importance of research to social work

The link between social work research and practice

When thinking about social work, some may consider the field to solely focus on clinical interventions with individuals or groups.

There may be a mistaken impression that research is not a part of the social work profession. This is completely false. Rather, the two have been and will continue to need to be intertwined.

This guide covers why social workers should care about research, how both social work practice and social work research influence and guide each other, how to build research skills both as a student and as a professional working in the field, and the benefits of being a social worker with strong research skills. 

A selection of social work research jobs are also discussed.  

• Social workers and research
• Evidence-based practice
• Practice and research
• Research and practice
• Build research skills
• Social worker as researcher
• Benefits of research skills
• Research jobs

Why should social workers care about research?

Sometimes it may seem as though social work practice and social work research are two separate tracks running parallel to each other – they both seek to improve the lives of clients, families and communities, but they don’t interact. This is not the way it is supposed to work.

Research and practice should be intertwined, with each affecting the other and improving processes on both ends, so that it leads to better outcomes for the population we’re serving.

Section 5 of the NASW Social Work Code of Ethics is focused on social workers’ ethical responsibilities to the social work profession. There are two areas in which research is mentioned in upholding our ethical obligations: for the integrity of the profession (section 5.01) and for evaluation and research (section 5.02). 

Some of the specific guidance provided around research and social work include:

• 5.01(b): …Social workers should protect, enhance, and improve the integrity of the profession through appropriate study and research, active discussion, and responsible criticism of the profession.
• 5.01(d): Social workers should contribute to the knowledge base of social work and share with colleagues their knowledge related to practice, research, and ethics…
• 5.02(a) Social workers should monitor and evaluate policies, the implementation of programs, and practice interventions.
• 5.02(b) Social workers should promote and facilitate evaluation and research to contribute to the development of knowledge.
• 5.02(c) Social workers should critically examine and keep current with emerging knowledge relevant to social work and fully use evaluation and research evidence in their professional practice.
• 5.02(q) Social workers should educate themselves, their students, and their colleagues about responsible research practices.

Evidence-based practice and evidence-based treatment

In order to strengthen the profession and determine that the interventions we are providing are, in fact, effective, we must conduct research. When research and practice are intertwined, this leads practitioners to develop evidence-based practice (EBP) and evidence-based treatment (EBT).

Evidence-based practice is, according to The National Association of Social Workers (NASW) , a process involving creating an answerable question based on a client or organizational need, locating the best available evidence to answer the question, evaluating the quality of the evidence as well as its applicability, applying the evidence, and evaluating the effectiveness and efficiency of the solution. 

Evidence-based treatment is any practice that has been established as effective through scientific research according to a set of explicit criteria (Drake et al., 2001). These are interventions that, when applied consistently, routinely produce improved client outcomes. 

For example, Cognitive Behavioral Therapy (CBT) was one of a variety of interventions for those with anxiety disorders. Researchers wondered if CBT was better than other intervention options in producing positive, consistent results for clients.

So research was conducted comparing multiple types of interventions, and the evidence (research results) demonstrated that CBT was the best intervention.

The anecdotal evidence from practice combined with research evidence determined that CBT should become the standard treatment for those diagnosed with anxiety. Now more social workers are getting trained in CBT methods in order to offer this as a treatment option to their clients.

How does social work practice affect research?

Social work practice provides the context and content for research. For example, agency staff was concerned about the lack of nutritional food in their service area, and heard from clients that it was too hard to get to a grocery store with a variety of foods, because they didn’t have transportation, or public transit took too long. 

So the agency applied for and received a grant to start a farmer’s market in their community, an urban area that was considered a food desert. This program accepted their state’s version of food stamps as a payment option for the items sold at the farmer’s market.

The agency used their passenger van to provide free transportation to and from the farmer’s market for those living more than four blocks from the market location.

The local university also had a booth each week at the market with nursing and medical students checking blood pressure and providing referrals to community agencies that could assist with medical needs. The agency was excited to improve the health of its clients by offering this program.

But how does the granting foundation know if this was a good use of their money? This is where research and evaluation comes in. Research could gather data to answer a number of questions. Here is but a small sample:

• How many community members visited each week and purchased fruits and vegetables? 
• How many took advantage of the transportation provided, and how many walked to the market? 
• How many took advantage of the blood pressure checks? Were improvements seen in those numbers for those having repeat blood pressure readings throughout the market season? 
• How much did the self-reported fruit and vegetable intake increase for customers? 
• What barriers did community members report in visiting and buying food from the market (prices too high? Inconvenient hours?)
• Do community members want the program to continue next year?
• Was the program cost-effective, or did it waste money by paying for a driver and for gasoline to offer free transportation that wasn’t utilized? What are areas where money could be saved without compromising the quality of the program?
• What else needs to be included in this program to help improve the health of community members?

How does research affect social work practice?

Research can guide practice to implement proven strategies. It can also ask the ‘what if’ or ‘how about’ questions that can open doors for new, innovative interventions to be developed (and then research the effectiveness of those interventions).

Engel and Schutt (2017) describe four categories of research used in social work:

• Descriptive research is research in which social phenomena are defined and described. A descriptive research question would be ‘How many homeless women with substance use disorder live in the metro area?’
• Exploratory research seeks to find out how people get along in the setting under question, what meanings they give to their actions, and what issues concern them. An example research question would be ‘What are the barriers to homeless women with substance use disorder receiving treatment services?’
• Explanatory research seeks to identify causes and effects of social phenomena. It can be used to rule out other explanations for findings and show how two events are related to each other.  An explanatory research question would be ‘Why do women with substance use disorder become homeless?’
• Evaluation research describes or identifies the impact of social programs and policies. This type of research question could be ‘How effective was XYZ treatment-first program that combined housing and required drug/alcohol abstinence in keeping women with substance use disorder in stable housing 2 years after the program ended?’

Each of the above types of research can answer important questions about the population, setting or intervention being provided. This can help practitioners determine which option is most effective or cost-efficient or that clients are most likely to adhere to. In turn, this data allows social workers to make informed choices on what to keep in their practice, and what needs changing. 

How to build research skills while in school

There are a number of ways to build research skills while a student.  BSW and MSW programs require a research course, but there are other ways to develop these skills beyond a single class:

• Volunteer to help a professor working in an area of interest. Professors are often excited to share their knowledge and receive extra assistance from students with similar interests.
• Participate in student research projects where you’re the subject. These are most often found in psychology departments. You can learn a lot about the informed consent process and how data is collected by volunteering as a research participant.  Many of these studies also pay a small amount, so it’s an easy way to earn a bit of extra money while you’re on campus. 
• Create an independent study research project as an elective and work with a professor who is an expert in an area you’re interested in.  You’d design a research study, collect the data, analyze it, and write a report or possibly even an article you can submit to an academic journal.
• Some practicum programs will have you complete a small evaluation project or assist with a larger research project as part of your field education hours. 
• In MSW programs, some professors hire students to conduct interviews or enter data on their funded research projects. This could be a good part time job while in school.
• Research assistant positions are more common in MSW programs, and these pay for some or all your tuition in exchange for working a set number of hours per week on a funded research project.

How to build research skills while working as a social worker

Social service agencies are often understaffed, with more projects to complete than there are people to complete them.

Taking the initiative to volunteer to survey clients about what they want and need, conduct an evaluation on a program, or seeing if there is data that has been previously collected but not analyzed and review that data and write up a report can help you stand out from your peers, be appreciated by management and other staff, and may even lead to a raise, a promotion, or even new job opportunities because of the skills you’ve developed.

Benefits of being a social worker with strong research skills

Social workers with strong research skills can have the opportunity to work on various projects, and at higher levels of responsibility. 

Many can be promoted into administration level positions after demonstrating they understand how to conduct, interpret and report research findings and apply those findings to improving the agency and their programs.

There’s also a level of confidence knowing you’re implementing proven strategies with your clients. 

Social work research jobs

There are a number of ways in which you can blend interests in social work and research. A quick search on Glassdoor.com and Indeed.com retrieved the following positions related to social work research:

• Research Coordinator on a clinical trial offering psychosocial supportive interventions and non-addictive pain treatments to minimize opioid use for pain.
• Senior Research Associate leading and overseeing research on a suite of projects offered in housing, mental health and corrections.
• Research Fellow in a school of social work
• Project Policy Analyst for large health organization
• Health Educator/Research Specialist to implement and evaluate cancer prevention and screening programs for a health department
• Research Interventionist providing Cognitive Behavioral Therapy for insomnia patients participating in a clinical trial
• Research Associate for Child Care and Early Education
• Social Services Data Researcher for an organization serving adults with disabilities.
• Director of Community Health Equity Research Programs evaluating health disparities.

No matter your population or area of interest, you’d likely be able to find a position that integrated research and social work. 

Social work practice and research are and should remain intertwined. This is the only way we can know what questions to ask about the programs and services we are providing, and ensure our interventions are effective. 

There are many opportunities to develop research skills while in school and while working in the field, and these skills can lead to some interesting positions that can make a real difference to clients, families and communities. 

Drake, R. E., Goldman, H., Leff, H. S., Lehman, A. F., Dixon, L., Mueser, K. T., et al. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52(2), 179-182. 

Engel, R.J., & Schutt, R.K. (2017). The Practice of Research in Social Work. Sage.

National Association of Social Workers. (n.d). Evidence Based Practice. Retrieved from: https://www.socialworkers.org/News/Research-Data/Social-Work-Policy-Research/Evidence-Based-Practice

Social Work Research Methods That Drive the Practice

Social workers advocate for the well-being of individuals, families and communities. But how do social workers know what interventions are needed to help an individual? How do they assess whether a treatment plan is working? What do social workers use to write evidence-based policy?

Social work involves research-informed practice and practice-informed research. At every level, social workers need to know objective facts about the populations they serve, the efficacy of their interventions and the likelihood that their policies will improve lives. A variety of social work research methods make that possible.

Data-Driven Work

Data is a collection of facts used for reference and analysis. In a field as broad as social work, data comes in many forms.

Quantitative vs. Qualitative

As with any research, social work research involves both quantitative and qualitative studies.

Quantitative Research

Answers to questions like these can help social workers know about the populations they serve — or hope to serve in the future.

• How many students currently receive reduced-price school lunches in the local school district?
• How many hours per week does a specific individual consume digital media?
• How frequently did community members access a specific medical service last year?

Quantitative data — facts that can be measured and expressed numerically — are crucial for social work.

Quantitative research has advantages for social scientists. Such research can be more generalizable to large populations, as it uses specific sampling methods and lends itself to large datasets. It can provide important descriptive statistics about a specific population. Furthermore, by operationalizing variables, it can help social workers easily compare similar datasets with one another.

Qualitative Research

Qualitative data — facts that cannot be measured or expressed in terms of mere numbers or counts — offer rich insights into individuals, groups and societies. It can be collected via interviews and observations.

• What attitudes do students have toward the reduced-price school lunch program?
• What strategies do individuals use to moderate their weekly digital media consumption?
• What factors made community members more or less likely to access a specific medical service last year?

Qualitative research can thereby provide a textured view of social contexts and systems that may not have been possible with quantitative methods. Plus, it may even suggest new lines of inquiry for social work research.

Mixed Methods Research

Combining quantitative and qualitative methods into a single study is known as mixed methods research. This form of research has gained popularity in the study of social sciences, according to a 2019 report in the academic journal Theory and Society. Since quantitative and qualitative methods answer different questions, merging them into a single study can balance the limitations of each and potentially produce more in-depth findings.

However, mixed methods research is not without its drawbacks. Combining research methods increases the complexity of a study and generally requires a higher level of expertise to collect, analyze and interpret the data. It also requires a greater level of effort, time and often money.

The Importance of Research Design

Data-driven practice plays an essential role in social work. Unlike philanthropists and altruistic volunteers, social workers are obligated to operate from a scientific knowledge base.

To know whether their programs are effective, social workers must conduct research to determine results, aggregate those results into comprehensible data, analyze and interpret their findings, and use evidence to justify next steps.

Employing the proper design ensures that any evidence obtained during research enables social workers to reliably answer their research questions.

Research Methods in Social Work

The various social work research methods have specific benefits and limitations determined by context. Common research methods include surveys, program evaluations, needs assessments, randomized controlled trials, descriptive studies and single-system designs.

Surveys involve a hypothesis and a series of questions in order to test that hypothesis. Social work researchers will send out a survey, receive responses, aggregate the results, analyze the data, and form conclusions based on trends.

Surveys are one of the most common research methods social workers use — and for good reason. They tend to be relatively simple and are usually affordable. However, surveys generally require large participant groups, and self-reports from survey respondents are not always reliable.

Program Evaluations

Social workers ally with all sorts of programs: after-school programs, government initiatives, nonprofit projects and private programs, for example.

Crucially, social workers must evaluate a program’s effectiveness in order to determine whether the program is meeting its goals and what improvements can be made to better serve the program’s target population.

Evidence-based programming helps everyone save money and time, and comparing programs with one another can help social workers make decisions about how to structure new initiatives. Evaluating programs becomes complicated, however, when programs have multiple goal metrics, some of which may be vague or difficult to assess (e.g., “we aim to promote the well-being of our community”).

Needs Assessments

Social workers use needs assessments to identify services and necessities that a population lacks access to.

Common social work populations that researchers may perform needs assessments on include:

• People in a specific income group
• Everyone in a specific geographic region
• A specific ethnic group
• People in a specific age group

In the field, a social worker may use a combination of methods (e.g., surveys and descriptive studies) to learn more about a specific population or program. Social workers look for gaps between the actual context and a population’s or individual’s “wants” or desires.

For example, a social worker could conduct a needs assessment with an individual with cancer trying to navigate the complex medical-industrial system. The social worker may ask the client questions about the number of hours they spend scheduling doctor’s appointments, commuting and managing their many medications. After learning more about the specific client needs, the social worker can identify opportunities for improvements in an updated care plan.

In policy and program development, social workers conduct needs assessments to determine where and how to effect change on a much larger scale. Integral to social work at all levels, needs assessments reveal crucial information about a population’s needs to researchers, policymakers and other stakeholders. Needs assessments may fall short, however, in revealing the root causes of those needs (e.g., structural racism).

Randomized Controlled Trials

Randomized controlled trials are studies in which a randomly selected group is subjected to a variable (e.g., a specific stimulus or treatment) and a control group is not. Social workers then measure and compare the results of the randomized group with the control group in order to glean insights about the effectiveness of a particular intervention or treatment.

Randomized controlled trials are easily reproducible and highly measurable. They’re useful when results are easily quantifiable. However, this method is less helpful when results are not easily quantifiable (i.e., when rich data such as narratives and on-the-ground observations are needed).

Descriptive Studies

Descriptive studies immerse the researcher in another context or culture to study specific participant practices or ways of living. Descriptive studies, including descriptive ethnographic studies, may overlap with and include other research methods:

• Informant interviews
• Census data
• Observation

By using descriptive studies, researchers may glean a richer, deeper understanding of a nuanced culture or group on-site. The main limitations of this research method are that it tends to be time-consuming and expensive.

Single-System Designs

Unlike most medical studies, which involve testing a drug or treatment on two groups — an experimental group that receives the drug/treatment and a control group that does not — single-system designs allow researchers to study just one group (e.g., an individual or family).

Single-system designs typically entail studying a single group over a long period of time and may involve assessing the group’s response to multiple variables.

For example, consider a study on how media consumption affects a person’s mood. One way to test a hypothesis that consuming media correlates with low mood would be to observe two groups: a control group (no media) and an experimental group (two hours of media per day). When employing a single-system design, however, researchers would observe a single participant as they watch two hours of media per day for one week and then four hours per day of media the next week.

These designs allow researchers to test multiple variables over a longer period of time. However, similar to descriptive studies, single-system designs can be fairly time-consuming and costly.

Learn More About Social Work Research Methods

Social workers have the opportunity to improve the social environment by advocating for the vulnerable — including children, older adults and people with disabilities — and facilitating and developing resources and programs.

Learn more about how you can earn your  Master of Social Work online at Virginia Commonwealth University . The highest-ranking school of social work in Virginia, VCU has a wide range of courses online. That means students can earn their degrees with the flexibility of learning at home. Learn more about how you can take your career in social work further with VCU.

From M.S.W. to LCSW: Understanding Your Career Path as a Social Worker

How Palliative Care Social Workers Support Patients With Terminal Illnesses

How to Become a Social Worker in Health Care

Gov.uk, Mixed Methods Study

MVS Open Press, Foundations of Social Work Research

Open Social Work Education, Scientific Inquiry in Social Work

Open Social Work, Graduate Research Methods in Social Work: A Project-Based Approach

Routledge, Research for Social Workers: An Introduction to Methods

SAGE Publications, Research Methods for Social Work: A Problem-Based Approach

Theory and Society, Mixed Methods Research: What It Is and What It Could Be

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The Current State of Evidence-Based Practice in Social Work: A Review of the Literature and Qualitative Analysis of Expert Interviews

While there is recent movement toward Evidence-Based Practice (EBP) in social work, criticisms subsist regarding the profession’s translation of research into viable practices. Evidence describing effective interventions exists, but research that addresses dissemination and implementation is generally lacking. This paper highlights existing literature on dissemination and explores the barriers, themes, and trends in EBP through eight expert interviews. The interviews reflect the issues described in the literature and provide additional insight to the process of implementation and dissemination of EBP. Findings from the literature and interviews are synthesized into research and practice recommendations.

While there is a call for Evidence-Based Practice (EBP) in social work and mental health services, there have also been a number of criticisms about the implementation of research findings into viable methods of practice. These barriers range from the egregious lag-time between research development to dissemination of evidence to practice settings to a veritable lack of support and training for community practitioners. There is a growing body of evidence describing effective interventions, but there is not a substantial body of work addressing the dissemination of these programs and other research findings for use in the field. This paper highlights some of the work around dissemination of EBPs in the field of social work with an emphasis on mental health services including an overview of the barriers to the use of evidence in practice and proposed models of conceptualization and implementation of EBP. To further highlight the current barriers, themes, and trends in EBP eight experts in the field of EBP were interviewed. The goal of the interviews was to survey the opinions of expert researchers in the area of EBP to supplement knowledge described in the literature. The experts’ responses reflected many of the same issues described in the literature as well as additional information regarding their efforts toward determining the most viable options to address the barriers to implementing and disseminating EBP. Findings from the literature review and interviews are synthesized into recommendations for future research and practice efforts.

INTRODUCTION

Practice decisions based on research evidence have increasingly become an identified need in the treatment of mental illnesses. Three of the most influential reports on mental health services policy in recent years, The President’s New Freedom Commission on Mental Health Report (2003) , The World Health Organization Report on Mental Health (2001) , and Mental Health: A report of the Surgeon General (1999), emphasize the need for research and evidence-based practices (EBPs) in mental health services. Even more broad health policy reports, such as Healthy People 2010 (2000) from the U.S. Department of Health and Human Services (DHHS), point to “an emphasis on translating new knowledge into clinical applications” in the mental health arena. The President’s New Freedom Commission on Mental Health (2003) recently released a final report calling for evidence based and recovery focused interventions in the treatment of mental illness; and the National Institute of Mental Health echoes this approach (Insel, 2003). Goal five of the President’s New Freedom Commission on Mental Health Report (2003) stresses the need to deliver excellent mental health care by accelerating research to promote recovery, resilience, prevention, and a cure for mental illness, advancing evidence-based practice dissemination and demonstration, expanding the workforce providing evidence-based practices, and developing a knowledge base in mental health disparities, long term medication effects, trauma, and acute care.

These national and international health and mental health reports are important to social work, not only as signposts of current trends in policy thought, but also as frameworks for future policy and funding activity. Federal agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Healthcare Research and Quality (AHRQ), and National Institute on Drug Abuse (NIDA) are beginning to link grants and contracts to EBP themes such as research-based interventions and the translation of research into practice as well as hosting conferences dedicated to EBP. These and other agencies are also outlining science-based program standards and rating systems. For example, the Center for Substance Abuse Prevention (CSAP) and SAMHSA recently constructed a comparison matrix of science based prevention programs examining the standards and effectiveness ratings of 150 different programs sponsored by five different federal agencies (2002).

According to Thomas Insel (2004) , director of the National Institute of Mental Health, social workers are doing the majority of front line work treating individuals with mental illnesses. Citing a 1998 SAMHSA report, the current psychotherapy workforce is dominated by social work consisting of 192,814 social workers, 73,014 psychologists, 33,486 psychiatrists, and 17,318 psychiatric nurses ( Insel, 2004 ). Despite social worker dominance in the field of mental health and the National Association of Social Workers (NASW) code of ethics emphasis on research based service, the majority of social workers do not appear to draw on research findings to inform their practice ( Gibbs & Gambrill, 2002 ; Kirk & Rosenblatt, 1981 ; Mullen & Bacon, 2004 ; NASW, 1996 ; Rosen, 1994 ). Social workers, including researchers, educators, agency administrators, and practitioners, are therefore challenged with an important question: “How can the profession better disseminate the rich and growing body of research and evidence based interventions in social work and mental health services to practitioners providing direct services to individuals with mental illnesses?” This paper contains a review of the current literature around the dissemination of EBP, current social work models for dissemination of EBP, interviews with experts in the field, and a synthesis of this combined knowledge into recommendations for future dissemination of research and EBP efforts.

LITERATURE SEARCH METHOD

For this project, research was conducted through a review of the literature, including both books and scholarly articles, on EBP in mental health services in social work as well as other relevant professions and by interviewing a convenience sample of experts currently conducting research related to the development and dissemination of evidence based interventions for mental illnesses. Relevant literature was identified through a search of local social work and public health library holdings and by searching electronically using the following databases: Social Work Abstracts, PsychLit, and Medline. Additional citations were collected via the reference lists of identified sources and through the draft reference list of EBP dissemination literature collected by the Research Unit for Research Utilization (RURU), a part of the Evidence Network of Great Britain ( RURU, 2003 ). This review was limited to published literature that directly describes the use of research in social work practice specifically.

LITERATURE REVIEW

The call for evidence-based practice.

The first widespread push for EBP in social work came out of a series of studies that began to appear in the 1970s and called into question the effectiveness of existing social work interventions ( Fisher, 1973 ; Reid, 1994 ). The 1970s and 1980s witnessed a movement to develop evidence based models of practice in mental health and further the development of well researched psychosocial intervention models such as the behavioral, cognitive, interpersonal, and social approaches, as well as the biological and biopsychosocial theories of mental illness ( Turnbull, 1991 ). Evidence-based researchers in many disciplines pioneered models used in social work practice including: psychology, psychiatry, and social work. In the late 1980s and early 1990s substantial evidence regarding the treatment of common mental health disorders were high-lighted by the publication of the results of studies such as the National Institute of Mental Health Treatment of Depression Collaborative Research Program ( Elkin, Shea, Watkins et al., 1989 ). Over the past decade, the proportion and number of articles referring to EBP published in professional journals has risen in the disciplines focused on mental health services, health, and social welfare ( Shlonsky & Gibbs, 2004 ). For a more detailed description of the history of the development and use of EBP in social work see Kirk and Reid (2002) .

Today, New York State’s Office of Mental Health, identified as a progressive program by NIMH (Insel, 2003), is promoting the use of the following EBP for adults with serious mental illnesses. These EBP interventions include: Assertive Community Treatment (ACT), supported employment, intensive case management, wellness self-management, family psychoeducation, integrated treatment for co-occurring substance abuse and mental health disorders, medication (and guidelines for practitioners to promote optimal prescribing practices), self-help and peer support services, and post-traumatic stress disorder (PTSD) treatment ( New York State Office of Mental Health, 2001 ). The President’s New Freedom Commission (2003) report identified the following additional EBPs for the treatment of mental health disorders: cognitive and interpersonal therapies for depression, preventive interventions for children at risk for serious emotional disturbances, treatment foster care, multi-systemic therapy (MST), parent-child interaction therapy, and collaborative treatment in primary care. The commission also recommended emerging best practices including: consumer operated services, jail diversion, and community re-entry programs, school mental health services, trauma-specific intervention, wraparound services, multi-family group therapies, and systems of care for children with serious emotional disturbances and their families ( New Freedom Commission, 2003 ).

Translation and Implementation

The wider field of social science knowledge utilization is just beginning to build a theoretical framework that explains why research evidence, such as the EBPs listed above, is or is not utilized in social work practice ( Landry, Amara, & Lamari, 2001 ). While researchers have identified evidence-based mental health services, the translation and implementation of these services into practice has been problematic. One of the greatest complaints has been the lag of nearly 15 to 20 years between the identification and incorporation of EBP interventions into routine care ( Balas & Boren, 2000 ). Moreover, social work is a profession that claims expertise and specialized knowledge, values, skills, and professional ethics aimed at addressing difficult human problems, including mental illness ( Gambrill, 1999 ); however, licenses, experiences, and training are not supported by evidence as necessarily related to helping clients through the use of evidence ( Dawes, 1994 ).

Gambrill (1999) describes two different strategies for addressing the problem that social work is a profession based on “claimed rather than demonstrated effectiveness” in assisting clients in obtaining targeted outcomes. The first strategy, and arguably the most common historically, has been to ignore the contradiction between claims and reality and to censure this information from the academic and practice community ( Gambrill, 1999 ). The second strategy is to investigate the values, skills, and knowledge needed to achieve certain outcomes and then to identify who has these resources and the capability to provide them ( Gambrill, 1999 ). Social workers can, in this way, become integral participants in the process of shaping and delivering supported and needed interventions for clients and communities.

Perhaps the most common subject described in the EBP literature has been the concrete and psychological barriers that impede dissemination and implementation of EBPs. These barriers, outlined by practitioners, researchers, and administrators alike, have generally revolved around four major themes: knowledge, lack of fit, suspicion, and resources.

Knowledge barriers are those that speak to the general lack of awareness of available EBPs and the difficulty in processing or understanding research findings when they are identified ( Anderson, Cosby, Swan, Moore, & Broekhoven, 1999 ; Mullen & Bacon, 2004 ). This Includes practitioners’ lack of knowledge about how to best access, critically evaluate, and translate evidence for appropriate use with their clients. Gray, one of the foremost thinkers in evidence based healthcare and policy, likens research-based facts to uncut diamonds, which are valuable but of little use in their raw form (1997). Few practitioners access traditional outlets for research findings, such as scholarly journals ( Kirk & Reid, 2002 ) and the information found in these journals is not easily digested or translated into practice ( Anderson, Cosby, Swan, Moore, & Broekhoven, 1999 ; Bartels, Haley, & Dums, 1998). Even when evidence is identified in journals, much journal evidence is three-to four-years-old by the time it is published ( Thyer, 2004 ). The lack of knowledge also includes arguments that are based on a misunderstanding of what constitutes an EBP. For example, some have argued that social work is already using and teaching EBP, that effectiveness is a matter of personal opinion, or that no clear evidence is available for the questions social workers pose ( Gibbs & Gambrill, 2002 ).

Even if practitioners are able to identify and understand research they may still discredit its value. The lack of fit theme includes the reasons why practitioners feel that available evidence or research is not often helpful. Some feel that the EBPs are cookbook approaches that are too broad and do not speak to the unique contextual or cultural needs of clients (Bartels, Haley, & Dums, 1998; Gibbs & Gambrill, 2002 ; Mullen & Bacon, 2004 ). Others have noted that the methodology of treatment may not be applicable within the confines of their practice. For example, many EBPs emphasize short-term treatment, but this format is not appropriate to all clients across diverse settings ( Mullen & Bacon, 2004 ). Moreover, practitioners have noted that research and current policy are often at odds. Research findings are slow to develop, and once findings are presented, it may take considerable time before policies are aligned with new knowledge. As a result, policy and agency requirements and technology frequently do not support current evidence ( Anderson, Cosby, Swan, Moore, & Broekhoven, 1999 ; Gibbs & Gambrill, 2002 ). Finally, the culture of knowledge transmission within social work has been historically unsupportive of the use of research evidence in practice ( Barratt, 2003 ).

Related to the idea of the lack of fit between research findings and practice is the theme of suspicion . This includes a basic distrust for evidence, based on objections related to political, ethical, or control issues. Gibbs sites a natural resistance to innovation (including EBPs) as one of the main barriers of teaching EBP to practitioners ( Gibbs, 2003 ). Some practitioners feel that research evidence is simply a cost-cutting tool, politically motivated, guided by efficiency, or otherwise influenced by something other than the client’s best interest ( Anderson, Cosby, Swan, Moore, & Broekhoven, 1999 ; Gibbs & Gambrill, 2002 ). Other practitioners feel the experts are more often guided by their own view or model rather than an objective examination of the evidence ( Barratt, 2003 ). Landry, Amara, and Lamari (2001) point oat that there is an inherent disconnect between the goals and needs of researchers and practitioners. Practitioners need and want guidance that is tailored to clients and practice. However, the degree to which research results are customized to only one or two users increase costs to the scholars. Their work becomes less generalizable to the wider world and they must reformat or repackage it if they want others to utilize their work. It becomes a catch-22 where researchers are pushed toward developing broad applications and their work becomes likewise less useful for the individual practitioner. Moreover, as Barnes and Clouder (2000) point out, the determination of what is disseminated is largely dependent upon the researcher’s judgment of what is significant or worth sharing. Others believe that EBPs exclude the practitioner’s professional judgment, clinical expertise, or the judgment, values and preferences of the client ( Gibbs & Gambrill, 2002 ; Mullen & Bacon, 2004 ). An argument has also been made that those who advocate EBP want only to set trends, be first, be controversial, or further their reputations and that evidence can be found to support any favored point of view or that all methods are equally valuable in arriving at the truth ( Gibbs & Gambrill, 2002 ). The idea that research is suspect seems also, in part, due to the generally poor relationship that researchers and scholars have had with community agencies and practitioners in the past. Administrators have described a lack of communication and a disjoint between the goals of the agency and that of researchers ( Anderson, Cosby, Swan, Moore, & Broekhoven, 1999 ; Barratt, 2003 ). Furthermore, practitioners’ may collaborate in creating or testing interventions with researchers, but their participation in building and sharing knowledge with the wider profession has generally been limited ( Kirk & Reid, 2002 ). The chasm between research and practice is further widened by practitioners’ inability to contribute to the formal body of social work knowledge that they are expected to employ. “Thus, knowledge production and dissemination is largely in the hands of a small number of academics, while expectations for use have often been placed on the vast number of practitioners” (p. 205, Kirk & Reid, 2002 ).

Even practitioners and agencies that understand, appreciate, and want to use research evidence in their work may find themselves incapable due to a lack of resources ( Anderson, Cosby, Swan, Moore, & Broekhoven, 1999 ; Barrett, 2003; Mullen & Bacon, 2004 ) and reluctance to ask more of an overextended staff ( Barratt, 2003 ). Without the necessary training, materials, time and staff dedication to researching the evidence, EBPs cannot often be employed. Interventions may be shaped instead by limitations rather than knowledge. A lack of technology is particularly troublesome in a day and age where most cutting-edge information is accessed through computers and the Internet. Many agencies do not have access to these resources. The issue is not only what resources are realistically available, but also beliefs or policies about who can have access to these resources. Some administrators feel that not all social workers should have access to computers and the Internet ( Barratt, 2003 ). The issue of a lack of resources is partly a result of generally poor or inconsistent funding for many social work agencies. However, funds that are available are rarely routed toward identifying, instituting and maintaining research, technology, or EBPs.

Growing Body of Evidence-Based Services and Programs and Arguments for Use

Despite the numerous barriers to dissemination outlined above, social workers in the mental health services arena do have a number of compelling reasons to implement evidence into their practice with mentally ill individuals. Practitioners have cited advantages of using EBPs such as: (1) conceptualizing, planning, and guiding treatment, (2) increasing knowledge and skills, (3) improving treatment outcomes for clients, (4) integrating and supplementing, not supplanting, clinical judgment and knowledge, (5) complying with current practice, values, and professional consensus, and (6) satisfying grant or managed care reimbursement requirements ( Mullen & Bacon, 2004 ). Overall, the basic tenet of EBPs is that clients should receive the benefit of the best technology that social work has to offer.

It is, however, difficult to imagine the basis on which structured, fact-based and well-informed decision making and planning referenced to the best available published research can be viewed as counter either to the provision of effective outcomes for service users, or to the ethos of the social work professional, (p. 144, Barratt, 2003 )

There are many questions as to what exactly should be used as evidence to identify the best technology possible. Undoubtedly this argument will, and should, continue within the field. However, if some agreement upon what is a validated intervention can be secured, the question becomes one of dissemination and implementation.

Current Strategies for Dissemination and Implementation

Until recently the prevailing approach to dissemination has been to report evidence in journal articles and published or unpublished practice manuals or to provide limited didactic trainings (Gibbs & Gambrill, 2003). Additionally, in recent years some masters programs have offered limited numbers of courses on some EBPs, such as cognitive behavioral therapy ( Gibbs & Gambrill, 2002 ). However, evidence suggests that these strategies have been largely unsuccessful in social work, as well as in the other professions treating individuals with mental health needs, as few mental health professionals are basing practice decisions on research evidence ( Gibbs & Gambrill, 2002 ; Kirk & Reid, 2002 ; Kirk & Rosenblatt, 1981 ; Mullen & Bacon, 2004 ; NASW, 1996 ; Rosen, 1994 ). To facilitate implementation of EBPs in the community, “… it is increasingly recognized that simply improving the content and availability of the evidence base is not sufficient to secure such changes. Explicit and active strategies are required to ensure that research really does have an impact on policy and practice” (p. 2, Walter, Nutley, & Davies, 2003 ). In order to flourish, efforts to implement evidence-based practices must be “multifaceted, broad-based and carefully targeted” (p. 144, Barratt, 2003 ).

Many researchers, program developers, and others have employed a cornucopia of what Walter, Nutley, and Davies (2003) term “mechanisms” to disseminate research findings. These authors reviewed over one hundred papers that evaluated or described efforts to facilitate the use of research. Nearly two hundred individual practices or packages were identified through this review. Based on these, the authors developed a taxonomy of approaches by both intervention type (format through which the information flows) and mechanisms employed, as well as a brief description of the research or theory that lends support to the specific approach. For example, one category of mechanisms described by the authors is incentives. The adoption of desired behaviors or information is encouraged through reward, or perhaps linking funding to specific practices. This mechanism is supported by learning theories, economic models of rational behavior, and power theory. Using such taxonomy to organize and understand dissemination research could potentially prove useful.

A number of researchers have taken the process a step further than individual mechanisms or approaches and proposed more developed frameworks for the delivery of research evidence into practice. While no single best method has been identified, there are a number of emerging social work implementation strategies described in the literature. The following is a brief overview of this work.

Anderson and colleagues

Based on interviews with community organization leaders, Anderson and colleagues suggest a model based on a relationship between researchers and community organizations that moves through three different stages. In the first stage, awareness , both researchers and community organizations are educated about the needs of one another ( Anderson, Cosby, Swan, Moore, & Broekhoven, 1999 ). In many cases both researchers and community-based organizations have little contact and are generally ignorant of the other’s work. In the second stage, communication , mechanisms are built to facilitate the transfer of information. Both community organizations and research stakeholders come together to formulate a plan for sharing skills and knowledge. A variety of methods may be employed such as: workshops, databases, and open houses. Finally, in the last stage, interaction , mutual activities toward common goals are shared and negotiated. In this model, a relationship is built to facilitate communication and knowledge transfer between community organizations and researchers allowing each to inform the other’s work. This model is general, offers some specific recommendations, but seems to focus largely on encouraging local groups to work together in order to find the methods that match their shared needs, abilities, and resources.

Gambrill and Gibbs

Leonard Gibbs and Eileen Gambrill propose a model defining EBP as the ‘conscientious, explicit, and judicious use of current best evidence to make decisions about the care of clients’ ( Gibbs & Gambrill, 2002 ). The aim of their model is to create lifelong learners who, in collaboration with clients, draw on practice related research findings to make practice related decisions ( Gibbs & Gambrill, 2002 ). In this model, EBP is a process that results from the careful consideration of practitioner’s individual experience, best available evidence, and client values and expectations ( Shlonsky & Gibbs, 2004 ). EBP is characterized by: (1) becoming motivated to apply evidence to practice decision making, (2) an individual assessment and well formulated question, (3) an external electronic search for practice findings related to practice questions, (4) decision-making regarding the evidence’s fit with the individual client, (5) using individual expertise to integrate the best external practice evidence, (6) evaluating the outcome (7) and sharing what is learned with others ( Gibbs, 2003 ; Gibbs & Gambrill, 2002 ). These authors propose a method of dissemination heavily focused on the education of practitioners in this model of EBP at the master’s level ( Gibbs, 2003 ; Gibbs & Gambrill, 2002 ).

Outside of the implementation of EBP as core curricula in master’s level social work programs and continuing education, Gibbs and Gambrill offer little advice on implementation suggesting that practitioner’s ‘obey your own conscience and implement EBP into your own practice however you feel it most appropriate to do so’ ( Gibbs, 2003 ). The following suggestions are offered, (1) consider the quality and applicability of evidence, (2) consider the context or organizational environment, and (3) consider the process of implementing change ( Gibbs, 2003 ). However, a clear design for implementation, outside of teaching, master’s level education, and continuing education, is not offered.

Rosen and Proctor

Aaron Rosen and Enola Proctor have devised an implementation strategy that relieves the practitioner of the burden of formulating and identifying the relevant research, locating, and assembling the information, critically evaluating the relevancy and validity of the evidence with regard to their practice decisions with an individual client, and adapting that knowledge to the client’s particular needs and situation ( Rosen, Proctor, Morrow-Howell, Auslander, & Staudt, 1993 ). The strategy proposed involves the use of Systematic Planned Practice (SPP), a tool for treatment planning and evaluation that includes the planning and recording of critical elements of practice such as the presenting problem(s), desired outcomes, interventions, and observed results ( Rosen et al., 1993 ). Application is guided by forms that serve two functions: to prompt and guide the worker in laying out the treatment plan and as a rationale for decisions made and to provide documentation for treatment planning decisions, what is actually implemented, and the outcomes obtained ( Rosen et al., 1993 ). A dissemination plan is proposed that combines SPP with components of practice guidelines to facilitate practitioner use and knowledge of evidence in practice (Rosen, 2002). According to Proctor, the adoption of EBP consists of multiple distinct outcomes whose attainment requires “systematic, targeted efforts by many players, at multiple levels of influence” ( Proctor, in press ). These include the following provider outcomes necessary for evidence based practice; identifying and accessing EBPs, accepting and adopting EBPs, implementing EBPs and evaluating EBPs (Proctor, 2004). As in the Gambrill and Gibbs model, Rosen and Proctor place much of the burden of utilization on the practitioner to locate and implement research knowledge. While Anderson and colleagues frame the process as more of a partnership between researchers and practitioners, it lacks specificity in terms of implementation.

Tool Kit Method

Another approach to the dissemination of EBPs is the tool kit method. Tool kits are materials constructed from original research and translated for use by practitioners, agencies, or institutions. In this model, specific tools rather than a framework or mandate are provided to support social workers’ efforts toward using EBPs. Resources, such as the Sociometrics Program Archives, have taken up the business of culling through research with the help of expert panels to develop a collection of tools such as: user’s guides, teacher or facilitator manuals, student or participant workbooks, videos or other supplemental media, and homework or exercises ( Card, 2001 ). Practitioners can order such tool kits from for profit and nonprofit enterprises at a cost. The idea is that the necessary research evidence is distilled into an attractive user-friendly format that is ready for implementation in the community. Evaluation processes are also sometimes included to provide a conduit for user feedback and further refinement of the toolkit package ( Card, 2001 ).

Practice Guidelines

Instituting practice guidelines, which have often been employed in using practice theory and wisdom since the beginning of the profession, has been another method recommended for the dissemination of EBPs ( Kirk & Reid, 2002 ). Using this format, treatment is directed by an outline of acceptable practices in specific areas of treatment. These practices would be determined by a professional body-charged with surveying, evaluating, and choosing both prescribed and proscribed interventions. Researchers have made arguments against such guidelines including: (1) the paucity of research needed to support good guidelines, (2) the lack of agreement on what constitutes evidence, (3) too little flexibility for practitioners, (4) little agency support, (5) and the fear of the use of guidelines as de facto standards in litigation against practitioners (Howard & Jensen, 1999). Despite these objections, Howard and Jensen (1999) argue that practice guidelines can go a long way toward improving social work interventions (for an excellent discussion of the potential problems and benefits of practice guidelines in social work please see the May 1999 issue of the journal Research on Social Work Practice ).

Other models

Historically other models have been explored to marry research and practice. Kirk and Reid (2002) describe efforts that grew out of industry and technology beginning in the 1960s and 70s such as the Research Development and Diffusion (RD&R) and Design and Development (D&D) models. These models describe a paradigm by which research and practice can be mutually informative in a constant feedback loop. However, as Kirk and Reid point out, these efforts would be enhanced if they were to be exposed to the same processes that they propose in order to become more flexible and useful across diverse social work contexts.

General recommendations

Beyond the more developed models described above, several researchers have made general recommendations for dissemination of evidence into practice. First, it is essential to secure organizational and practitioner buy-in ( Anderson, Cosby, Swan, Moore, & Broekhoven, 1999 ; Lewis, 1998 ; Mullen, 2004 ). Before any real progress is made toward dissemination stakeholders must both agree that EBP is valuable and important enough to merit a commitment of time, training, and other resources. Leadership is a crucial ingredient for change in this area ( Barratt, 2003 ). Although the dissemination of EBPs must occur at all levels, important issues such as protecting practitioner time for research and training as well monitoring and following up on implementation activities must be guided by administrators and other persons or agencies with authority. Also, some authors have described the importance of establishing a network of local organizations and practitioners so that they can pool resources such as training and research, become actively involved, and develop broad community goals ( Anderson, Cosby, Swan, Moore, & Broekhoven, 1999 ; Howard & Jensen, 1999). McKay and colleagues stress the importance of training and the establishment of an “engagement team” consisting of intake workers, clinical and administrative staff, and supervisors who oversee the implementation of interventions at each site ( McKay, Hibbert, Hoagwood, Rodriguez, Murray, Legerski, & Fernandez, 2004 ). Agencies and practitioners cannot be realistically expected to “go it alone” on tight budgets, timelines, and a research base that is a moving target. A much more efficient approach seems to be one of networking and sharing with other social workers, community organizations, educational institutions, and other stakeholders.

Unfortunately, the authors found few studies testing the efficacy of these approaches to the dissemination and utilization of research in practice. In essence, the research evidence on the use of EBPs has not been well developed. “Researchers have been relatively oblivious to the processes by which knowledge, once developed, might be effectively disseminated and used” ( Kirk & Reid, 2002 ).

QUALITATIVE INTERVIEWS

Based on themes identified in the literature review, the authors conducted qualitative interviews with experts in the field of EBP. The goal of the interviews was to survey expert researchers in order to explore current strategies, struggles, and observations about EBP to supplement and speak to the themes described in the literature.

Interviews with expert researchers experienced in mental health services research and evidence-based clinical interventions were conducted using open ended questions related to the topic of the dissemination and implementation of evidence based practices. Because this research is exploratory in nature, a convenience sample of interview candidates was selected on the basis of reputation and body of work in the field of EBP. In addition, a snowball method of interviewee selection was employed where respondents referred the authors to other experts for further data collection. All participants were researchers trained at the doctoral level. In total eight experts were interviewed including: five social worker professors, one professor of psychiatric epidemiology, one psychiatrist who directs a children’s mental health research program, and one national policy organization researcher.

Human Subjects Protections

Each potential respondent was invited to share thoughts and opinions regarding the use of EBP in mental health services and was provided a copy of the questions before the interview. Interviews were voluntary and the experts were not compensated for participating. Any identifying information regarding the individual interviewees was not included in the analysis and confidential interviews were maintained on password-protected computers in a locked office. Participants were given copies of the data collected in order to edit or make any additions to their responses.

Interview Schedule

The three authors interviewed all of the participants in the participants’ offices. For six of the eight interviews all three authors were present. For two of the interviews, only two authors were present. Each author took detailed notes during the interview highlighting major themes. Participants were provided with the following list of questions prior to the interview:

• What is your experience with Evidence Based Practice (EBP)?
• Have you done research around topics of EBP?
• What do you see as the barriers to implementing EBP in practice settings?
• What means of disseminating EBP have you seen employed?
• What are some of your ideas about how to improve the dissemination of EBP?
• Why do you think more practitioners don’t use EBP?
• What are the results of not using EBP?
• Where do you see gaps in EBP?
• How would you characterize the future of EBP?
• Do you know of any existing models or tools for the implementation of EBP? What are your thoughts about their usefulness?

Transcription

Authors took notes to highlight major themes in the interviews from each respondent. Following the interviews, the authors compiled notes for content analysis. To ensure inter-rater reliability the three interviewers transcribed all interviews separately. Transcription reports were compiled into one report for each participant to generate the most accurate representation of their comments.

Content analysis was conducted for each interview. Krippendorf (1980) defines content analysis as “a research technique for making replicable and valid inferences from data to their context” (p. 21). Janis (1965) defines it as:

Any technique (a) for the classification of the sign-vehicles (words that carry meaning), (b) which relies solely upon the judgment (which theoretically may range from perceptual discrimination to sheer guesses) of an analyst or group of analysts as to which sign-vehicles fall into which categories, (c) provided that the analyst’s judgments are regarded as the report of a scientific observer, (p. 55)

For the purpose of this analysis, semantical content analysis was conducted to classify sign-vehicles according to their meanings. The interviewers reviewed protocols for three types of semantical content analysis; designations analysis , which determines the frequency with which certain objects are mentioned, attribution analysis , which examines the frequency with which certain characterizations or descriptors are used, assertions analysis , which provides the frequency with which certain objects are characterized in particular ways. Assertions analysis involves combining designation analysis and attribution analysis. Such an analysis often takes the form of a matrix, with objects as columns and descriptors as rows.

Because assertions analysis is the most comprehensive form of semantical analysis, the authors employed this method of examination. Past experience with EBP, levels of dissemination, barriers to dissemination, gaps in dissemination, methods of addressing barriers, results of not using EBP, and the future of EBP were designated as objects and 70 items were designated as descriptors.

Past Experience with EBP

The majority of participants had experience with EBP program design including; running an intervention, evaluating the effectiveness of interventions, the process of forensic evaluation of children referred for sexual abuse, adapting interventions, and coordinating advocacy, policy, technical assistance, and research synthesis efforts at the state level. Beyond program design, participants had developed evidence based interventions, taught EBP in the classroom, and developed tool kit models of EBP.

Levels of Dissemination

The experts had experience with tool kits, literature, and training as methods of disseminating evidence based practice. Inclusion of practitioners in design, developing programs in the communities where they will be implemented, state and agency dissemination, norm changing, appropriate targeting of stakeholders, Requests for Proposals (RFPs) for models, supervision, national networks, quality assurance, and masters education programs were mentioned as means of dissemination they have seen employed. One interviewee said that when evidence based practices are disseminated and implemented they look like “rocket science” in comparison to standard care because standard care is so poor. However, as one expert stated, “there is a lot more ‘talk’ about EBP than actual implementation.”

Interviewees mentioned training time and funding policies as the biggest barriers to implementing EBP. They cited lack of consumer input, lack of practitioner input, lack of translation research, and lack of EBP training in master’s level education as barriers. For example, one expert described how clients may not like interventions based on EBP because practitioners who employ EBPs tend to approach treatment as if they are the experts. However, practitioners need to use EBP and remain open to the idea that the consumer has something to teach.

A lack of practitioner involvement, testing EBP in research labs, limited provider skills, training time, and belief that EBP is too restrictive were each described by the experts as problems. “Most agencies are reactive and just trying to get by. EBP isn’t part of the culture.” Also mentioned were dissent among stakeholders, a lack of education across systems, lack of agency staff, misunderstanding of what EBP is, and professors who do not apply their EBP research to their teaching as ultimate barriers to implementing EBP.

There was less variation in responses to gaps in implementing EBP than in respondents’ description of barriers to implementation. Experts mentioned both the limited research of EBPs and unclear methods of training in EBP as gaps in the system of dissemination. Also cited was a lack of consumer input and the limited number of EBPs, a reluctance to over generalize interventions, and the difficulty of transferring programs from research into practice as limitations. Respondents claimed that lack of education and training in EBP were major problems that keep EBP from being disseminated and implemented in the practice community. One respondent suggested:

The language is off when we talk about dissemination. There is an assumption that development happens in one place and then it is rolled out elsewhere. You can get into trouble with this. You need to include practitioners and support staff. How do they integrate services? Roll-out is rejected by providers because there is no ownership. You need key constituents to sit around the table and create something that will fit–knowledge about practice outside of practice. You have to get practitioners invested in the process of adaptation. Without early involvement of administrators and practitioners, the treatment will not be sustained after the researcher leaves the setting.

Addressing Barriers

To address barriers the respondents recommended ongoing training, EBP in master’s level curriculum, stakeholder buy-in and consumer buy-in. For example, the Gibbs model that incorporates EBP, client preference, and practitioner expertise allows enough flexibility for all parties to feel invested in the intervention. Manualized treatments and beginning research in agencies, as well as tool kits, technical assistance on site, and systemization were identified as effective strategies to overcome the hurdles of disseminating and implementing EBP. According to some of the experts interviewed, state involvement in EBP curriculum for universities has proven to be a good method to address the barriers for disseminating EBPs.

Results of Not Using EBP

Research experts agreed that interventions may not be helpful, and may even be harmful, if they are not backed by research evidence. Some felt that in the future agencies will not be reimbursed if they fail to practice from an evidence base and the field of social work will fail to progress in the absence of EBPs. Social work will continue to be viewed as a second-class citizen in comparison to other professions that are more willing to embrace research evidence.

Respondents offered diverse views of the future of EBP. Some respondents stated that there will be more funding for EBP in the future. On the other hand, other respondents felt that EBP is a buzz term that will probably die out with time. The experts interviewed described the future of EBP moving toward more qualitative methods, training in EBP at the master’s level, incorporation of the art of clinical practice, diverse EBP models, well-developed research on EBP, studies in actual practice settings, and more sophisticated and informed implementation and dissemination efforts.

Strengths, Limitations, and Recommendations

This analysis is limited due to its sample size as well as by the lack of variation of professional affiliation. However, it does provide a starting point for future analysis. It is clear that experts in the field are indeed aware of the gaps and barriers to EBP dissemination. Future efforts would benefit from the incorporation of larger and more varied interview samples that include researchers and educators as well as agency administrators, direct service providers, and consumers of mental health and social work services. Additionally, future researchers should focus their attention on addressing barriers to dissemination and on the opinions and recommendations of other mental health services stake-holders such as clients, community members, and policy makers. Future EBP research needs to focus greater attention on strategies of effectively disseminating the programs that constitute the best practice standards.

The original aim of this study was to build a framework for the dissemination of evidence based mental health practices for social workers in community agencies through a review of the literature and interviews with experts in the field. Both the literature reviewed and the respondents offer similar observations and themes regarding EBP. The greatest agreement between the different researchers was found in the description of gaps and barriers to implementing and disseminating EBP. Problems include poor funding, a lack of training and support for agency staff and practitioners, a lack of consumer involvement, a failure to translate research into practice, and a lack of EBP education, particularly at the master’s level. Interviewees also described efforts to identify the most viable options to address barriers to implementing and disseminating. They, along with other researchers, have identified needs that must be addressed to move EBP forward. If social work does not meet these challenges, practitioners, and community organizations will not be best serving clients and will be in danger of losing competitive funding for services.

Some of the misconceptions about EBPs must be addressed in order to facilitate dissemination and implementation of evidence based interventions. EBPs are not promoted by the experts interviewed in this study as the final draft of best practices for mental health services. Rather, they are being promoted as efficacious treatments for specific disorders in certain populations of individuals suffering from mental illnesses. While further testing is needed to validate findings regarding EBPs for additional mental health disorders and different cultural groups, the information currently available regarding EBPs may be a best beginning practices guide in treatment planning for individuals with mental illnesses. Empirically validated EBPs are not recommended as a ‘magic bullet’ for the treatment of all mental illnesses. Research has, and continues to, explore the populations and disorders that are responding to specific EBPs, develop approaches to the flexible and practical employment of EBPs, and acknowledge that it is equally important to understand when the utilization of EBPs in treatment planning is or is not indicated.

IMPLICATIONS

Perhaps the most important finding of this study with regard to future research is the paucity of studies testing and validating implementation and dissemination strategies. No such studies have been conducted in social work (Gibbs, 2002). This research is needed to meet the growing demand for practitioners to base decisions on evidence. Researchers must also face the challenge of developing collaborative relationships with agencies, practitioners, communities, and clients. If research is not tailored to the questions posed by these stakeholders as well as researchers, the likelihood of its implementation into everyday practice is greatly decreased. The challenge to researchers in academic settings has the added component of focusing on incorporating research on EBPs into teaching curriculum.

Any successful effort toward the dissemination of EBP will have to address the four areas of barriers described in the literature and by respondents: knowledge, lack of fit, suspicion, and resources. Efforts that are not active and multifaceted seem unlikely to succeed. Organizational, practitioner, community, and client buy-in are also essential to a well-formed dissemination approach. Leadership backed by the power to effect change will be crucial. It takes more than an individual practitioner, agency, or educational institution to effect a cultural change within social work mental health services.

Existing frameworks offer a step in the right direction. However, they do not appear to provide a comprehensive and united approach to improving the dissemination of EBPs. Anderson and colleagues’ framework highlights the importance of developing shared goals between community organizations and researchers to combat problems inherent in poor relationships and communication and thus has the potential for impacting all four barriers by increasing coordination, understanding, and efficiency. However, this framework seems overly general. More detailed solutions would assist researchers and community organizations in efforts toward translating research into practice and constructing common goals. Additionally, the question of leadership is not addressed. Forging networks and consensus building can take a heroic effort and consume a considerable amount of time and energy. Strong leadership is needed to catalyze this process of change. Gibbs and Gambrill similarly offer useful approaches, such as involving social work education in the process of change and helping individual workers to be flexible and skilled in processing and applying new research. However, a large burden is placed on the practitioner and the problem of resources in particular is not addressed. Many social workers do not have the time or access to needed resources such as the internet. Rosen and Proctor’s model is more specific than either Anderson and colleagues or Gibbs and Gambrill, however they do not offer solutions to the problems of resources, translation of research into practice, or needed professional and cultural buy-in. While the industry-inspired D&D models offers important insights into how researchers might form a feedback loop with practitioners in the field to form more user-friendly tools, these approach seems limited in its application, particularly in the absence of a sophisticated infrastructure to support activities. General methods such as toolkits and practice guidelines are potentially useful strategies, and may supplement any of the other models. While each framework offers important insights into the best approaches toward the dissemination of EBP, none stands alone or above the rest.

CONCLUSIONS

To encourage practitioners to implement EBPs a unified approach that incorporates the best of all of the strategies outlined above and addresses the major barriers identified in this paper:

• Increase EBP education (particularly at the master’s level) as well as access to high quality continuing education based on EBPs.
• Build partnerships toward sharing EBP resources, including technology, training, and technical assistance, between agencies and practitioners.
• Facilitate buy-in and ownership of EBPs at all levels of stakeholders including practitioners, administrators, researchers, policy makers, and community members.
• Translate research into user-friendly, digestible, and specific approaches, providing tools such as tool kits, guidelines, and technical support to both support and encourage the use of EBPs.
• Improve the communication, feedback loop and relationship between researchers and practitioners.
• Increase the number of EBPs available to the field.
• Test the different types and mechanisms of dissemination, perhaps through analyses based on a taxonomic framework like the one proposed by Walter, Nutley, and Davies, to organize future research efforts.

The most important factor in facilitating change toward the use of research in professional practice is whether or not the profession wants to change ( Naylor, 1995 ). As the call for EBP in mental health services grows, social workers will benefit by being more research-minded and thereby improve services for their clients. The call for the use of research evidence in practice is not limited to a trend of policy, but is also aligned with the professional code of ethics ( NASW, 1996 ) and meeting the expectations of an increasingly savvy consumer movement in mental health ( Mowbray & Holter, 2002 ). Major national reports, which often shape federal and private funding streams, continually call for the use of research-supported interventions. However, policies that encourage, if not require, the use of EBPs cannot succeed without adequate training, resources, technical assistance and other infrastructure support necessary to deliver evidence based mental health interventions, Even if social workers endorse the value of EBP, practitioners and administrators may not have the knowledge or the resources to implement research based practices. The search for research evidence alone is difficult, and the more complicated the decision the less available the evidence ( Gray, 1997 ). Additional demonstration projects, and research and policy efforts aimed at moving EBPs into community-based organizations there-by building professional and organizational capacity are needed to address these and other barriers. Social workers are poised to move this work forward by transferring the increasingly broad and sophisticated body of research mindfully into the hands of the community agencies and practitioners.

Acknowledgments

The authors would like to thank Edward J. Mullen and Sandra Nutley for their assistance with this project. In addition, the contributions of all experts interviewed for this project are gratefully acknowledged.

This work was supported by the National Institute of Mental Health Grant 5T32-MH014623-24.

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This work was presented at the AcademyHealth 2004 Annual Research Meeting, San Diego, CA; the National Service Research Award (NSRA) Trainee Conference, San Diego, CA; and the Fourth International Conference on Social Work in Health and Mental Health, Quebec City, Quebec, Canada.

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Focusing on what matters - research and evidence in social work

Published: 15 November 2018

Since I took up the post of the Chief Social Worker for Adults in England, one of my enduring priorities has been to encourage the development and use of research and evidence to inform social work practice and improve life outcomes for the people we serve.

Understanding which approaches and interventions work best and gathering the evidence to support them is essential. Why must we do this? To sustain and improve social work as part of the wider social care and health offer. This is how we will continue to deliver high quality care and support, centred on people's strengths, needs and aspirations.

For social workers and other social care professionals, having access to quality research and evidence is increasingly important. It supports decision making and challenges ingrained thinking and ways of working that are often taken for granted.

I am really pleased that the NIHR is helping raise the profile, and investing in social care and social work research.

The social care sector must be recognised and valued for the difference it makes to people’s lives and be put on an equal footing with health. Only then can we ensure the whole system really does achieve integrated outcomes for people, making the best use of all available approaches and resources.

The sector itself is recognising this imperative. The Professional Capabilities Framework (PCF) which underpins all social workers’ professional development has been updated to include greater reference to the importance of research and evidence-informed practice.

However, for people in contact with social care services, decisions made about which areas to research can often seem remote and disconnected from the reality of their lives and the things that matter to them.

That is why I am so pleased to welcome the publication of the  James Lind Alliance (JLA)  report setting out the priorities for adult social work research.

Developed using their tried and tested methods, this is the first time anywhere in the world that this kind of research prioritisation has happened for adult social work and the first time the JLA approach has been used in a non-health related area.

Their approach is unique in fully involving people who use services, their carers and practitioners in identifying the questions that social work research should answer. Over 1150 people were involved in narrowing the field to  a final top 10 , which covers a diverse range of issues and themes for adult social work.

This report is a critical first step in helping us to make sure that future research answers the questions that are important, both to social workers and to those who are - or have been - in contact with them. I would ask all of you to read and share this report and to consider developing the research capability in your organisations and partnerships. More than that, I want you to encourage people and their carers, social workers and academics, to come together to shape and use research to make a real difference to people’s lives.

I look forward to working with you as we start the process of turning these questions into research. This is our opportunity to transform the quality of social work practice and social care support for the many individuals and families we strive to help.

• This blog was originally published on  Lyn Romeo's blog on gov.uk .
• The NIHR is running a campaign to raise awareness of social care and social work research. Find out more on the  NIHR website .

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So why is research important to social work?

As social workers, we train to be able to see the multitude of invisible lines within the systems that hold our lives together, or divide us. We learn to recognize the disconnects, and to help our clients figure out how to reconnect the dots. We view the world through a lens of person-in-environment, that is to say, we seek to understand the context in which our clients live.

The social sciences have an inherent obligation not only to keep abreast of current relevant research, but also to be competent enough to apply new treatments and insights within their practice. Social workers are truly dedicated professionals who have to complete a minimum number of continuing education credits to continue practicing. We don’t get to pick and choose the individuals we help, which is why we have to constantly develop our cultural competencies to identify the strengths of those we are helping. So, research is important to social work because it helps us be effective!

According to the NASW, research in social work helps us:

• Assess the needs and resources of people in their environments
• Evaluate the effectiveness of social work services in meeting peoples needs
• Demonstrate relative costs and benefits of social work services
• Advance professional education in light of changing contexts for practice
• Understand the impact of legislation and social policy on the clients and communities we serve (Retrieved from http://www.socialworkpolicy.org/research)

I still do not know what my research question will be for my senior thesis, but I am beginning to pare down some topics that interest me such as:

• Effects of childhood trauma
• The school-to-prison pipeline
• Trauma-informed therapies within prisons
• Effectiveness of prison diversion programs

8 thoughts on “ So why is research important to social work? ”

try explaining in detail

article quite informing for an amateur in research

In doing any of interventions;evidence based is needed. Not intuition,you need to do assessment of the problem before intervention.Then again you need to to evaluation on the service you provided if has positive impact to your client.

It is a very informative piece of work

try explaining in detail the points listed as to where the nexus between Research and Social work lie

are there means to conduct dual research projects with your institutions?

Akulu muziika zithu zonse ap tisamachiteso kuvutika iyayi 😏😏

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Social work research and its relevance to practice: "The gap between research and practice continues to be wide"

The social work profession requires a body of scientific evidence supporting the effectiveness of interventions; yet, the social work scientific community could benefit from strengthening its contribution to the profession’s body of evidence. Through twenty qualitative interviews with social work professors who are employed at four-year academic institutions (referred to as “social work academics”), this study explored how academics define social work research and how they perceive research to inform practice. The data were analyzed along the six steps of thematic analysis, resulting in 13 themes and six sub-themes in relation to the definition of research activity and social work research, the extent to which research informs practice, and the barriers and facilitators to research informing practice. The findings revealed that social work continues to lack a clear definition of research and produces research that only minimally influences practice, often due to the pressure for social work academics to research and publish in support of their career trajectory within academia versus writing for practitioners. The social work profession should take action to address and further research the research-practice disconnect by establishing a clear definition and aims of social work research, and training academics in effective research-to-practice translational methods.

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Whole Person Health: What It Is and Why It's Important

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Whole person health involves looking at the whole person—not just separate organs or body systems—and considering multiple factors that promote either health or disease. It means helping and empowering individuals, families, communities, and populations to improve their health in multiple interconnected biological, behavioral, social, and environmental areas. Instead of just treating a specific disease, whole person health focuses on restoring health, promoting resilience, and preventing diseases across a lifespan.

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Health and disease are not separate, disconnected states but instead occur on a path that can move in two different directions, either toward health or toward disease.

On this path, many factors, including one’s biological makeup; some unhealthy behaviors, such as poor diet, sedentary lifestyle, chronic stress, and poor sleep; as well as social aspects of life—the conditions in which people are born, grow, live, work, and age—can lead to chronic diseases of more than one organ system. On the other hand, self-care, lifestyle, and behavioral interventions may help with the return to health.

Chronic diseases, such as diabetes, cardiovascular disease, obesity, and degenerative joint disease, can also occur with chronic pain, depression, and opioid misuse—all conditions exacerbated by chronic stress. Some chronic diseases increase the immediate and long-term risks with COVID-19 infection. Understanding the condition in which a person has lived, addressing behaviors at an early stage, and managing stress can not only prevent multiple diseases but also help restore health and stop the progression to disease across a person’s lifespan.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} Is whole person health being used now in health care?

Some health care systems and programs are now focusing more on whole person health.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} U.S. Department of Veterans Affairs (VA) Whole Health Approach

The VA’s Whole Health System of Care and Whole Health approach aims to improve the health and well-being of veterans and to address lifestyle and environmental root causes of chronic disease. The approach shifts from a disease-centered focus to a more personalized approach that engages and empowers veterans early in and throughout their lives to prioritize healthy lifestyle changes in areas like nutrition, activity, sleep, relationships, and surroundings. Conventional testing and treatment are combined with complementary and integrative health approaches that may include acupuncture, biofeedback, massage therapy, yoga, and meditation.

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The Total Force Fitness program arose within the U.S. Department of Defense Military Health System in response to the need for a more holistic approach—a focus on the whole person instead of separate parts or only symptoms—to the demands of multiple deployments and the strains on the U.S. Armed Forces and their family members. The focus extends the idea of total fitness to include the health, well-being, and resilience of the whole person, family, community, and U.S. military.

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Established in 2020, the Whole Health Institute’s Whole Health model helps people identify what matters most to them and build a plan for their journey to whole health. The model provides tools to help people take good care of their body, mind, and spirit, and involves working with a health care team as well as tapping into the support of family, friends, and communities.

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The North Carolina Department of Health and Human Services has incorporated a whole person health approach into its health care system by focusing on integrating physical, behavioral, and social health. The state has taken steps to encourage collaborative behavioral health care and help resolve widespread inequities in social conditions, such as housing and nutritious food access.

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The Ornish Program for Reversing Heart Disease is an intensive cardiac rehabilitation program that has been shown to reverse the progression of coronary heart disease through lifestyle changes, without drugs or surgery. The program is covered by Medicare and some health insurance companies. The program’s lifestyle changes include exercise, smoking cessation, stress management, social support, and a whole-foods, plant-based diet low in total fat. The program is offered by a team of health care professionals who provide the support that individuals need to make and maintain lasting changes in lifestyle.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} What does research show about whole person health?

A growing body of research suggests the benefits of healthy behaviors, environments, and policies to maintain health and prevent, treat, and reverse chronic diseases. This research includes several large, long-term epidemiological studies—such as the Framingham Heart Study, Nurses’ Health Study, and Adventist Health Studies—that have evaluated the connections between lifestyle, diet, genetics, health, and disease.

There is a lack, however, of randomized controlled trials and other types of research on multicomponent interventions and whole person health. Challenges come with conducting this type of research and with finding appropriate ways to assess the evidence. But opportunities are emerging to explore new paths toward reliable and rigorous research on whole person health.

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Yes, NCCIH plans to fund research on whole person health . (Details can be found in the NCCIH Strategic Plan FY 2021–2025: Mapping a Pathway to Research on Whole Person Health . )

By deepening the scientific understanding of the connections that exist across the different areas of human health, researchers can better understand how conditions interrelate, identify multicomponent interventions that address these problems, and determine the best ways to support individuals through the full continuum of their health experience, including the return to health.

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Nccih clearinghouse.

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1

Website: https://www.nccih.nih.gov

Email: [email protected] (link sends email)

Know the Science

NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.

Explaining How Research Works (NIH)

Know the Science: How To Make Sense of a Scientific Journal Article

Understanding Clinical Studies (NIH)

A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed .

Website: https://pubmed.ncbi.nlm.nih.gov/

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• Aggarwal M, Ornish D, Josephson R, et al. Closing gaps in lifestyle adherence for secondary prevention of coronary heart disease. American Journal of Cardiology. 2021;145:1-11.
• Centers for Medicare & Medicaid Services. Decision Memo for Intensive Cardiac Rehabilitation (ICR) Program—Dr. Ornish’s Program for Reversing Heart Disease (CAG-00419N). Accessed at https://www.cms.gov/ on April 26, 2021.
• Deuster PA, O’Connor FG. Human performance optimization: culture change and paradigm shift. Journal of Strength and Conditioning Research. 2015;29(suppl 11):S52-S56.
• Gaudet T, Kligler B. Whole health in the whole system of the Veterans Administration: how will we know we have reached this future state? Journal of Alternative and Complementary Medicine. 2019;25(S1):S7-S11.
• Malecki HL, Gollie JM, Scholten J. Physical activity, exercise, whole health, and integrative health coaching. Physical Medicine and Rehabilitation Clinics of North America. 2020;31(4):649-663.
• National Center for Complementary and Integrative Health. NCCIH Strategic Plan FY 2021–2025: Mapping a Pathway to Research on Whole Person Health. National Center for Complementary and Integrative Health website. Accessed at https://www.nccih.nih.gov/about/nccih-strategic-plan-2021-2025 on May 14, 2021.
• North Carolina Department of Health and Human Services website. Healthy Opportunities and Medicaid Transformation. Accessed at https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/healthy-opportunities-pilots/healthy on April 26, 2021.
• Military Health System website. Total Force Fitness. Accessed at https://health.mil/Military-Health-Topics/Total-Force-Fitness on April 26, 2021.
• Tilson EC, Muse A, Colville K, et al. Investing in whole person health: working toward an integration of physical, behavioral, and social health. North Carolina Medical Journal. 2020;81(3):177-180.
• U.S. Department of Veterans Affairs website. Whole Health. Accessed at https://www.va.gov/wholehealth/ on April 26, 2021.
• U.S. Department of Veterans Affairs website. Whole Health Library. Accessed at  https://www.va.gov/wholehealthlibrary/ on April 26, 2021.
• Vodovotz Y, Barnard N, Hu FB, et al. Prioritized research for the prevention, treatment, and reversal of chronic disease: recommendations from the Lifestyle Medicine Research Summit. Frontiers in Medicine (Lausanne). 2020;7:585744.
• Whitehead AM, Kligler B. Innovations in care: complementary and integrative health in the Veterans Health Administration Whole Health System. Medical Care. 2020;58(9S)(suppl 2):S78-S79.

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• Alborzkouh P, Nabati M, Zainali M, et al. A review of the effectiveness of stress management skills training on academic vitality and psychological well-being of college students. Journal of Medicine and Life. 2015;8(4):39-44.
• Bisht K, Sharma K, Tremblay M-È. Chronic stress as a risk factor for Alzheimer's disease: roles of microglia-mediated synaptic remodeling, inflammation, and oxidative stress. Neurobiology of Stress. 2018;9:9-21.
• Buettner D, Skemp S. Blue Zones: lessons from the world’s longest lived. American Journal of Lifestyle Medicine. 2016;10(5):318-321.
• Chen T-L, Chang S-C, Hsieh H-F, et al. Effects of mindfulness-based stress reduction on sleep quality and mental health for insomnia patients: a meta-analysis. Journal of Psychosomatic Research. 2020;135:110144.
• Conversano C, Orrù G, Pozza A, et al. Is mindfulness-based stress reduction effective for people with hypertension? A systematic review and meta-analysis of 30 years of evidence. International Journal of Environmental Research and Public Health. 2021;18(6):2882.
• Katz DL, Karlsen MC, Chung M, et al. Hierarchies of evidence applied to lifestyle medicine (HEALM): introduction of a strength-of-evidence approach based on a methodological systematic review. BMC Medical Research Methodology. 2019;19(1):178.
• Kruk J, Aboul-Enein BH, Bernstein J, et al. Psychological stress and cellular aging in cancer: a meta-analysis. Oxidative Medicine and Cellular Longevity. 2019;2019:1270397.
• Levesque C. Therapeutic lifestyle changes for diabetes mellitus. Nursing Clinics of North America. 2017;52(4):679-692.
• Ni Y, Ma L, Li J. Effects of mindfulness-based stress reduction and mindfulness-based cognitive therapy in people with diabetes: a systematic review and meta-analysis. Journal of Nursing Scholarship. 2020;52(4):379-388.
• Ornish Lifestyle Medicine website. The Ornish Reversal Program: Intensive Cardiac Rehabilitation. Accessed at https://www.ornish.com/intensive-cardiac-rehab/ on April 26, 2021.
• Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annual Review of Clinical Psychology. 2005;1:607-628.
• Seal KH, Becker WC, Murphy JL, et al. Whole Health Options and Pain Education (wHOPE): a pragmatic trial comparing whole health team vs primary care group education to promote nonpharmacological strategies to improve pain, functioning, and quality of life in veterans—rationale, methods, and implementation. Pain Medicine. 2020;21(suppl 2):S91-S99.
• Tamashiro KL, Sakai RR, Shively CA, et al. Chronic stress, metabolism, and metabolic syndrome. Stress. 2011;14(5):468-474.
• Whayne TF Jr, Saha SP. Genetic risk, adherence to a healthy lifestyle, and ischemic heart disease. Current Cardiology Reports. 2019;21(1):1.
• Whole Health Institute website. Accessed at https://www.wholehealth.org/ on May 19, 2021.

Acknowledgments

NCCIH thanks Mary Beth Kester, M.S., and Helene M. Langevin, M.D., NCCIH, for their review of this publication.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

Related Topics

NCCIH Strategic Plan FY 2021–⁠2025 Mapping a Pathway to Research on Whole Person Health

Methodological Approaches for Whole Person Research Workshop

Transforming Veterans’ Health: Implementing a Whole Health System of Care

Complementary, Alternative, or Integrative Health: What’s In a Name?