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Clinical Social Work: Introduction to EBP Literature

Steps of EBP

1. Convert one's need for information into an answerable question

2.  Track down the best clinical evidence to answer that question

3. Critically appraise that evidence in terms of its validity, clinical significance, and usefulness

4. Integrate this critical appraisal of research evidence with one's clinical expertise and the patient's values and circumstances

5. Evaluate one's effectiveness and efficiency in undertaking the four previous steps, and strive for self-improvement

From: Thyer, B. A. (2006). What is evidence-based practice? In A. B. Roberts and K. Yeager (Eds.) Foundations of evidence-based social work practice (p. 35-46). New York: Oxford

Creating an Answerable Question

Constructing an "answerable" question is the first step of EBP.

The COPES Model

  • Client type and problem: How would I describe a group of clients of a similar type?
  • What might you do?: Apply a treatment; act to prevent a problem; measure to assess a problem; survey clients; screen clients to assess risk.
  • What is the main alternative?: Alternate course of action
  • What do you want to accomplish?: Outcome of treatment or prevention? Valid measure? Accurate risk estimation, prevented behavior, accurate estimation of need

The PICO Model

  • Patient, Population or Problem: What are the characteristics of the patient or population? What is the condition or you are interested in?
  • Intervention or Exposure: What main intervention are you considering?
  • Comparison: What is the alternative to the intervention?
  • Outcome: What are the relevant outcomes or desired resolution?

Levels of Evidence

Different types of research demonstrate stronger or weaker levels of evidence, in order: 

  • practice guidelines and manuals, 
  • systematic reviews and meta-analyses
  • randomized control trials and other quantitative studies
  • qualitative studies and clinical experience

The pyramid organizes these types of research in order of strength, but also makes note of the difference in the amount of research available. For example, while systematic reviews and meta-analyses provide strong sources of evidence to answer a clinical question, there are quite a bit fewer of these resources than the more common quantitative research article. 

illustration of ebp pyramid, hierarchy of evidence

Robin A. Paynter, (2009) "Evidence-based research in the applied social sciences", Reference Services Review, 37 (4), pp.435 - 450.