Practitioner's Guide to Using Research for Evidence-Informed Practice. Allen Rubin

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practitioner's individual expertise, and client values and expectations. Unlike misconceptions of EIP that characterized it as requiring practitioners to mechanically apply interventions that have the best research evidence, Figure 1.1 shows EIP residing in the shaded area, where practice decisions are made based on the intersection of the best evidence, practitioner's individual expertise, and client values and expectations. In discussing this diagram, Shlonsky and Gibbs (2004) observe:

       None of the three core elements can stand alone; they work in concert by using practitioner skills to develop a client-sensitive case plan that utilizes interventions with a history of effectiveness. In the absence of relevant evidence, the other two elements are weighted more heavily, whereas in the presence of overwhelming evidence the best-evidence component might be weighted more heavily. (p. 138)

Schematic illustration of newer EIP model.

      Modified from Haynes et al., (2002).

Schematic illustration of the transdisciplinary model of evidence-informed practice.

      From “Toward a Transdisciplinary Model of Evidence-Based Practice,” by Satterfield et al. (2009). Reprinted with permission of John Wiley & Sons, Inc.

      The cyclical process of EIP can be conceptualized as involving the following five steps: (a) formulating a question, (b) searching for the best evidence to answer the question, (c) critically appraising the evidence, (d) selecting an intervention based on a critical appraisal of the evidence and integrating that appraisal with practitioner expertise and awareness of the client's preferences and clinical state and circumstances, and (e) monitoring client progress. Depending on the outcome observed in the fifth step, the cycle may need to go back to an earlier step to seek an intervention that might work better for the particular client, perhaps one that has less evidence to support it, but which might nevertheless prove to be more effective for the particular client in light of the client's needs, strengths, values, and circumstances. Chapter 2 examines each of these five steps in more detail.

      When asking which approach has the best effects, we implicitly acknowledge that for some target problems there is more than one effective approach. For example, the book Programs and Interventions for Maltreated Children and Families (Rubin, 2012) contains 20 chapters on 20 different approaches whose effectiveness with maltreated children and their families has been empirically supported. Some of these programs and interventions are more costly than others. Varying costs are connected to factors such as the minimum degree level and amount of experience required in staffing, the extent and costs of practitioner training, caseload maximums, amount number of treatment sessions required, materials and equipment, and so on. The child welfare field is not the only one in which more than one empirically supported approach can be found. And it is not the only one in which agency administrators or direct service practitioners are apt to deem some of these approaches to be unaffordable. An important part of practitioner expertise includes knowledge about the resources available to you in your practice context. Consequently, when searching for and finding programs or interventions that have the best effects, you should also ask about their costs. You may not be able to afford the approach with the best effects, and instead may have to settle for one with less extensive or less conclusive empirical support.

      But affordability is not the only issue when asking about costs. Another pertains to the ratio of costs to benefits. For example, imagine that you were to find two empirically supported programs for reducing dropout rates in schools with high dropout rates. Suppose that providing the program with the best empirical support – let's call it Program A – costs $200,000 per school and that it is likely to reduce the number of dropouts per school by 100. That comes to $2,000 per reduced dropout. In contrast, suppose that providing the program with the second best empirical support – let's call it Program B – costs $50,000 per school and that it is likely to reduce the number of dropouts per school by 50. That comes to $1,000 per reduced dropout – half the cost per dropout than Program A.

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