EVIDENCE-BASED PRACTICE & PRACTICE GUIDELINES©

General Course Information         

Instructor Information

EDWARD J, MULLEN

Willma & Albert Musher Chair Professor

School of Social Work

Columbia University

1255 Amsterdam Ave

New York, New York 10027    

E-mail: ejm3@columbia.edu

Prerequisites

This course is a 7 week social work practice course offered to students in their final semester of the two year master’s of social work program. This course satisfies one of the two fourth semester practice elective requirements. The course is open to doctoral students and other students within the University with the instructor’s permission.

Course Objectives

This course aims to introduce practitioners to principles of evidence-based practice and policy, practice guidelines, and information utilization for practice modeling. Increasingly, social work practitioners and policy analysts are presented with new information about recent findings from research and professional consensus statements regarding best-practices and practice guidelines. This information pertains to practice assessment, intervention and the evaluation of outcomes. Social work agencies, accrediting and standard setting organizations, and funding bodies both pubic and private are encouraging social workers to engage in best-practices using guidelines and to provide evidence of cost-effective outcomes. However, as autonomous practitioners, social workers are expected to make judgments about this evidence and to individualize services rather than to adopt this new information uncritically, out-of-context and on a wholesale basis. This course focuses on preparing students to engage in evidence-based practice, providing the skills needed to critically evaluate new information that is available from research findings and professional consensus statements. Furthermore, the course provides skills for integrating this new information into the students own, personalized approach to practice. The general process of assessing and integrating new information into an individual practitioner’s approach to practice is called personal practice modeling.

The specific objectives are to:

• Introduce students to evidence-based practice
• Introduce students to practice guidelines including how guidelines are developed and structured
• Provide students with skills needed to develop and revise personal practice models incorporating evidence from research and experience
• Provide students with opportunities to begin to form a personal practice model by specifying one or more evidence-based, practical, practice relevant questions and examining evidence pertaining to the questions

Expected Outcomes:

Upon completion of the course, students should have:

• Learned the steps of evidence-based practice
• Developed skills for critically assessing evidence and practice guidelines
• Gained knowledge about major internet sources for locating practice and policy relevant evidence in the U.S. as well as in other countries
• Develop skills for developing and evaluating personalized practice guidelines

Method of Instruction

The course will be conducted as a seminar. Readings and internet sources will be assigned pertaining to each topic. The sessions will be used to critically discuss the readings. In addition the class sessions will provide assistance to each student in the formulation of practice problems, search strategies, and evaluation methods.

Assignments & Method of Evaluation

In addition to the reading and internet assignments students will submit a final paper. The final paper will present the student’s practice questions formed during the course, including:

• One client oriented, practical, evidence-search (COPES) question for each of the five types (effectiveness, prevention, assessment, descriptive, risk)
• Search plan and search history forms for each of the five questions
• Results of the evidence search and evaluation process
• Resulting guidelines in the form of a beginning personal practice model for a specialized area of practice of choice

This paper should be no more than 10 pages, double spaced and written according to APA format. The course grade will be based on work conducted during the class sessions (50%) and the final paper (50%).

Bibliography

Required text

Gibbs, L. E. (2003). Evidence-based practice for the helping professions: A practical guide with integrated multimedia. Pacific Grove, CA: Brooks/Cole-Thompson Learning.

Recommended readings

Brief Treatment and Crisis Intervention, 2004, 4(numbers 2&3). Special issues on evidence-based policy and practice.

Gray, J. A. M. (2001). Evidence-based healthcare (2 ed.). New York: Churchill Livingstone.

Roberts, A. R., & Yeager, K. R. (Eds.). (2004). Evidence-based practice manual: Research and outcome measures in health and human services. New York: Oxford University Press.

Roberts, A. R., & Yeager, K. R. (Eds.). (2006). Foundations of evidence-based social work practice. New York: Oxford University Press.

Rosen, A., & Proctor, E. (Eds.). (2003). Developing practice guidelines for social work intervention: Issues, methods, and a research agenda. New York: Columbia University Press.

Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005). Evidence-based medicine: How to practice and teach EBM (3rd ed.). Edinburgh: Churchill Livingstone.

Additional Relevant Readings:

Gambrill, E. (1999). Evidence based practice: An alternative to authority-based practice. Families in Society: The Journal of Contemporary Human Services, 80, 341

Gambrill, E. Evidence-based practice and policy: Choices ahead. Research on Social Work Practice. May 01, 2006; 16: 338-357.

Gambrill, E. Social work: An authority-based profession. Research on Social Work Practice. Mar 01, 2001; 11: 166-175.

Gibbs, L.E., & Gambrill, E. (2002). Evidence-based practice: Counterarguments to objections. Research on Social Work Practice, 12, 452-476.

Gilgun, J. F. The four cornerstones of evidence-based practice in social work. Research on Social Work Practice. Jan 01, 2005; 15: 52-61.

Howard, M. O., McMillen, C. J.,  & Pollio, D. E. Teaching evidence-based practice: Toward a new paradigm for social work education. Research on Social Work Practice. Mar 01, 2003; 13: 234-259.

Mullen, E. J., Bellamy, J. L., & Bledsoe, S. E. (2007). Best practices. In T. Mizrahi & L. Davis (Eds.), Encyclopedia of Social Work (20 ed.). New York: Oxford University Press.

Mullen, E. J., Bellamy, J. L., & Bledsoe, S. E. (2007). Evidence-based social work practice. In R. M. Grinnell & Y. A. Unrau (Eds.), Social Work Research and Evaluation: Quantitative and Qualitative Approaches (8 ed.). New York: Oxford University Press.

Mullen, E. J., & Streiner, D. L. (2004). The evidence for and against evidence based practice. Brief Treatment and Crisis Intervention, 4(2).

Proctor, E. K. (2004). Leverage points for the implementation of evidence-based practice. Brief Treatment and Crisis Intervention, 4(3).

Shlonsky, A., & Gibbs, L. (2004). Will the real evidence-based practice please stand up? Teaching the process of evidence-based practice to the helping professions. Brief Treatment and Crisis Intervention, 4, 137-153.

Thyer, B. A. (2004). What is evidence-based practice? Brief Treatment and Crisis Intervention, 4(3).

Howard, M. O. & Jenson, J. M. Clinical practice guidelines: Should social work develop them? Research on Social Work Practice. May 01, 1999; 9: 283-301.

Internet Resources

• The Social Care Institute for Excellence in the UK has a web site for social work and social care publications at http://www.scie.org.uk/ . At that site the data base called Social Care Online provides access to publications.
• The Campbell Collaboration web site includes access to systematic reviews of social work interventions (as well as in education and criminal justice) at http://www.campbellcollaboration.org/ .
• A national workshop on teaching evidence-based practice in social work was held at the University of Texas at Austin. The prepublication papers for that workshop are available at: http://www.utexas.edu/ssw/ceu/practice/articles.html . This set of papers is a major resource since the papers were authored by most of the key players in social work education for EBP. These will be published in a special issue of Research on Social Work Practice (fall 2007).
• A wide range of evidence-based policy and practice readings and internet resources may be found at the instructors web site:  http://www.columbia.edu/cu/musher/evidence-based%20practice%20reference%20list.htm

Class Session Outline

Session 1

Topic:

Introduction to Evidence-based Practice, Policy & Guidelines

Class Plan:

• This session will provide an introduction to core ideas defining evidence-based practice, policy, & guidelines.
• Students will be introduced to how evidence-based methods can help practitioners form personal practice models which can be used to provide guidance in future practice situations.
• Readings and internet resources will be reviewed.
• The class will watch an example of evidence-based practice, namely, the Hospital Interactive Team Thinking exercise (HITTT) provided on the text’s accompanying CD-ROM. This video, recorded on an active Neurosciences Ward at Luther Hospital in Eau Claire, Wisconsin, demonstrates the steps of evidence-based practice.

Assignments Due:

Students will complete a brief questionnaire pertaining to initial knowledge and practices.

Required Readings:

Gibbs, L. E. (2003). (Chapter 1).

Mullen, E. J., & Streiner, D. L. (2004)

Recommended Readings:

Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005).(Introduction)

Gray, J. A. M. (2001). (chapters 1 & 2)

 Session 2

 Topic:

Forming questions of importance to your client’s welfare & making decisions about services

Class Plan:

The evidence-based practice & policy process begins with a policy or practice question which is of practical importance to a problematic situation that you are facing. This session examines how such questions can be formed from your practice or policy experience. Evidence-based practice requires motivation to engage in such practice as well as organizational support.

During this session students will be asked to:

• Write down and then report the reasons why they are motivated to use evidence-based practice
• Write down and then report what organizational qualities they would require so that they could engage in evidence-based practice
• Write down and then report a COPES question based on their current field work experience (specifying which type of question it is - effectiveness, prevention, assessment, description, risk/prognosis; and, how the question incorporates each of the four elements required for a COPES question - population/problem, action contemplated, alternative action considered, and result sought).

At the end of this class students should have:

• Gained knowledge about how to formulate COPES questions
• Gained clarity about their motivation for using evidence-based practice
• Gained understanding of some of the organizational supports needed by those attempting to engage in evidence-based practice
• Specified in writing at least one COPES question for use in next session’s assignment, namely, planning and conducting an electronic search.

Assignments Due:

Students should begin to formulate a practice or policy question of relevance to their field work experience. These questions can be used by the class throughout the remaining sessions so as to gain experience in following the evidence-based practice & policy process.

Required Readings:

Gibbs, L. E. (2003). (chapters 2 & 3)

Recommended Readings:

Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005). (chapter 1)

Gray, J. A. M. (2001). (chapter 3)

 Session 3

Topic:

Locating evidence to answer your question

Class Plan:

Following formulation of a practice question of importance to policy or practice the next step is to locate relevant evidence by searching internet sources as well as published and unpublished reports of evidence.  This session introduces some proposed methods for conducting such searches as well as some of the more useful sources with special attention to internet-based sites which publish systematic reviews, meta-analyses, guidelines, reviews of assessment instruments, and individual research study reports.

Assignments Due:

• Begin to think about how you will conduct a search for evidence to answer your question.
• What sources will you use?
• What search terms will you use?
• How will you record your findings?

Prior to this session each student should:

• Write down at least one COPES question based on their field work experience that can be used for today’s session
• Based on the readings for today’s session plan a search strategy to answer the COPES question
• Attempt to implement the search using electronic databases
• Be prepared to report all of the above to the class so as to facilitate peer-based learning.

• Students should feel free to write this down as a handout and/or to use the internet during class to demonstrate a search. Remember that searches do not need to result in location of research findings that answers the COPES question. Failure to find supporting evidence is also a valuable result of a search since in such cases you will be able to conclude that there is no evidence to support a contemplated action (assuming the search has been carried out well).

Required Readings:

Gibbs, L. E. (2003).(chapter 4)

Recommended Readings:

Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005). (chapter 2, card 8B)

Gray, J. A. M. (2001). (chapter 4, appendices 1, 2, 3)

Course bibliography list of internet sites :

·        Students are advised to become familiar with the various internet sites commonly used to search for evidence. These are listed in the readings as well as on the bibliography.

·        Each of the required and recommended books has internet sites with evidence sources listed.

·        Students are advised to access the internet sites through the University library web site since the University subscribes to most electronic databases. Accordingly, registered students have free access so long as these sites are accessed through the University.

Session 4

Topic:

Evaluating the evidence about effectiveness of interventions

Class Plan:

This session examines practical ways that can be used to evaluate the quality, importance, and relevance of the evidence that is presented in reports of research studies found in the search for evidence. Common measures used in evidence-based evaluations are introduced such as for:

• Sensitivity
• Specificity
• Statistical significance
• Effect size
• Absolute risk reduction
• Number needed to treat
• Number needed to harm
• Odds ratios
• Estimates oonfidence intervals.

Assignments Due:

Students should evaluate the evidence found in their respective searches using some of the techniques reviewed in this session.

Required Readings:

Gibbs, L. E. (2003).(chapter 5)

Recommended Readings:

Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005) (chapter 5)

This books web site has excellent resources providing simple explanations of some of the technical methods used to assess evidence (e.g., number needed to treat, odds ratios, risk).

Gray, J. A. M. (2001). (chapter 6, appendix 3)

 Session 5

Topic:

Systematic reviews & meta-analysis

Class Plan:

The most comprehensive way to gather evidence about a policy or practice question is to locate systematic reviews of relevance to the question.

Systematic reviews are comprehensive “reviews” of all available research pertaining to a topic area that meet specified criteria.. They are conducted according to explicit, rigorous search processes and evaluation methods.These reviews summarize findings, assess the quality of the evidence, and, at times, propose policy or practice guidelines thought to flow from the review. Learning how to locate and evaluate systematic reviews is central to evidence-based policy and practice. This session examines the systematic review process, including meta-analysis (which is a quantitive method used to combine results from more than one study).

Assignments Due:

Students should search for systematic reviews and meta-analyses pertaining to their respective questions.

Required Readings:

Gibbs, L. E. (2003). (chapter 6)

Recommended Readings:

Borenstein, M., & Rothstein, H. (2006). Comprehensive meta-analysis: A computer program for research synthesis. Englewood, NJ: Biostat, Inc. http://www.meta-analysis.com/ (Browse for future use)

Cooper, H. & Hedges, L.V. (Eds). (1994). The handbook of research synthesis. New York: Russell Sage Foundation.

Higgins J. P. T. & Green S., (editors). Cochrane handbook for systematic reviews of interventions. 4.2.5 [updated May 2005]. In: The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd. (Available on-line at: www.cochrane.org/resources/handbook/).

Lipsey, M. W. & Wilson, D. B. (2001) Practical meta-analysis. Thousand Oaks: Sage.

Mullen, E. J. (2006). Choosing outcome measures in systematic reviews: Critical challenges. Research on Social Work Practice, 16(1)

National Health Service Centre for Reviews and Dissemination. (2000). Undertaking systematic reviews of research on effectiveness. York, England: University of York. (Available at: http://www.york.ac.uk/inst/crd/report4.htm).

Session 6

Topic:

Evaluating assessment & risk studies

Class Plan:

In addition to questions pertaining to the outcomes of interventions social work practitioners and policy analysts have questions about how to evaluate the needs and conditions of individuals, groups, and communities so as to plan prevention and treatment interventions. This session examines some ways to evaluate the studies:

·        Relevance

·        Reliability

·        Validity

·        Utility

·        Applicability of such measures.

Assignments Due:

Students should formulate an assessment question and use some of the methods discussed in this class to critically appraise research evidence pertaining to the assessment question.

Required Readings:

Gibbs, L. E. (2003). (chapter 7)

Recommended Readings:

Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005). (chapter 3)

Gray, J. A. M. (2001). (chapter 8)

Session 7

Topic:

Student Presentations & Formulation of Beginning Personal Practice Models

Class Plan:

The last class will provide each student with opportunity to present the results of their work over the semester. Over time an evidence-based practitioner and policy analyst will find answers to many questions. The results of these numerous searches for evidence, the evaluations of the evidence, and the identification of action plans (guidelines) would be wasted if not organized in a manner suitable for future use and future revision-refinement. Student presentations should include three inter-related ways that previously collected evidence can be preserved and refined for future use.

1. Formulation of guidelines
2. Evaluating data in practice about the use of guidelines
3. Formulating personal practice models as retainers of this work.

Assignments Due:

The final assignment is due at the end of this class. The final assignment should be a personal practice model incorporating the one, two, or more questions and evidence examined during the course of this class. It is a beginning personal practice model (only a modest beginning).

Required Readings:

Gibbs, L. E. (2003). (chapter 9)

Mullen, E. J., & Bacon, W. F. (2003).

Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005).(chapters 7 & 9)