Social work theory · Volume G: Knowledge, Ethics & Professional Practice

Evidence-informed practice

Evidence-informed practice is an approach to professional decision-making that integrates the best available research evidence with professional judgement, the values and preferences of service users, and the circumstances of the practice context.

1. What it is

Evidence-informed practice is an approach to professional decision-making that integrates the best available research evidence with professional judgement, the values and preferences of service users, and the circumstances of the practice context. It developed from evidence-based practice (EBP), which began in medicine, and the two terms are often used interchangeably. Many social work writers now prefer “evidence-informed” because it signals that research informs judgement without dictating it (Nevo & Slonim-Nevo, 2011). Evidence-informed practice is a professional framework for decision-making. It is not a theory of human behaviour, and it can be used with any practice theory or method. Its epistemological assumptions are discussed in G1.

Origins in evidence-based medicine (Sackett et al.). Evidence-based medicine emerged at McMaster University in Canada in the early 1990s. Sackett et al. (1996) defined it as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. They stressed that it integrates individual clinical expertise with the best external evidence, and later added patient values as a third component (Sackett et al., 2000). The approach set out a sequence of steps: pose an answerable question, search for evidence, appraise it critically, apply it with the patient, and evaluate the outcome.

Eileen Gambrill and EBP in social work. Gambrill (1999) introduced EBP to social work as an alternative to authority-based practice, in which decisions rest on tradition, consensus, popularity or the status of the person making them. She argued that clients have a right to be informed about the evidence for and against proposed services. Gambrill (2006) linked EBP closely with critical thinking, including the habit of questioning claims and recognising errors in reasoning. Gambrill also stressed the ethical side of EBP: offering services of unknown effectiveness without disclosing that uncertainty compromises informed consent. Gibbs and Gambrill (2002) responded to common objections, arguing that many criticisms rested on misunderstandings of the approach.

The hierarchy of evidence and its critics. EBP traditionally ranks evidence in a hierarchy, with systematic reviews and randomised controlled trials (RCTs) at the top, followed by observational studies, case series and expert opinion. The hierarchy reflects the strength of each design for answering questions about whether an intervention works. Petticrew and Roberts (2003) argued that different questions require different kinds of evidence. Qualitative research, for example, is better suited to questions about acceptability, meaning and process. Critics in social work note that RCTs are often difficult or unethical in social care, and that complex interventions in varied contexts may not suit experimental designs (Webb, 2001).

Integrating research, professional judgement and service-user knowledge. Evidence-informed practice treats three sources of knowledge as necessary. Research evidence indicates what has worked for whom under what conditions. Professional judgement, including practice wisdom and knowledge of the local context, determines how evidence applies to a particular person. Service-user knowledge, grounded in lived experience, provides understanding of what matters, what is acceptable and what has helped (Glasby & Beresford, 2006). Australian writers have argued that integration depends on organisational support as well as individual effort (Plath, 2006).

Practice-based evidence. Practice-based evidence reverses the direction of EBP by gathering evidence systematically from routine practice. Barkham and Mellor-Clark (2003) argued that outcome data collected in everyday services complement trial evidence, because they show how interventions perform with typical clients in real settings. In social work, practice-based evidence includes routine outcome measurement, single-case evaluation and practitioner research.

2. Historical development

EBP grew from clinical epidemiology and the movement to make medical decisions more transparent and accountable. It became a distinct framework because it offered a defined process for finding and applying research to individual decisions. Its spread to social work, psychology and public policy was supported by systematic review organisations and by policy interest in “what works”.

Social work’s engagement has been mixed. Some scholars saw EBP as a way to protect clients from ineffective or harmful services and to strengthen the profession’s credibility (Gambrill, 1999). Others argued that it imported a positivist model that ignored values, context and the complexity of social problems (Webb, 2001). The term evidence-informed practice emerged partly as a compromise that retains commitment to research while recognising professional judgement and service-user knowledge (Nevo & Slonim-Nevo, 2011).

3. Practical guidance

Evidence-informed practice can be built into routine work.

• Ask answerable questions. Frame practice questions clearly, for example: for adolescents leaving residential care, what supports improve housing stability (Sackett et al., 2000)?
• Use trustworthy summaries. Systematic reviews from the Cochrane and Campbell Collaborations, and Australian clearinghouses, save time and reduce bias.
• Appraise evidence critically. Consider study design, sample, context and whether outcomes matter to service users.
• Match evidence to the question. Use trials for questions of effectiveness and qualitative studies for questions of experience and acceptability (Petticrew & Roberts, 2003).
• Bring service users into the decision. Share what the evidence suggests, including uncertainty, and incorporate the person’s values and preferences (Gambrill, 2006).
• Collect practice-based evidence. Use routine outcome measures and review progress with the client to check whether an intervention is working (Barkham & Mellor-Clark, 2003).
• Acknowledge gaps in the evidence. Where research is weak or absent, say so. Draw on practice-based evidence and sound theory, and monitor outcomes closely.
• Consider cultural fit. Interventions tested with non-Indigenous populations may need adaptation, or may be less appropriate than community-led approaches for Aboriginal and Torres Strait Islander people.

4. Critical evaluation

Strengths. Evidence-informed practice strengthens accountability to service users by reducing reliance on habit and authority. It protects clients from ineffective or harmful interventions and supports transparent decision-making. Its process model gives practitioners a practical method for using research, and its emphasis on client values aligns with social work’s commitment to self-determination (Gambrill, 1999).

Limitations. Critics argue that EBP can privilege experimental evidence and marginalise other forms of knowledge, including practice wisdom and lived experience (Webb, 2001). Evidence for many social work interventions is limited, and trial findings may not transfer to diverse populations or complex contexts. In managerial settings, EBP has sometimes been used to mandate manualised programs and restrict professional discretion. Practitioners also face barriers of time, access to research and organisational support (Plath, 2006).

Overall importance. Evidence-informed practice is now an expectation of social work in Australia and internationally. Its most defensible form integrates research evidence, professional judgement and service-user knowledge within an ethical and culturally responsive framework. It connects with critical thinking, reflective practice (G4) and ethics (G6).

5. References

• Barkham, M., & Mellor-Clark, J. (2003). Bridging evidence-based practice and practice-based evidence: Developing a rigorous and relevant knowledge for the psychological therapies. Clinical Psychology & Psychotherapy, 10(6), 319–327. https://doi.org/10.1002/cpp.379
• Gambrill, E. (1999). Evidence-based practice: An alternative to authority-based practice. Families in Society, 80(4), 341–350. https://doi.org/10.1606/1044-3894.1214
• Gambrill, E. (2006). Social work practice: A critical thinker’s guide (2nd ed.). Oxford University Press.
• Gibbs, L., & Gambrill, E. (2002). Evidence-based practice: Counterarguments to objections. Research on Social Work Practice, 12(3), 452–476.
• Glasby, J., & Beresford, P. (2006). Who knows best? Evidence-based practice and the service user contribution. Critical Social Policy, 26(1), 268–284.
• Nevo, I., & Slonim-Nevo, V. (2011). The myth of evidence-based practice: Towards evidence-informed practice. British Journal of Social Work, 41(6), 1176–1197. https://doi.org/10.1093/bjsw/bcq149
• Petticrew, M., & Roberts, H. (2003). Evidence, hierarchies, and typologies: Horses for courses. Journal of Epidemiology and Community Health, 57(7), 527–529. https://doi.org/10.1136/jech.57.7.527
• Plath, D. (2006). Evidence-based practice: Current issues and future directions. Australian Social Work, 59(1), 56–72.
• Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312(7023), 71–72. https://doi.org/10.1136/bmj.312.7023.71
• Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Churchill Livingstone.
• Webb, S. A. (2001). Some considerations on the validity of evidence-based practice in social work. British Journal of Social Work, 31(1), 57–79. https://doi.org/10.1093/bjsw/31.1.57