Abstract
This reviewer has taught a three-credit master-level course designed to help social work students learn how to practice evidence-based practices (EBP). Upon meeting a new class each semester, a challenge always arises, which appears partly triggered by the course description in an online registration system that states the course will teach EBP. After reading the course description, many students automatically build a far-fetched expectation that they will learn a multitude of interventions that are supported by research evidence. This expectation is impossible to meet with a three-credit course that evolved from a research methods course from the pre-EBP era. The narrow content of each instructor’s expertise has also limited the capacity to deliver hundreds of research-supported treatments scattered around different problem areas (e.g., substance abuse, schizophrenia) and demographic groups that students are passionate about. Research-supported treatments not only exist in the social work literature but also for other disciplines addressing the biopsychosocial needs of human beings (e.g., public health, psychology). With this concern in mind, Dr. Thomas O’Hare provides a glimmer of hope to overcome this challenge.
This book is a well-constructed building of cohesively and congruently combined basic materials such as bricks, a steel infrastructure, and interior finishing. It was originally published in 2005, and this review examines the third edition, which incorporates recently available peer-reviewed references about research-supported treatments and academic discourses (e.g., cultural competency) relevant to EBP. It aims to deliver a well-organized collection of existing research-supported treatments possibly applicable to social work practice settings, which are “rapidly expanding” (p. ⅺ). Not only addressing adults with a mental illness and substance abuse problems defined in the Diagnostic and Statistical Manual of Mental Disorder, some chapters are dedicated to helping clients with nonclinical symptoms such as marital conflict. Readers will readily discover a congruent and consistent presentation of problem-solving processes and strategies relying on tenets of EBP for groups with challenges that span mental and substance abuse problems, lack of social support, financial difficulties, and other stressors. This rich portfolio of challenges and their clinical solutions will definitely help students graduating from master of social work (MSW) programs, attracting them to keep this book as a useful reference.
The book has two sections, each with a different goal. Part 1, Chapters 1–4, presents frameworks and theories that social workers should know in order to implement EBP. To achieve this goal, the author introduces a definition and working model for EBP for social workers (Chapter 1); presents a compilation of assessments that focus on three measurement objectives, “dimensionality,” “functionality,” and “a systems perspective,” that are exemplified by a case study at the end of each chapter that offers guidance to implement EBP with a client with specific behavioral health services (Chapter 2); strategies to select and implement interventions supported by empirical evidence from controlled trials (Chapter 3); and diverse approaches for evaluation and monitoring that include single-system and group designs (Chapter 4).
Parts 2 and 3 offer 12 chapters that are written in the same structure and format, which helps digest information, even if the topic may not be familiar to the reader. They summarize existing research-supported treatments, offering students and social workers an overview of relevant interventions that they can use in diverse circumstances. The chapters collectively demonstrate the scope of behavioral problems, potentially appropriate instruments to measure relevant symptoms and functionality, a portfolio of interventions tested for efficacy in treating symptoms and improving quality of life among people with a particular behavioral issue (e.g., schizophrenia), and a hypothetical evaluative approach for monitoring key outcomes. This book clearly offers benefits to social work students and practitioners who need a collection of research evidences for assessment, intervention, and strategies to monitor and evaluate progress with each client.
A positive aspect of this book is that it is a well-packaged reference for prevalent mental illnesses and behavioral problems. Chapters 5–16 begin with the introduction of diagnostic criteria for a particular illness; major symptoms; brief epidemiological data, such as prevalence of the mental illness; and relevant demographic and clinical factors that clinicians should consider while assessing the scope of the client’s problems, as well as available resources. Descriptions of assessments used for evaluating symptoms and relevant psychosocial functioning are presented. Offering an assessment relevant to the focal behavioral health issue distinguishes this book from others about EBP. For instance, Chapter 9 focuses on post-traumatic stress disorder (PTSD) and presents an original version of the PTSD Symptoms Scale Interview inside the chapter (pp. 294–295), which will save some readers search time. Readers will find a more expansive portfolio of useful instruments in the appendix. Then, a collection of existing research-supported treatments and an elaboration of what specific therapeutic activities comprise research-supported treatments introduced in the chapter follows. The detailed description of services and activities that are packaged as research-supported treatment is quite informative.
A perk comes near the end of each chapter of Parts 2 and 3, where the author offers a case study of a hypothetical client with the focal behavioral health problem of that chapter. In addition to encyclopedic coverage of research-supported treatments for a variety of behavioral health needs, the author made an excellent decision to include real-life scenarios at the end of Chapters 5–16. This will help readers engage in vicarious modeling, and rehearse meaningful services and activities, for the behavioral health problem of that chapter. The case studies demonstrate an example of implementing EBPSW, given client’s symptoms, demographic and clinical characteristics, and practice contexts. The author has done a superb job with providing detailed description of circumstances for and unmet need of a client featured in each case studies, instructors who choose to use this book for a textbook will be well-equipped to promote group discussion of what students would do as a social worker, if they had such a client.
Another area of strength is the critical assessment of existing debates surrounding EBP, covered in Part 1. The coverage of the way that cultural competency is accepted by the practitioner was interesting. The author rightly pointed out that there is poor agreement and operationalization of what efforts would improve cultural competency of EBP. It is beneficial to introduce a debate over what specific adaptations (e.g., language) could effectively improve cultural competency and what existing frameworks are available that guide the process of enhancing cultural competency. The coverage of the debate over the extent that practitioners should comply with manualized guidance is also informative. The growing availability of manuals for research-supported treatments creates another area of contention, as many social workers feel a dilemma in whether to comply with a manual for the sake of good fidelity. At the same time, social workers have difficulty with considering a client’s unique characteristics and contexts, and meeting their needs, by giving up flexibility.
I have a few thoughts about revision of the next edition, if there is one, of which the author may already be aware. This book is quite heavy to digest, which may give instructors a pause before adopting it as a textbook for a semester-long course, even at the graduate level. After spending many hours, I reached the end of the 666-page book, fairly exhausted by having been bombarded with so much information. Extensive coverage of research-supported treatments for 12 problem areas has inevitably produced a vast amount of information. Yet many social work students who normally take 15 credits of courses, as well as participate in 18 hr of field education, would not be able to complete reading this book in a single semester. Also, a lack of visual aids that encapsulate key ideas and facts is another hurdle for efficient consumption of the invaluable information in this book. The existing visual aids are still too wordy and somewhat fuzzy, and that could limit student comprehension of figure contents.
Intentional avoidance appears to exist when it comes to offering a more inclusive discussion about the definition of EBP. This absence may be a point of contention rather than a weakness. In the preface, the author said that, I have also side-stepped some academic debates over semantics and straw man issues regarding the definition and meaning of evidence-based practice and other matters concerning education, dissemination, training, administration, and policy. (p. ⅹⅰⅰⅰ)
However, this voluntary avoidance may not help instructors who, at the first meeting, have to manage discussion with students regarding the definition and scope of EBP. This book sees EBP as an “intervention” that has convincing research evidence from “controlled trials” (p. ⅸ), which could garner objections from some (e.g., Thyer & Pignotti, 2011). To subdue confusion among students and social workers concerning terminology, there have been efforts to articulate that EBP refers to two different constructs (Oh et al., 2020; Rubin & Bellamy, 2012; Thyer & Pignotti, 2011). The definition in the preface covers only one, what could be called the research-supported intervention or empirically supported treatment (Thyer & Pignotti, 2011). The second construct is the EBP process model, which refers to the process by which the social worker determines distinctive stages of behavior and from that determines best interventions while keeping in mind the idiosyncratic nature of the client’s situation (Rubin & Bellamy, 2012). This book does not entirely ignore the existence of the practice model which is part of EBP. For instance, Chapter 1 highlights “procedural framework” (p. 10) that schematizes a protocol to entail a research-supported treatment into practice. The author seems to have implied that the EBP process model may not be positioned in the comparable status that the research-supported intervention occupies within the discourse of the EBP, likely to weaken the significance of the EBP process model while training students and social workers. In addition to knowing numerous research-supported interventions, it is important to teach how to competently implement the EBP process model in different practice situations.
To prevent such a misconception, the author could have amplified the portion that talks about the EBP process model available in literature (Rubin & Bellamy, 2012; Sackett et al., 1996). Distinguishing between these two constructs of EBP would offer novel insights into the barriers MSW students would encounter when implementing either model when delivering services based on tenets of EBP (Oh et al., 2020). In other words, more weight could be given to the EBP process model in conjunction with hundreds of research-supported treatments highlighted.
This book is an impeccable reference that social workers are encouraged to own and keep on their office desk. In addition to a massive collection of 3 decades of published references relevant to research-supported treatments, the elaboration of therapeutic activities for a hypothetical client in 12 areas of behavioral health issues will provide endless wisdom to readers regarding successful implementation of EBP.
