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  Management
  Alternatives Pty Ltd
  ABN 23 050 334 435

 

 

 


4. Key questions

When thinking about evidence based practice some of the key questions are:

  • What do we want evidence about?
  • What is best evidence?
  • How do we generate and disseminate best evidence?
  • How do we ensure best evidence is used in practice?

What do we want evidence about?

The ‘what’ of much of evidence based practice is interventions. For example ‘does this medication get this result’?

In human services there are many ‘whats’ that we require best evidence about including:

a) Society and people
Evidence for understanding society, people and issues

b) Local community
Evidence for understanding the local community and local issues

c) Processes for working with complex adaptive systems
Evidence for the effectiveness of processes of working with complex adaptive systems (eg work with families, community development processes and organisational change processes).

d) Our practice
Evidence about our practice (eg systematic analysis of casework data).

e) Practice interventions
Evidence for the effectiveness of specific interventions (eg using ‘Circle of Security’ in preschools)

f) Reflective practice
Evidence for practitioners using reflective practice in using the evidence in a) to e) above (eg supervision, peer consultation, etc).

What is best evidence?

There is not agreement across professions about what is best evidence.

Within the medical evidence based practice framework a typical hierarchy of evidence is:

1. multiple randomized controlled trials (RCT), preferably large ones, suitably meta-analysed
2. at least one properly designed RCT of appropriate size
3. well-controlled trials without randomisation
4. well-designed cohort or case control studies
5. multiple time series or dramatic results from uncontrolled experiments
6. opinions of respected authorities based on clinical evidence, descriptive studies or expert committee
7. small uncontrolled case series and samples

(Stevens and Abrams (2001) Consensus, reviews and meta-analysis: an Introduction in Stevens A (2001) Methods in evidence based healthcare and health technology assessment: an overview p 368)

This hierarchy of evidence is focused on evidence of results from specific interventions.

While this framework is useful in healthcare and health technology and has had a significant impact on thinking about evidence based practice more generally it is not the most appropriate evidence based model for working with people in social interventions.

In social interventions there are other 'whats', for example understanding the local community, understanding processes for working with complex adaptive systems, etc.

These 'whats' require different kinds of evidence. Many 'whats' in social interventions are not specific interventions for which randomised control trials or other similar experiments are appropriate for generating the evidence required.

What constitutes best evidence needs to be considered in the light of:

  • What are we wanting evidence about?
  • In what context?
  • For what purpose?

In many situations the typical hierarchy of evidence used in a medical evidence based practice framework will not be appropriate.

How can we generate and disseminate best evidence?

In human services the generation of best evidence will include all the key players:

  • Service organisations (including clients, staff and managers)
  • Peak organisations
  • Research organisations (including Universities)
  • Funding bodies
  • Government (policy makers)

In Australia there is a significant gap in the strategic generation and dissemination of best evidence in relation to human services.

How can we ensure best evidence is used in practice?

To ensure that best evidence is used in practice there need to be organisational processes and practitioner processes in place.

Some of the organisational processes include:

  • Developing policy which includes the theoretical frameworks that underpin service models and the state of knowledge in relation to interventions
  • Collecting and analysing relevant data that can be used in reflecting on practice and developing further knowledge about practice
  • Putting in place processes to reflect on practice and validate professional judgments
  • Developing a research agenda and relevant partnerships to generate knowledge

Some of the practitioner processes include:

  • Being motivated to do evidence based practice
  • Converting information needs related to practice decisions into questions that can be answered with appropriate evidence
  • Finding the best evidence with which to answer these questions
  • Critically appraising the evidence
  • Applying the results to the practice decisions
  • Evaluating the above .