Evidence-Based Practice
Vikki Vandiver, Dr.P.H., M.S.W.

What is Evidence-Based Practice?

Evidence-based practice (EBP) as we know it today emerged from the field of evidence based medicine (EBM) whose origins can be traced back to 19 th century France. The concept originated in the field of physical health with the idea that for medical conditions a specific set of practices properly administered would ensure the greatest likelihood of recovery for the patient. The mental health field has begun the process of scientific evaluation to identify evidence-based practices within the last 25 years.

Definitions of Evidence-based Mental Health (EB-MH)

• services or interventions offered to individuals with mental illness that have demonstrated outcomes in multiple research studies ;
• process of utilizing a continuum of empirical and non-empirical databases (e.g., research studies, systematic review and practice guidelines) to guide interventions that foster client change;
• use of treatments for which there is sufficiently persuasive evidence to support their effectiveness in attaining desired outcomes;
• strategy for clinicians and clients to select from the corpus of available evidence the most useful information to apply to a particular client who has sought services;
• use of clinical interventions for a specific problem that have been 1) evaluated by well-designed clinical research studies, 2) published in peer-reviewed journals and 3) consistently found to be effective or efficacious upon consensus review;
• blending of the best researched evidence and clinical expertise with patient values;
  
  Sources: Vandiver, 2002; Roberts & Yeager, 2004; IOM, 2001.

Principles of EBP-MH

Principle of Assessment Driven Intervention: When a mental health intervention is derived from the evidence-based practice literature, treatment effectiveness is likely to be enhanced. The best evidence will be of questionable value if the problem is incorrectly assessed, framed, or the diagnosis is inaccurate.

Principle of Right to Informed and Effective Treatment: The principle of a right to informed and effective treatment is a core principle in the social work field. Consumer and family members have a right to information about effective treatments and, in clinical areas where evidence based practice exists, have a right to effective services (Moore, 2003; Thyer, 2004)

Goals of EBP-MH:

• Increase the empirical basis and effectiveness of clinical practice by helping clinicians and clients select the most accurate, valid information derived from the best available methods
• To help clients realize their own strengths to diminish or alleviate symptoms or state of being that cause discomfort through the acquisition of behavioral change strategies (Dziegielweski, 2002)

 Strategies for Practice

• Let the assessment be the guide to selecting the appropriate diagnosis which in turn will lead to the selection of the best intervention;
• Use information from multiple sources (e.g., systematic reviews, practice guidelines, and expert consensus guidelines) to determine the most appropriate interventions;
• If no guideline is available for a particular diagnostic category (e.g., schizoaffective disorder), then review the professional literature for cutting edge research or practice articles for applying evidence-based knowledge to practice.
• Remember, EBP ’s are guides and will never substitute for sound clinical, ethical and professional judgement that is culturally relevant (Vandiver, 2002)

EBP Continuum: From research-based to non research-based to promising

The following section describes the continuum of “evidence” that is the conventional guide for most mental health practitioners, researchers, and policy makers. These levels are developed from a wide range of sources and are meant to be a guide. They do not represent a single federal agency or academic center (Vandiver, 2006).

• Level 1: Systematic reviews using meta-analyses or two randomized controlled clinical trials (RCT). Highest level of evidence. Where to Go: http://www.cochrane.org/reviews (The Cochrane Collaboration); http://www.campbellcollaboration.org (Campbell Collaboration - Social Welfare)
• Level 2: No meta-analyses but one RCT or national consensus panel. Second highest level of evidence. Where to Go: American Journal of Psychiatry, Supplements; Ex. Practice Guidelines for the Treatment of Schizophrenia
• Level 3: Quasi-experimental; uncontrolled trial or observational study; expert consensus; descriptive studies. Less rigorous research. Where to Go: http://www.psychguides.com for Expert Consensus Guidelines
• Level 4:Anecdotal case reports; unsystematic clinical observations; descriptive reports; single subject designs. Non-research based but practical. Where to Go: Journal: Psychiatric Services: Case Report Column
• Level 5: Clinical opinion only; studies without comparison groups; no consistently positive measured outcomes; not research based. Where to Go: Practitioner Magazine: The Family Networker
• Level 6: Consistently poor outcomes for a particular population; intervention may be research based but is applied to the wrong population. Where to Go: your family lawyer for legal advice on impending lawsuit
• Level 7: Emerging Best Practices or Promising Practices are those that have not been subject to rigorous research methods but that could be undergoing research review, have strong clinical utility, are liked by clients and families and are deemed culturally competent. Where to Go: http://www.modelprograms.samhsa.gov