et al., 2005; Lilienfeld, 2007). Moreover, some studies that have concluded that relationship factors are more important have nonetheless found that while the choice of intervention might be less important, it is not unimportant. In light of those studies, one can argue that even if relationship factors are important it is a false dichotomy to conclude that relationship factors are all that matter. Why not work to maximize the benefit of both types of factors?
Another counterpoint to the dodo bird verdict argument against EIP is that virtually every treatment manual that accompanies interventions that are generally recognized as having the best scientific research evidence supporting their effectiveness stresses the importance of the therapeutic alliance and relationship skills as a necessary component of the intervention. Thus, if practitioners do not provide the intervention in the context of a strong therapeutic alliance and with good relationship skills, then they are failing to comply with the manual!
As a final counterpoint, let's suppose that the dodo bird argument is correct, that the choice of intervention does not matter, and that all that matters is relationship skills. Although we don't buy that argument, let's further suppose that practitioners choose, based on the research supporting the dodo bird argument, to focus exclusively on maximizing the strength of their relationship skills and of the therapeutic alliance. Would that mean that they are not engaging in the EIP process? The answer – paradoxically – is a resounding no! Why so? Because there is nothing in the definition of the EIP process that requires choosing a particular intervention. Instead, all that it requires is to choose to intervene in light of the best scientific evidence. If practitioners decide that the best evidence indicates that to be most helpful to their clients they must emphasize relationship skills exclusively (and if that emphasis is consistent with their practice knowledge and client characteristics), and they therefore decide to be guided by that evidence in their practice, then they are following the EIP process and being influenced by what they perceive to be the best evidence! That is what EIP is all about!
KEY CHAPTER CONCEPTS
The first step in the EIP process is to formulate a question about a practice decision. If the question pertains to the selection of an intervention, it can be open-ended or it can inquire as to the comparative effectiveness of one or more interventions that are specified in the question.
The second step in the EIP process is to search for evidence. This can involve going to websites that offer reviews as well as searching literature databases.
When searching literature databases, using Boolean operators such as and, or, and not in your search terms can limit or broaden the range of resulting references.
When conducting your own search, you don't have to read every study that you find. You can examine their titles and abstracts to ascertain which ones are worth reading.
The third step in the EIP process involves critically appraising the evidence. A key aim in this phase is to distinguish studies that have fatal flaws from those whose flaws are less serious and more acceptable.
A study that is very strong from a scientific standpoint, such as one that has only a few trivial flaws, should outweigh a large number of weaker studies containing serious (albeit perhaps not fatal) flaws.
The fourth step in the EIP process involves selecting and implementing the intervention. Rather than just automatically selecting and implementing the intervention with the best evidence, you need to consider the importance of the practice context. Also, you should inform the client about the evidence and involve the client in the decision of which intervention to use.
The fifth step in the EIP process involves monitoring client progress. Even the most effective interventions don't help everybody. Moreover, even if your client could benefit from the intervention, perhaps there is something about the way you are providing it – or something about your practice context – that is making it less effective than it was in the research studies.
In the real world of everyday practice, you may encounter some practical obstacles limiting your ability to implement the EIP process in an ideal fashion. Common obstacles include a lack of time, training, and access to Internet databases. You should always do the best you can, even if that involves taking some shortcuts. Not doing so, and thus practicing in disregard of the evidence, is not ethical or compassionate.
In order to leverage the best outcomes for clients it's important to both foster a strong working relationship with clients and carefully select the intervention through the EIP process.
REVIEW EXERCISES
1 Identify two different Internet-based search databases you might use for an online search. Find the help section and read about how the search engine uses Boolean operators, advanced search options, and other symbols or strategies that you might use to make your search more efficient. Make yourself a table with notes outlining these tools and tips for each of the search engines.
2 Formulate an EIP question to guide an intervention decision in a practice situation with which you are familiar. Using the Internet, search for studies providing evidence to inform that decision. In your search, see how the use of different search terms and different Boolean operators (and versus or) affect the range and types of studies that display. Just by examining titles, and perhaps reading some abstracts from some of the studies that seem most relevant to your question, determine whether some of the studies are reviews of studies. Briefly describe the different kinds of results you get using different search terms.
3 After examining some of the studies that you find in your review in Exercise 2, discuss how the practice context, including idiosyncratic client characteristics, might make one of the studies you find inapplicable to your practice decision even if that study might provide the best evidence from a research standpoint.
4 Go to the following website: http://www.lib.umich.edu/socwork/rescue/ebsw.html. Explore some of its links to additional sites relevant to EIP. Briefly describe one or two things you find that seem likely to be helpful to you in implementing the EIP process.
ADDITIONAL READINGS
1 Corcoran, J. (2003). Clinical applications of evidence-based family interventions. Oxford University Press.
2 Foa, E. B., Keane, T. M., & Friedman, M. J. (2000). Effective treatments for PTSD. Guilford Press.
3 Reddy, L. A., Files-Hall, T. M., & Shaefer, C. E.. (Eds.) (2005). Empirically based play interventions for children. American Psychological Association.
4 Roberts, A. R., & Yeager, K. R.. (Eds.) (2004). Evidence-based practice manual: Research and outcome measures in health and human services. Oxford University Press.
3 Research Hierarchies: Which Types of Research Are Best for Which Questions?
1 3.1 More than One Type of Hierarchy for More than One Type of EIP Question
