Transcript Slide 1

THE USE OF EVIDENCE IN MENTAL HEALTH PRACTICE:
AN ANALYSIS OF PILOT STUDY DATA.
Tracy C. Wharton, M.Ed., Doctoral Student, University of Alabama School of Social Work;
MSc Candidate, Evidence Based Social Intervention, Oxford University
In an extensive review of the literature, one theme that emerged is that
little, if any, literature addresses specifically how practitioners are accessing,
interpreting, and applying evidence that is available to them and/or whether
they are able to adapt information that may be contextually based elsewhere
or in different populations. There was a notable dearth of information
regarding how available evidence is actually interpreted and contextualized by
practitioners, particularly given the current environment of global and instant
access to information, not all of which is either applicable or even similar to
the context in which the practitioner may be embedded (a concept known as
“proximal similarity”).
The purpose of this study was to pilot test a survey instrument to be
used for the purpose of exploring this topic. Research questions framed the
survey to explore views and barriers of social work practitioners related to
the use of evidence and evidence-based practice.
Methodology & Analysis
An internet based survey was used for this research. The survey contained 4648 questions, depending on responses, including five open-ended questions. This
study was designed to be a pilot study of the survey instrument which might be
used in dissertation research. The survey was available on Survey Monkey from
December 2007 to March 2008. A $1 donation was made to the NASW Charitable
Fund for each participant.
Descriptive data was produced using SPSS for all variables, and crosstabs were
used to examine the effects of variables on one another. Narrative data was coded
using Atlas.ti, and an open coding scheme was used.
Recruitment
Snowball sampling was used for this research. Eighty-eight invitation emails
containing the hyperlink to the survey were sent out by direct email. Forty handouts
were given out in person at the SSWR conference. A week after the initial emails,
reminder emails were sent. Reminders were sent again at one month. A copy of the
invitation email was posted to the researcher’s Facebook page, and to the message
board of two Facebook social work groups. This text was the same for all emails,
posts and handouts.
Highlights from the results of the pilot study
A total of 84 people went to the web page and initiated the survey, and a total
of 61 people completed all primary questions, for a 73% completion rate. Response
rates ranged from 61 to 84 people throughout the survey, as respondents were able
to skip questions, return to them later, pause or quit the survey at any time.
Respondents were 73% female, 88% from the USA, 77% white, mostly licensed
practitioners of social work, with Master’s degrees (58%); 55% had no additional
formal training beyond their degree, and 58% belong to a professional organization.
Research Questions
Since this is an exploratory study, research questions were framed
that would allow for a broad exploration of gathered information,
without expectations related to specific hypotheses. Research questions
were based on findings from previous literature and the domains in
Plath’s (2006) model (See Figure 1).
•What do social work practitioners consider as “evidence” appropriate
for practice?
•What are the barriers that practitioners encounter in accessing
research evidence?
•Is their work environment oriented towards evidence-based practice?
•What are the views of social work practitioners of evidence-based
practice?
The researcher would like to acknowledge the support of the Center
for Mental Health and Aging Summer Fellowship program, 2008.
“Evidence-based practice holds the social worker accountable for activities and funding;
however, many times mental health cannot be measured that easily. It puts a huge strain on the
practitioner to show results quickly. So… it’s a double-edged sword.” –anonymous study
participant
Consistent with previous findings that
training may provide some skills linking
research to practice, data seem to
indicate that practitioners with graduate
degrees are more likely to self-identify
as evidence-based practitioners than
those who have undergraduate degrees.
Similarly, respondents practicing in
evidence oriented settings, such as
medical settings, were less likely than
those in other settings to respond
negatively to evidence based practice
models. Those in non-profit settings
were much more divided on this issue,
echoing the continuum suggested in the
literature.
Plath’s model offers an integrated view of practice and environment, where
factors are closely interrelated to one another. Findings from this survey seem to
support the model. Factors that contribute to the personal, professional, political, and
interpersonal domains of practice were endorsed by respondents, and seem to suggest
that practitioners may use each of these domains as a contributing factor to practice
decision making.
Respondents regularly consume research, particularly by attending ongoing
trainings and conferences. Most respondents search the internet for information
regularly, through publicly available web sites such as WebMD and Google Scholar.
Their work environments supported education and ongoing training. They are able to
access peer reviewed research on the internet, as well as through other sources, such as
print materials available through mail subscriptions or libraries. Comments throughout
the survey indicated that access to research material and time to read that material may
be barriers to some practitioners, although quantitative survey responses did not support
this assertion.
Data suggest low frequency of database access (such as the Cochrane or Campbell
Collaboration databases). It is unclear the extent to which practitioners have the skills to
identify peer-reviewed literature, and the extent to which they are able to access
rigorously obtained information and screen out less valid material.
Although respondents indicated that a significant number consider
themselves as evidence-based practitioners, substantial numbers of them are not
asked to justify their intervention choices by their supervisors.
Responses to open-ended questions in this survey trended towards a mention of
both positive and negative aspects of the EBP movement. There was an overwhelming
indication that practitioners recognize expertise as something that comes from field
experience, as well as research or education experience, and that research knowledge
alone was insufficient to call oneself an expert in practice-related matters.
Very few respondents aligned with the current procedural/process orientation
currently being discussed in the social work literature. This is notable, as it suggests a
disconnect between the academic discussion about EBP and the realities of
implementation, where practitioners have a view that seems to be more technical than
process oriented.