in its entirety, as designed and without changes. You cannot employ components of a practice in a piecemeal fashion and expect to get the same results as all the years of study have suggested for an evidence-based practice.
Aren’t EBPs expensive and hard to implement?
While EBPs may take a bit more work to implement with fidelity, the fact that they yield consistent, and consistently better, results than alternative programs means that in the end they are more cost effective programs. Additionally, most EBPs will have well established resources to aid in implementation, from manuals to experienced trainers. These resources make it easier to train staff in EBPs and provide a basis for well-constructed and well-timed trainings that will aid practitioners in adhering to the EBP program.
For an excellent discussion of evidence-based practice in greater detail, we can also recommend Child Trends Research to Results briefs on the topic: