关于循证实践的一场辩论

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  Can science solve social problems? That’s the question at the heart of the debate over “evidence-based practice,” the use of approaches that have been studied and found to be effective at helping people deal with a particular problem (such as homelessness and family conflict) or preventing problems (such as teen pregnancy and substance use).
  Social work professors Alex Gitterman and Carolyn Knight, writing in the pages of the journal, Families in Society, argue that their profession is as much an art as a science. They contend that evidence-based practice favors evidence at the expense of clients’ needs and wishes and social workers’ knowledge of theory and practice. Evidence-based practice, as currently promoted by its proponents, they write, limits social workers’ creativity and ignores the bigger problems that many social work clients face, like poverty and underfunded schools.
  Gitterman and Knight propose a new term, “evidence-guided practice,” that attempts to balance scientific research, social work theory and the “practice wisdom” gained by social workers in their day-to-day interactions with clients. Such an approach, they say, would capitalize on our knowledge about what works while granting social workers “the autonomy and flexibility to improvise and to be spontaneous.” They write:
  The worlds of theory and research are logical, orderly, and sequential. In contrast, the lives of people are confusing, disorderly, and contemporaneous. The very act of finding the connections among theory, research, and practice often requires a great deal of curiosity and creativity.
  Spirit of Debate
  As a counterpoint, Families in Society invited social work professor and evidence-based practice proponent Bruce Thyer to respond to Gitterman and Knight’s article. He argues that evidence-based practice already is a holistic approach that encourages practitioners to choose the best intervention that is appropriate for the client—not necessarily the intervention with the most evidence behind it. Thyer also contends that while social work theories could be integrated into evidence-based practice, perhaps eschewing them is best, writing:
  Though there is nothing as practical as a good theory, there is also nothing as harmful as a bad one (Thyer, 2012). Many theories in social work have been and are actively injurious to practitioners and clients. They waste our time, most are not well-supported empirically, and many have led to the development of interventions which do not work and in some cases are harmful. Give me a good empirical study over theoretical speculation any time.   Overall, Thyer argues that Gitterman and Knight are basically supporting evidence-based practice under a different name. But Gitterman and Knight are not convinced. In their response to Thyer’s response, the two make a plea for the social work profession to come together, rather than divide over evidence-based practice:
  We ask our professional colleagues to engage in the intellectual struggle of finding the realities to which research, theory, and practice wisdom belong together rather than to make antagonists of them. This effort will help all of us to find the realities to which each belongs, and to unite rather than separate and divide the profession.
  The overall gist of the debate seems to point to a need to define in a consistent way how social workers can balance research and practice to improve and create successful programs.
  (All articles in this FORUM column are contributed by National Clearinghouse on Families & Youth, a service of the Family and Youth Services Bureau of the U.S. Department of Health and Human Services. )
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