When thinking about evidence based practice some of the key questions are:
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
b) Local community
c) Processes for working with complex adaptive systems
d) Our practice
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:
(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:
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:
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:
Some of the practitioner processes include: