In 2006, the National Institutes of Health (NIH) Office of Behavioral and Social Science Research (OBSSR) commissioned the second author to undertake a project to harmonize the EBP approach to behavioral health interventions and support communication and collaboration across health disciplines. The resulting interprofessional Council for Training in Evidence-Based Behavioral Practice and its scientific and practitioner advisory boards include EBP experts from medicine, nursing, psychology, social work, public health, and library sciences (www.ebbp.org
). The group collaborated to create a trans-disciplinary model of EBP. 18
The EBBP model, process, and resources are discussed here because they are purposely interdisciplinary and have been implemented successfully in both academic and practice settings. Each discipline represented in the Council brought its own profession-specific perspectives, language, and resource base to the development of the model, process, and competencies for health care providers. 22
The Council implements objectives of the EBBP project with input from a Scientific Advisory Board and expert consultants.
The EBBP conceptual model (see ) uses an ecological framework as its foundation, and reflects shared decision-making among the practitioner, patient, and other affected stakeholders. 18
This ecological framework posits that in order to promote change, one must influence multiple levels that include interpersonal, organizational, community, and public policy. The model was developed after review of existing EBP conceptual models from each discipline that represent how evidence-based decisions are made in practice. Details of the development of the conceptual model are published elsewhere. 18
The Trans-disciplinary Model of Evidence-based Practice (EBP) and Health Professionals’ Roles in EBP
uses the EBBP conceptual model to illustrate the role of clinicians, evidence synthesizers, and researchers in evidence-based decision making in the EBBP model. Primary researchers generate evidence for practice. Those that conduct systematic review synthesize evidence for practice (e.g., Cochrane) and those that generate recommendations use systematic reviews (e.g., USPSTF). Health care practitioners incorporate all components of the model, including the best available research evidence (i.e., research studies and systematic reviews), patient characteristics (condition, needs, values, and preferences), resources (i.e., provider expertise) into health care decisions within a specific environment and organizational context. 18
Clinical decisions are based on the best available research evidence (randomized controlled trials, quasi-experimental and non-experimental or systematic reviews of research) practitioner expertise, patient (client)/population characteristics/ needs, values, and preferences, within a specific organizational context). 18, 23
Decision-making is the core concept that ties the other three together, and all action transpires within an organizational context.
In addition to a conceptual model, EBP entails a five-step process to synthesize research evidence by all the professions delivering care as a team: 1) Ask, 2) Acquire, 3) Appraise, 4) Apply, and 5) Analyze and Adjust. 23
describes the interprofessional provider competencies developed to clearly define the requisite provider skills and knowledge competencies necessary to implement the model and improve overall care. 24
Skills and Competencies for Evidence-based Behavioral Practice
The EBBP website (www.ebbp.org
) includes tools to help educators teach EBP and disseminate information about concepts and methods used in EBP. 25
Learning materials are also available to help providers acquire skills to perform the EBP process. Since its launch November 2008, EBBP’s website has attracted 20,775 visits (13,096 unique visitors) from 111 countries.
Five training modules are publically available to educators who teach graduate level EBP courses and can be used by any health professions educator. The modules include the EBP process, search for evidence, systematic review, randomized controlled trials, and critical appraisal of research methods. The intended audience is interprofessional and includes both researchers and practitioners. These interactive EBBP learning modules have been incorporated into graduate and post-graduate training of health professionals in the U. S., Canada, and Australia. According to the registration database, physicians, nurses, social workers, psychologists, and public health workers have all completed the modules. Comparison of pre- and post-test scores shows significant improvements in attitudes, skills, and knowledge about EBP. Qualitative evaluations have been favorable, with 80% indicating that the modules met or exceeded their expectations.
Evaluation of the model, process and tools has not focused on assessment of actual skills learned and implemented to date. Three Council members are conducting a randomized controlled trial funded by Robert Wood Johnson Foundation in 10 acute care hospitals to test the effect of the EBBP model and process on nurse evidence adoption, knowledge and skills. An important next step for the Council is to develop an implementation resource or tool kit to assist organizations in the implementation of evidence in practice settings.
Council members have also embarked on training and education initiatives for each discipline. Specific efforts to date have focused on psychology (Society of Behavioral Medicine) and medicine (Society of General Internal Medicine), with future continuing education planned for nursing, public health, and social work. Continuing education (CE) is important in parallel to academic infusion. Continuing education credit is available online on the EBBP website through the APA Office of Continuing Education in Psychology, Accreditation Council for Continuing Medical Education (ACCME), the American Nurses Credentialing Center (ANCC).
EBBP, Cochrane, and the USPSTF are all examples of interdisciplinary models with associated processes that support evidence-based shared decision-making on interprofessional health care teams. The steps in EBP go beyond asking a question and acquiring and appraising evidence. A major activity of interdisciplinary practice is in the application and evaluation of evidence in the practice setting. With few exceptions, however, the level of interdisciplinary activity is far too low within academic and clinical settings. What will it take to accelerate such activities?