This essay will focus on how EBP and ‘practice wisdom’ should be combined and not seen as opposing opposites as together they have great value for social work practice. Also both should determine the practitioners decision making processes in practice because failing to do so could actually be oppressive to both service users and practitioners. Also this integration could facilitate and encourage the use of research amongst social work practitioners in day to day practice.
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EBP in social work has been implemented at a slow pace and has not been greatly embraced and valued by practitioners (McNeill, 2006; Pignotti and Thyer, 2009; Mitchell 2011, Nevo and Nevo, 2011). Epstein (2011) highlights how practitioners have voiced that they resent EBP as it presents as a threat to their autonomy and creativity. This idea of EB knowledge solely determining practice could be perceived by practitioners as disempowering. An approach that devalues practice wisdom and professional judgement in favour of objective, manualised, and empirically supported interventions (Webb, 2001; Nevo and Nevo, 2011) can be seen to undermine professional autonomy as it places authority of science over the authority of the practitioner (Nevo and Nevo, 2011). Furthermore it can actually be seen to oppress practitioners as it seems to be ‘controlling’ their decision making process that may often conflict with their practice wisdom. An approach that alongside EB knowledge also embraced practice based knowledge may be of more use and value to practitioners and may be more likely to be used in practice as it detaches EBP from its solely scientific and thus its oppressive nature.
It is now increasingly being recognised in the EBP literature that social work values and practitioner wisdom need to be integrated with practice; however this integration is often unclear (Epstein, 2009; Mitchell, 2011; Nevo and Nevo, 2011). A shift towards evidence ‘informed’ practice (EIP) rather than evidence ‘based’ practice is now being recognised (Epstein, 2009; Haight, 2010; Nevo and Nevo, 2011). However practice is wisdom is still not acknowledged amongst some EIP advocates for example Haight (2010) but is greatly valued amongst others such as Nevo and Nevo (2011).
Stoesz (2010) argues that the social work profession is too subjective and reflexive and argues that only scientific evidence is acceptable and ethical as anything else could be depriving an individual of effective treatment (Stoesz, 2010; Gambrill, 2010). Randomised controlled trials (RCTs) are seen to provide ‘gold standard’ evidence for practice to be based on. Qualitative research and practice wisdom or clinical judgments are valued the least as are less scientific (Corby, 2006; Epstein, 2002; Dodd and Epstein, 2012). Epstein (2009) rejects the use of RCTs on ethical grounds as the methodology deprives the one group of intervention. RCTs may have value for research findings and in turn practice but its research methodology is unethical to some service users.
Ethics is of great importance within social work as it is of importance that social workers be ‘ethical professionals’ and work anti oppressively. And also be guided by research (Nevo and Nevo, 2011). BASW (2012) code of ethics states that evidence informed knowledge derived from research and practice evaluation is the basis of methodology in social work. However if practitioners are not using EB knowledge and are using only practice wisdom this could be depriving service users from an effective treatment and is not integrating evidence into practice. What would be of more value is to encourage and accept EB knowledge and practice wisdom so that not one or the other, but both are valued and used by practitioners so that research is being incorporated into and informing social work practice as BASW (2012) states. Also BASW (2012) states that knowledge should also come from ‘practice evaluation’ and mentions acknowledging context but does not mention practice wisdom. This evidence informed approach whereby acknowledging being specific to context but that does not mention practice wisdom is similar to EIP advocated by Haight (2010).
To ignore the existence of practice based wisdom and its perceived value by practitioners in influencing their decision making process will only further limit the potential of integrating EB research into practice.
McNeill (2006) highlights how practitioner’s decision making is not driven by research findings, even when provided with evidence of intervention effectiveness. Gambrill (2006) acknowledges how in social work practice a number of unsupported interventions are conventionally used and accepted in practice that are based on professional authority and clinical experience and not research evidence. Pignotti and Thyer (2009) concluded that just because social workers valued and used EBP interventions they also valued and used ‘Novel unsupported therapies’ (NUTs) in practice.
This could suggest that practice wisdom is valued in the decision making process and could be of priority even when provided with evidence of an interventions effectiveness (Gambrill, 2006; McNeill, 2006). It also could suggest that both EBP and practice wisdom are also co-existing in the decision making process in practice (Pignotti and Thyer, 2009). Pignotti and Thyer (2009) highlights how little is known about why social work practitioners choose NUTs. Similar Research could be of value in potentially identifying how Practice wisdom as well as EB knowledge together both are being used and are of value to practice.
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Mitchell (2011) illustrates how the sole use of EBP had limited valuable application in real world practice. Mitchell (2011) found that when attempting to implement EB services for young people with complex needs, this was limited without the integration of practice wisdom. As most research focuses on a single disorder or problem it is difficult to implement such research when faced with complex factors that interact in complex ways in real world settings. Also it could be seen as unethical and oppressive to arrange and reduce human beings using solely scientific EB interventions. Corby (2006) states how human beings are too complex to assume a one size fits all approach. In such complex cases as encountered by Mitchell (2001) practice wisdom and EBP were integrated in order to make a decision based not only on evidence but of relevance to the case at hand. Fook (2012) describes how a reflective practitioner situates themselves and their knowledge in the specific context of a situation, looking at the situation as a whole and in relation to their own experiences. Although the term of practice wisdom is not used this seems to reflect some of the nature of practice wisdom and how it can be of use to each individual case. With exclusion of ‘their own experiences’ Fook (2012) also seems to reflect BASW (2012) concerning Evidence informed knowledge.
It seems to be now increasingly acknowledged that practitioners are not passive recipients or implementers of information, however in addition to this practice based wisdom should also be acknowledged as of value. The understanding of the processes of how EB knowledge and practice based knowledge are integrated into practice is of importance to the purpose of research in social work. The integration of research and practice may then be of perceived value to practitioners.
One of Mitchells (2011) main arguments was that the main barriers to implementation and value of EBP in real world practice is the oppositional construction that remains concerning EBP verses practice based wisdom.
Fook (2012) describes the notion of ‘dichotomous thinking’ whereby most phenomena are seen to fit into ‘binary’ and ‘oppositional’ categories, with one being devalued in relation to the other. This ‘dichotomous thinking’ appears to be occurring within social work research and practice in relation to EBP and practice wisdom.
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