On the Sidelines of Guidelines: Further Thoughts on the Fit Between Clinical Guidelines and Social Work Practice

Abstract

Professors Howard and Jenson identify numerous potential benefits of clinical practice guidelines. We welcome the opportunity to join the dialogue and organize our comments around five questions: (a) Do guidelines ensure positive client outcomes? (b) Are published treatment outcome studies adequately representative of the universe of empirical knowledge about what works with diverse client problems and populations? (c) How can guidelines be integrated with professional decision making? (d) Will implementing guidelines translate into greater client compliance? (e) What is the fit between guidelines and paradigms of direct social work practice?

Integrating Evidence-Based Practice and Social Work Field Education

“…The challenges of translating research into practice have created several ongoing tensions between researchers and practitioners over: (1) the definition of evidence (Crisp, 2004;Raines, 2004;Shlonsky & Gibbs, 2004;Witkin & Harrison, 2001); (2) implementation of evidence into "best practices" (Ferlie, Fitzgerald, & Wood, 2000;Gonzales, Ringeisen, & Chambers, 2002;Hoagwood, 2002;Hoge, Huey, & O'Connell, 2004); and (3) development of empirically-based practice guidelines (Howard & Jenson, 1999;Jackson, 1999;Kirk, 1999;Nathan, 1998;Richey & Roffman, 1999;Williams & Lanigan, 1999).…”

The Role of Science in Social Work

“…Moreover, guidelines need to grapple with the multiple meanings 'effectiveness' may have across different stakeholders, a phenomenon that has been well documented (Lambert and Hill, 1994). Richey and Roffman (1999) pose an additional challenge. Guidelines in medicine and psychiatry have focused on treatment of the patient.…”

Barriers to Development, Utilization, and Evaluation of Social Work Practice Guidelines: Toward an Action Plan for Social Work

“…Several additional aspects of the social work scientific literature relevant to guideline de-velopment were addressed by other respondents. Richey and Roffman (1999) asked whether "published studies [are] truly representative of what is known about what works with whom and in what contexts" (p. 313) and requested that we address the potential effects of publication bias on guideline development. Wambach et al (1999) and Kirk (1999) described features of controlled clinical trials that limit the generalizability of their findings to realworld settings.…”

“…Although each of the issues raised by Richey and Roffman (1999), Wambach et al (1999), and Kirk (1999) is an important consideration in assessing the relevance of published clinical research to practice generally, none of these concerns is specific to the practice guideline movement. That is, any proponent of empirically based practice must grapple with the potentially misleading effects of publication bias and excessive dependence on the findings of highly controlled (and therefore artificial) studies on our current understanding of effective clinical practices.…”

“…Guidelines that present detailed, behaviorally specific, and sequential recommendations for practitioner conduct are much more likely to be consistently and effectively implemented than those that are general or nondirective in nature. Although it is true that guidelines will never be so detailed or directive as to obviate the need for sound analytic judgment on the part of practitioners (Richey & Roffman, 1999), it is critically important that guidelines are well operationalized; to the extent that they are not, their value to practitioners is diminished. Kirk's (1999) contention that because many practitioners fail to read scientific articles or to subscribe to academic journals that it is unlikely they will read guidelines may be erroneous.…”