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Macro Practice Teaching andCurriculum Development From an

Evidence-Based Perspective

John C. Bricout

David E. Pollio

Tonya Edmond

Amanda Moore McBride

ABSTRACT. This article contributes to the discourse around evi-dence-based practice (EBP) as an organizing principle and guidingframework for macro-practice education as it has developed in theGeorge Warren Brown School of Social Work at Washington Univer-sity in St. Louis. In examining the first five years of implementingevidence-based education at the macro level, some lessons learnedare provided. This learning has opened the door for continuing thedialogue on surmounting the challenges around training macro socialworkers in evidence-based practices. The overarching challenge inintegrating EBP into the curriculum lies in the complexity of themulti-dimensional conceptualization of evidence.

KEYWORDS. Macro practice, evidence-based education, curricu-lum development

John C. Bricout, PhD, Associate Professor, David E. Pollio, PhD, AssociateProfessor, Tonya Edmond, PhD, Associate Professor, and Amanda Moore McBride,PhD, Assistant Professor, are affiliated with the George Warren Brown School ofSocial Work, Washington University in St. Louis, Missouri.

Address correspondence to: John C. Bricout, George Warren Brown School ofSocial Work, Washington University in St. Louis, St. Louis, MO 63130 (E-mail:[email protected]).

Journal of Evidence-Based Social Work, Vol. 5(3–4) 2008http://www.haworthpress.com/web/JEBSW

© 2008 by The Haworth Press, Inc. All rights reserved.doi: 10.1080/15433710802084334 597

598 JOURNAL OF EVIDENCE-BASED SOCIAL WORK

Evidence-based practice (EBP) represents an emerging approachto grounding scientific and professional knowledge development insocial work education. The benefits of instituting EBP as a guidingprinciple in social work curriculum development have been exploredin the context of the United States (Drake, Hovmand, Jonson-Reid, &Zayas, 2007; Howard, McMillan, & Pollio, 2003; Zayas, Gonzalez,& Hanson, 2003) and internationally (Karvinen-Niinikoski, 2005).Meanwhile, the Council on Social Work Education (CSWE) (2004)has made evidence-based curriculum a new educational standard (forexample, see Zaparanick & Wodarski, 2004). The appearance of textsfocusing on teaching EBP (Cournoyer, 2004; Gibbs, 2003) has her-alded the emergence of EBP as an articulated approach to graduateeducation. Discussions in social work related to EBP have primarilyfocused on direct or micro practice, probably reflecting the clinicaltreatment roots of EBP, with a notable exception being Gambrill’s(2006) analysis of EBP policy implications and the systemic nature ofEBP. The impact of the EBP movement on macro practice in socialwork is far less clear, due in large measure to some of the uniqueproperties of macro practice.

Although it could be argued that macro practice has historicallybeen closely aligned with empirical evidence gathering and analysis,the articulation of how this is integrated into education and trainingin the EBP has proceeded rather more slowly. This may be, in part,because of the conceptual gap between evidence as construed formicro practice, and the more contextual and complex domain of macropractice. In macro practice, where the environment (social, physical,political, economic) is the primary target for change, context plays acritical role in the design, implementation, and evolution of evidence-based practices, informing the systems in which community and pol-icy interventions take place, generating opportunities, and imposingconstraints (Flybjerg, 2001).

The primary purpose of this article is to contribute to the discoursearound EBP as an organizing principle and guiding framework formacro practice education. After briefly defining macro practice insocial work, we review the empirical and theoretical literature thatdemarcates the unique attributes of EBP in the macro context. Theapproach to teaching macro EBP in the George Warren Brown Schoolof Social Work at Washington University in St. Louis (hereafter, theBrown School) is described, both its theoretical underpinnings andpraxis, or practical application. Subsequently, some of the challengesin teaching macro EBP and the lessons learned are recounted. Finally,we reflect upon the future of macro EBP instruction suggested by the

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lessons learned. We do not offer the EBP curriculum as it is emerginghere at the Brown School of Social Work as either a finished product oras a “best practice” for implementing the EBP curriculum. Rather, it isour intention to present the emerging realizations stemming from thefirst several years of grappling with implementing EBP, particularlyfor macro populations. Our purpose is to make a contribution to theongoing development of the macro EBP approach in graduate socialwork education.

DEFINING MACRO PRACTICE

Macro social work practice focuses on the “large scale” in contrastto micro (“small scale”) social work practice. Scale refers to the sizeof the social system that is being influenced, with macro practiceengaging larger social aggregates, such as organizations, communities,and even societies, while micro practice focuses on individuals andfamilies. The size of the social system is not the only factor differ-entiating micro and macro practice. Micro social work is primarilyaimed at influencing the behaviors of individuals, whereas macrosocial work is chiefly aimed at influencing the behavior of largersystems, or the environments of community and neighborhood groups.Rather than seek to provide individuals or family members withthe skills to navigate a health care delivery system, for example, amacro practitioner would seek to provide consumers with the nec-essary skills to make the health care delivery system and relevantpolicies more responsive to consumer needs (Long, Tice, & Morrison2006). Macro-focused social work includes roles and activities suchas social planning, community organizing, program evaluation, policydevelopment, administration, and lobbying. Social work practice inthe policy arena is defined as encompassing the roles of advocate,policy analyst, lobbyist, and policy maker guided by social justiceprinciples (Adams, 2004; Mendes, 2003). Micro social work, some-times called direct practice, encompasses activities and roles suchas case management and counseling (Freddolino & Knaggs, 2005;Harrigan, Fauri, & Netting, 1998; Long et al., 2006). Some system-influencing skills relevant to macro practice are advocacy, evaluativeresearch, coalition-building, community organizing, policy making,and organizational change skills, to name but a few.

Social work is ecological by its very nature and sensitive to thedifferent levels of what Netting and O’Connor (2005) call “servicework” that links micro roles, typically involving one-on-one service


relationships, and macro roles, usually involving larger entities (suchas organizations or institutions) or social aggregates (such as groupsand communities). It is readily apparent that social workers in eitherrole (macro or micro) will inevitably be called upon to function in theother domain. Although conceptually distinct, the micro and macrodomains are in fact permeable in practice, because of the overlapin required skills. Negotiation skills are needed for bargaining withsocial entities (such as institutions) and for working with individualclients. Due to the larger systemic frameworks from which socialworkers operate, skills influencing the participatory process capacitybuilding process and resource-building process are needed (Boehm,2003; Chaskin, 2001; Donaldson, 2004; Long et al., 2006; Neuge-boren, 1996; Secret, Jordan, & Ford, 1999).

Macro and micro practitioners may, for example, share a commoncommitment to therapeutic interventions and a systems approach, butthe target of the intervention will have very different properties andtherefore pose different challenges. For example, an agency-basedmacro practitioner working with social action groups aimed at collec-tive action targets the empowerment of the participants as a therapeuticaim, while also seeking to leverage the social justice mission of theagency in the process (Donaldson, 2004). This intervention involvestwo complex entities, the group and the agency, for which the metricsof intervention effectiveness are far less well defined than for anindividual. Aims of macro practice interventions also include system-focused change, for example, altered collective stakeholder participa-tory practices resulting from social action groups, in addition to moregroup intervention-specific aims, such as increased collective efficacy(Donaldson, 2004). Moreover, macro interventions are often less read-ily reduced to reproducible, context-free, discrete operations. Hence,the macro practitioner must be trained and educated to work withlarger, more ambiguous, and complex systems while using less well-defined, less controlled, and less readily measurable interventions.

EBP IN THE MACRO CONTEXT

Defining EBP

Practice that is evidence-based is characterized by the judicioususe of the best-available scientific evidence in conjunction with pro-fessional wisdom and ethics to optimize outcomes in real-world situ-ations (Blisker & Goldner, 2000; Gambrill, 2004; Pollio, 2002, 2006).

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Evidence-based practice thus encompasses both a process and a prod-uct. As a process, EBP refers to the manner in which the social workermethodically culls the best available scientific evidence and uses thatevidence guided by professional experience and values and ethics (i.e.,professional wisdom) to obtain outcomes that reflect client preferencesas well as professional judgment. As a product, EBP refers to themost effective practices, treatments, interventions, and protocols thatare based on the most rigorous scientific evidence available (Gambrill,2004). In order to keep the two meanings sharply delineated in ourdiscussion, we will refer to the process as EBP and specific evidence-based practices as EBPs.

EBP has been described as a paradigm (Gambrill, 2006), as adecision-making tool (Howard, Bricout, Edmond, Elze, & Jenson,2003), and as constantly devolving (Gambrill, 2006; Proctor, 2004).Hence, evidence-based practice is at once a world view, a guide forpractice, and a work in progress. As a world view, EBP stipulatesthat drawing upon the evidentiary basis for social work practice,including open admission of gaps in the knowledge base, is a moraland ethical imperative for professional social work practice (Gam-brill, 2006). In the guise of a decision-making tool, EBP informsempirically derived guidelines that increase the effectiveness of socialwork practice, without being prescriptive in nature (Howard et al.,2003). With respect to the ongoing development of EBP as a work inprogress, extant EBPs are always subject to evidentiary tests togetherwith practitioner judgments (Proctor, 2004). Moreover, the notion ofwhat are the proper foundations for claiming that a practice rises tothe level of an EBP (product), and the notion of what EBP entailsin different practice environments (i.e., medicine versus public healthor micro practice versus macro practice) is also evolving over time(Anderson et al., 2005; Dobrow, Goel, & Upshur, 2004; Fielding &Briss, 2006; Hausman, 2002; Jones & Santaguida, 2005; Kerner, 2006;Kohatsu, Robinson, & Torner, 2004; McQueen, 2001; Miller & Shinn,2005).

Within micro practice, the strictest definition of evidence suitablefor EBP includes EBPs developed through randomized controlled tri-als (RCT) and evidence of service or treatment effectiveness and costeffectiveness, in the name of providing the highest possible qualityof care (Rychetnik, Frommer, Hawe, & Shiell, 2002). This emphasison effectiveness absent the consideration of client preferences andperspectives has been criticized as reductionistic and detrimental tothe quality of services (Anthony, Rogers, & Farkas, 2003). Con-trolling for the potential for bias through more rigorous research,


within the constraints posed by ethical and pragmatic (i.e., resource)considerations, is often considered critical to the production of goodevidence (Rychetnik et al., 2002; Sackett, 2002). At the same timeas a stricter interpretation of evidence is the focus in the literature,within micro practice there remains an ongoing debate about the artof practice and the need to include multiple types of knowledge inmaking practice decisions, including clinician-generated informationand practice wisdom (Pollio, 2006).

This discussion about what is included as evidence is directlyapplicable to macro practice. For macro practice, where policies areoften developed in response to changes in context and where needsare often couched within unique contexts, evidence might be broadlydefined compared to micro practice. The evidence base for macro-level EBPs may be based in other forms of scientific research thanRCTs. For example, in the instance of an integrated community devel-opment/conflict resolution strategy, best practice may be establishedthrough international case studies (O’Brien, 2005). Population studieson health inequalities have formed the basis for developing possiblehealth disparity-sensitive EBPs (Lynam, 2005). Using multi-nationalcase study, interview, and observational data, Lewis (2004) suggestspathways for adapting an established macro-level EBP, micro financ-ing, for use by women with a disability. Sound arguments can bemarshaled in support of the notion that at the macro level of practice,good evidence should include political and practical concerns thatreflect both the priorities of the stakeholders and the realities ofthe policy environments and service systems through which they areimplemented, which implies a wide gamut of best available (i.e.,most rigorous available) qualitative and quantitative methodologiesto capture those elements (Dobrow et al., 2004; Kellam & Langevin,2003; Loisel et al., 2003; Ogilvie, Egan, Hamilton, & Petticrew, 2005;Rychetnik et al., 2002).

EBP in the Macro Practice Environment

The macro practice environment, as we have defined it, includesorganizational, community, and policy practice. Understanding thechallenges faced in moving toward EBP instruction requires somediscussion of evidence within macro practice, as well as an exami-nation of specific methodologies with direct application to the macroenvironment. In this section, we will lay out the macro practice en-vironment and EBP, as well as differences between micro and macro

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constructs. In what follows, we address a range of issues unique to themacro practice environment, including the nature of the environment,ethics, values, assessment methods and procedures, and the weighingof evidence.

Community practice in social work is understood to include ser-vices directed at individuals in the community (i.e., Gould, 2006;Hardiman, Theriot, & Hodges, 2005) and neighborhood or collectivecommunity action (Chaskin, 2001; Ohmer & Korr, 2006). As such,it is inclusive of community development and community organiz-ing as well as community-based service provision. Community-basedservices exist in an environment that is far less controlled than thatof micro settings, which poses serious challenges to the effectivenessof EBP whose efficacy is generally established in near-ideal (i.e.,controlled) conditions. From the standpoint of macro practice, theinput of stakeholders (such as community members, service providers,and policy makers) is critical to the weighing, significance, and evenmeaning of evidence gathered by various means (Kellam & Langevin,2003). For example, in response to the need to implement an RCT-developed return-to-work program for persons with a disability forwidespread adoption in the Province of Quebec, Loisel and colleagues(2003) adapted the model program using inputs from communitymembers, government workers and officials, and policy makers.

The ethical principle of beneficence at the macro level is expressedin terms of maximizing welfare (Slowther, Ford, & Schofield, 2004).Work in primary care medicine has illustrated how this notion ofmaximizing welfare has two meanings in community social workpractice: (a) at the population level where it is probabilistic; and (b)at the level of the individual public health care recipient, for whom itis highly idiosyncratic. The dilemma for the macro level practitionerlies in striking a balance between public health ethics claims andethical claims stemming from personal autonomy rights (Slowtheret al., 2004). From a social work practice perspective, client autonomy,preferences, and self-determination are critical concerns and requirethat clients be informed of gaps in the EBP knowledge base as wellas inherent uncertainties in the evidence base (Gambrill, 2006).

At the level of international macro social work practice, additionalethical concerns at the macro level for EBP arise when there is(a) a mismatch between the priorities (i.e., values) of developingcountries and the EBP developers; (b) a mismatch between evidence-based treatments and developing country resources to procure them;and (c) the relative paucity of EBP, particularly RCT-based EBPdevelopment and/or testing in developing countries, although this last


concern is vitiated by the growing acceptance of alternatives to RCT-based evidence (McMichael, Waters, & Volmink, 2005). Similarly,dominant group biases, discrimination, and resource constraints alsooperate in disadvantaged communities in developed countries, raisingparallel social justice-based ethical concerns for macro social workers(Gould, 2006).

For policy makers, in particular, there are several unique consider-ations in using EBP as a basis for decision-making and action apartfrom strictly scientific concerns, including (a) ideological attractive-ness (i.e., congruency to previously held beliefs); (b) similar modelsin other jurisdictions to draw upon; (c) the need to make decisionswith incomplete information; (d) fit with target community and/orpopulation context; (e) feasibility (technical and political); (f ) imple-mentation cost; (g) cost-effectiveness; (h) incremental gain comparedto extant practices; and (i) congruence with extant services/systemsof service (Anderson et al., 2005; Dobrow et al., 2004; Fielding &Briss, 2006; Greenberg, Mandell, & Onstott, 2000).

Because macro practice operates on many levels at once in a com-plex environment, it requires multi-dimensional assessment methodsand procedures, for example, cluster evaluations combining case stud-ies, naturalistic observations, and context-sensitive rules of evidencein a collaborative process between researchers and others stakeholders(Hausman, 2002). It is important to note that the stakeholder groupis heterogeneous and includes policy makers or politicians, as well ascommunity members; each stakeholder group holds distinct notions ofwhat constitutes effectiveness as well as evidence (Bedregal & Ferlie,2001). Because of these complexities, even widely disseminated com-munity interventions with an empirical and conceptual base, such ascommunity-based rehabilitation for persons with a disability, still lacka sufficiently well developed, comparable core of studies to permitconfidence in the evidence base (Finkenflugel, Wolffers, & Huijsman,2005). A recent comprehensive review of the social work macro-practice literature conducted by Ohmer & Korr (2006) concluded thatmore rigorous studies are needed to build the evidence base relatedto community practice, in order to respond to the complex physical,social, and economic problems of disadvantaged communities.

In understanding the effectiveness of community practice withinits complex contexts, community scientists have identified a range ofmodeling and analytic methods by which to assess the effectiveness ofinterventions in complex, multi-level community settings. GeospatialInformation Systems (GIS) is a technology particularly well suited toinvestigating community contexts for participation, collective action,

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and/or service delivery. GIS renders all manner of community-leveldata, from vital statistics to key community resources and to patternsof participation by different stakeholder groups into layered elementsthat build a visual and spatial picture of how the various commu-nity attributes stand in relation to one another. This picture can bemodeled through a series of frames to represent a temporal axis ascommunity attributes change over time in response to either deliberateinterventions or to latent processes (Ghose, 2003; Luke, 2005).

System Dynamics Modeling (SDM) is another analytical approachcapable of assessing the effectiveness of macro interventions. At theheart of SDM is a systems approach to complex social problemsthat locates those problems in the dynamic, nonlinear behavior ofsystems (Lane, 1999). The dynamism of the system is captured in partthrough the identification of feedback loops moving the system awayfrom stability (reinforcing feedback loops) and counteracting balanc-ing feedback loops (Hoard et al., 2005). Owing to the complexity ofsocial problems, computer simulations are enlisted to model changesin the target system over time. SDM has been used in support ofevidence-based disaster planning (Hoard et al., 2005). A third mod-eling approach, social network analysis, is used to uncover patternsin relational data, making it possible, for example, to map out thenature and degree of connectedness among community actors thatshape community participation (Langhout, 2003; Luke, 2005). At theBrown School, we have incorporated two out of the three proposedmodeling approaches, GIS and SDM, in the curriculum to supportboth student understanding of the deployment of macro EBPs, suchas micro financing, and the culling of macro practice evidence in theEBP process.

Teaching EBP in the Macro Context

At the Brown School, the teaching of EBP takes place in thebroader context of the graduate curriculum teaching philosophy, theadult learner model, and an emerging consensus among our facultyat the foundation (first year) level around the model of the reflectivepractitioner. The reflective practitioner model of practice complimentsboth the adult learning model and the paradigm of EBP, since itsupports a bridge between practice wisdom and the use of EBP.

The Adult Learner Model. The adult learner model, currently thestandard model of student learning at the Brown School, is basedupon the notion of a distinct andragogy or adult way of learning that


is contrasted with the more familiar pedagogy guiding the educationof children (Merriam, 2001). The adult learner model presupposesthat learners are self-directing, bring questions based on their ownexperience, are task- or problem-oriented, possess an independent self-concept, and have internal motivations that are stronger than externalmotivations (Borduas, Gagnon, Lacoursiere, & Laprise, 2001; Langer,2002; Merriam, 2001; Ross-Gordon, 2003). These assumptions havebeen critiqued on a number of fronts: (a) as unwarrantedly limitedto adults; (b) as de-contextualized from individual learning stylesand subject matter; (c) as individual focused and lacking an explicitemancipatory, socio-political focus; and (d) as overlooking the poten-tial for classroom oppression and power-imbalanced teacher-studentinteractions (Merriam, 2001; Ross-Gordon, 2003). We acknowledgethese shortcomings and address them in the context of macro socialwork perspectives (i.e., ecological, environmental) and social workvalues (i.e., social and economic justice).

By adopting the adult learner model, we have committed our-selves to teaching that is community-situated, practical, problem-solving oriented, matched with learner characteristics and interests inan atmosphere of mutual respect, and experiential to the greatest extentpossible (Gold, 2005; Hansman, 2001; Laird, 1985). Concretely, in ourmacro-practice classes, these commitments translate into field-basedassignments (i.e., community assessments, organizational evaluations,presentations to state legislators) and group work that includes peer-evaluations, off-campus consultations with community, administrative,and policy practitioners as well as guest lectures by them. Writtenassignments are focused on active macro practice problem-solving,for example, using ethical practice frameworks for resolving organi-zational dilemmas around the costs/risks of not raising staff conscious-ness of discriminatory service practices or gauging the appropriatenessof civil disobedience that would implicate vulnerable third parties,such as children, in the face of societal injustice.

Precisely how adult learners engage in learning is a matter ofdebate, but one model, developed by Honey and Mumford, seemsespecially appropriate to our previous discussion (Kotval, 2005) ofhow community practitioners engage in community change through alearning cycle characterized by activity, reflection, theory, and prag-matism (Langer, 2002). The learning process, or cycle, in which ourstudents engage as adult learners, is complimentary to that of thereflective practitioners we are training them to become. Within thefield of adult education, evidence-based research has been challengedas providing an insufficient basis for teaching practice on the grounds

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that practice is not solely instrumental, nor are the challenges of adulteducation wholly reducible to testable propositions (Dirkx, 2006).In other words, akin to macro social work practice, social workeducation needs to incorporate practice wisdom. Adult education mustintegrate “what Schön termed the ‘craft-like’ knowledge” of reflectivepractitioners (Dirkx, 2006, p. 281).

The Reflective Practitioner. Macro-level EBP poses challenges thatrequire of the student practitioner in training, not only a high degreeof adaptability, creativity, leadership abilities, interpersonal skills, andsystems knowledge, but also a structured way of bridging the rigorousassumptions of scientific evidence with the confounding expectationsof macro practice. One such bridging model is provided by DonaldSchön’s notion of the “reflective practitioner” and what he called“technical rationality,” the decision-making process of professionalswho apply scientific theories in an uncritical fashion to practicalproblems in the field (Schipper, 1999; Schön, 1983, 1987; Weston,2005). In the place of technical rationality, Schön proposed a re-flective conversation about the problem (system), with the conversa-tion being guided by overarching theories and appreciative systems(Schipper, 1999). Although both overarching theories and appreciativesystems appear to evade precise definition—probably intentionallyso—Schön’s later work suggests that he is harkening to a higherlevel of reflection in which the macro level actors, their contexts andbeliefs, contribute to co-creating frames out of which facts (evidence)can make the normative leap to action (Schön & Rein, 1994).

The reflective practitioner generates frames for both interrogatingand understanding real-world problems, out of which new insightsemerge (Mann, 2004). Moreover, the reflective practitioner is sensibleto challenges to his or her sphere of expertise (the zone of mastery)when confronted by a surprise; this generates new hypotheses (calledreflection in action) that elicit a re-examination (called reflection onaction) out of which the zone of mastery is extended, hence a processculminating in “knowledge in action” (Borduas et al., 2001). Clientconcerns and ethical behavior are also critical inputs into the reflec-tions of the practitioner (Borduas et al., 2001).

These basic attributes of the reflective practitioner provide a veryhelpful framework for our students to think about their critical roleas a burgeoning macro practitioner using the EBP process and phi-losophy. EBP in macro-level (and for that matter micro-level) settingsrequires a continual learning process in which the metaphorical framesfor understanding and for action must be adaptable to local condi-tions, and the practitioner’s knowledge for action must be receptive


to changing environmental demands. In the case of macro practice,the reflective practitioner model calls for students to learn, amongother things, skills of trust building, understanding others’ positions,an appreciation of political context, practice and policy modificationinventiveness, and an ability to hold multiple frames of referencesimultaneously in their development as policy practitioners (Schön& Rein, 1994). Schön and Rein argue that policy inquiry should besituated as in a situated causal inquiry, calling into play differentmeanings of validity, rigor, and generalizability. “Situation-specific,case-based studies of practice” are extolled, whereas “covering lawgeneralizations that do prove relatively invulnerable to empirical dis-confirmation usually turn out : : : to be ‘trivial truths’: : : ” (Schön& Rein, 1994, p. 204). Hence, the reflective macro practitioner isadvised to update both his or her practice wisdom and the prescriptionsof specific macro-level EBPs to be more consonant with situated(local, contextual) demands in a disciplined, thoughtful, ethical, andcollaborative fashion.

Students are called upon to use the reflective practitioner frame-work to articulate their problem-solving process in the context ofspecific macro level EBP dilemmas. For example, students might beasked, given the widespread adoption of community-based rehabilita-tion (CBR) as a model for the community integration of persons witha disability, albeit with uneven success and the lack of a rigorous sys-tematic empirical basis, how might a macro reflective-practice socialworker use what is known about CBR together with his/her consideredexperience, client preferences, stakeholder feedback, and evaluationskills to develop an effective community integration program? Moreoften than not, the topical applications of the reflective practitionermodel stem from the students’ own questions about how one mightreconcile the low level or development and/or fit of extant macro EBPto situated problems in particular group, organizational, community,or policy settings.

CHALLENGES IN TEACHING MACRO PRACTICE

The overarching challenge in integrating EBP into a macro practicecurriculum lies in the complexity of the construct of evidence relativeto micro practice. Rather than conceptualizing practice evidence pri-marily from the concept of an intervention model and deconstructingit to individuals (as in micro practice), evidence-based macro practicerequires a more multi-dimensional conceptualization of evidence. We

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have identified challenges to implementing EBP in macro practiceat three distinct levels: (a) at the classroom level, providing high-quality evidence in a timely manner; (b) at the knowledge-acquisitionlevel, providing sufficient knowledge of research methods not only toanalyze the available evidence, but also to understand how the researchmight be interpreted by those implementing the knowledge; and (c)at the curriculum level, developing generalist (foundation) first-yearcourses that provide a springboard to develop a sophisticated andworking knowledge of EBP, sufficient to ground instruction in specificEBPs in concentration (second-year) courses. In this section, we willpresent a brief discussion delineating each of these challenges and howthey might be addressed. We will close the section with a particularexample of integrating a new methodological approach, GeospatialInformation Systems (GIS), for extending the macro level evidencebase, as well as informing the EBP decision-making process.

EBP at the Individual Class Level

One of the primary challenges for incorporating evidence into prac-tice at both micro and macro levels has been assuring that eachindividual class reflects an evidence-based approach. We have ensuredthat all graduate-level classes have the values of EBP incorporated intotheir learning goals and objectives through a monitoring process over-seen by the Curriculum Policy Committee (CPC) and administrators.However, determining that evidence is both up-to-date and relevanthas proved extremely difficult. In part, this is because there is no ex-isting metric to determine whether any individual class is sufficientlygrounded in EBP, whether in the process, at the foundation level, orin specific EBPs at the concentration level. While the challenge toproviding quality classroom instruction is a generic one, establishinga metric of what constitutes a good-quality evidence-based class—far less, one specific to macro practice—remains an ongoing needparticularly relevant to the task of fully implementing the paradigmof EBP across the curriculum.

In the absence of an existing metric to evaluate the integrationof evidence into the classroom, we have grappled with the issue ofproviding adequate guidance and supervision at the individual classlevel. Our current model of quality control and supervision delegatesthis task to the lead teachers (one for each foundation course), founda-tion coordinator, concentration coordinators, and specialization chairs,whose oversight extends to most of the curriculum, apart from free-


standing elective courses for which the CPC and the Associate Deanof the graduate program provide oversight. Each of these curriculumleaders is required to meet each semester with course instructorsand ensure the integrity of the instruction in each section, includingadherence to the highest standards of EBP relevant for that course.Having said that, no oversight mechanism can substitute for the in-depth knowledge and commitment to continuous learning necessaryfor assuring the quality of macro EBP and/or specific macro EBPsas taught in the classroom. Thus, the goal of providing “quality”evidence is, to a good degree, the provenance of the individual in-structor, which makes it imperative to provide occasions for continuallearning and updating, which we provide for the full-time faculty ina number of ways, including seminars and faculty meetings. For theadjunct and part-time faculty, occasions for continual learning andupdating include seminars and meetings as well, but the integrationwith the mainstream EBP discussions and development at the schoolare admittedly more difficult for extramural instructors who are oncampus far less than full-time faculty.

EBP at the Knowledge-Acquisition Level

Building on the previous section, there is an additional complicationin teaching macro EBP. To understand policy making, it is not onlyimportant to assess the evidence, it is equally (if not more) impor-tant to understand the context of how the evidence is interpreted byrelevant policy makers. Thus, in instructing students to use evidencein policy making, it is important not just that they understand whatthe evidence means from a scientific standpoint, but also ways inwhich the evidence can be variously interpreted by policy makerswith specific socio-political standpoints.

Thus, an additional challenge for understanding evidence for aspecific policy area requires not only an up-to-date understandingof the available evidence and political context, it requires an in-depth understanding of the methods through which this information isgathered and the possible variance in understanding the best availableevidence. Although this challenge somewhat overlaps with that frommicro-based research, it is far more complex in that there is no singleprimary “gold standard” available for understanding policy-relevantinformation. In micro practice, the primary, albeit still debated, metricfor judging whether an intervention is effective is the existence ofone or more randomized controlled trials. Although this metric is

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somewhat possible for macro interventions, it is complicated by theemphasis on newly emerging issues and the complexity of organiza-tions and communities, composed as they are of multiple inter-relatedindividuals. Thus, it becomes increasingly difficult to establish a “goldstandard” for macro practices and interventions.

Furthermore, rather than viewing validity and reliability as the pri-mary tools for judging the relevance of research, these measures mustalso be more deeply understood as potential sources for interpretation(and misinterpretation) of evidence (Fielding & Briss, 2006). Forexample, one need only scan the headlines to see the most frequenterror of assigning causation to an action when the research design isassociative.

EBP at the Curriculum Level

A final set of challenges around creating an evidence-based macrocurriculum lies in the need to coordinate knowledge presentation andskill development in a sequential manner to assure that each buildsfrom the general to the particular. At the Brown School, the founda-tion/generalist (usually first year) curriculum focuses on groundingin the macro- (and micro) level EBP process, while also provid-ing foundational competencies, such as critiquing evidence, researchdesigns, analytical frameworks, ethical decision-making, professionaljudgment, and theoretical knowledge. At the concentration/advancedpractice level (usually the second year) students are introduced tospecific macro level EBPs, for example, Individual Development Ac-counts (IDA) that were developed by faculty member Michael Sher-raden (1988). Research related to the IDA continues to be conducted(Schreiner, Ng, & Sherraden, 2006). Curriculum content regarding theIDA is introduced to students in a variety of Brown School gradu-ate courses, and in one concentration course, theories of disability(Putnam et al., 2005).

A Case Example: GIS in the Macro Curriculum. The best exampleof the opportunities we have taken for introducing social problemmodeling technologies relevant to the implementation of macro levelEBP is found in GIS. Although the concept of systems has long beenimplicit in macro practice, the tools for examining the relationshipbetween communities and the “real world” environment has long beenlimited by a lack of tools to conduct the same sorts of sophisticatedanalyses as are available in micro practice. The past decade has seenthe emergence of GIS (as well as SDM) technology as a powerful new


tool for examining the relationships between individuals and theirenvironments: political, social, economic, and physical (Freisthler,Lery, Gruenwald, & Chow, 2006; Hoard et al., 2005). In addition, asthe technology has become more sophisticated and available, and theapplications have become more user friendly, important opportunitieshave opened up for the use of this technology in social work researchand practice, both macro and micro.

At the university level, a major investment has been made in devel-oping distributed GIS resources across campus, and a university-wideadvisory committee has been created, with one of the authors beinga founding member. At the Brown School, GIS has been used inconducting research by about one-third of our faculty members. It isthe Brown School’s philosophy to integrate research and teaching asmuch as possible, which provided a major impetus for the integrationof GIS into the graduate curriculum, as well as a cadre of full-time faculty having some familiarity with the technology. We arealso dedicated as a school to integrate knowledge and tools used inthe field into our classes, and we are fortunate that GIS is beingfairly extensively used by a number of the non-profit and governmententities in the St. Louis area, from which we have drawn our ad-junct faculty members, making it possible for them also to bring alevel of familiarity with GIS into the graduate curriculum and, morespecifically, into macro practice classes. These pre-existing teachingresources do not diminish the challenges of bringing the instructionalcadre, full- and part-time, to a level of GIS competence sufficientfor training our students. There are inherently more challenges inensuring baseline technical skills, as well as the acquisition of newskills for the extramural instructional cadre, adjunct and part-timefaculty members. Thus, we are devoting considerable attention, withtheir assistance, to collaboratively bridge those gaps. In point of fact,our current strategy has been to devolve much of the responsibility foractual GIS training to external consultants, who also serve as advisorsto the course instructors.

GIS has now been incorporated into the foundation course oncommunity and organization practice, following a three-year periodof pilot work, beta testing and revision, and incremental adoptioninitiated by one of the authors in collaboration with several keyinstructors familiar with GIS. An external expert, who graduated fromthe School, was contracted to provide the technical training and todevelop the training modules with feedback from the course instruc-tors. The GIS unit has supplemented previous applications taught incommunity mapping, and has been explicitly tied to class lectures on

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macro research methods and EBP. As a result, the vast majority of ourgraduate students are now receiving a basic exposure and groundingin the technology, its applications to macro practice evidence, andEBP.

At the concentration level, the community development course,which for several years had integrated an optional GIS training inone course section, has now adopted GIS training across all sections.Students in the community development course have more technicalproficiency than those in the foundation course, for whom the learningis largely conceptual in nature, but are still not technically proficient.However, proficiency in GIS is not a course objective. As in thefoundation course, GIS is conceptualized as a decision-making toolfor macro EBP, and as a tool for developing macro-level evidence.

In terms of future curricular investments, a GIS-focused coursesyllabus at the concentration level has been proposed. Most recently,the social and economic development concentration, one of the fiveconcentrations in the Brown School, has begun to integrate moreadvanced GIS theory and application in its curriculum. Although theprocess is ongoing, it is safe to assume that GIS will be adapted bothas a core technique and an advanced theoretical application for thisconcentration.

In a more modest and preliminary fashion, we are beginning to ex-plore the implementation of SDM as a tool for macro EBP (Robards &Gillespie, 2000). A system dynamics course was piloted over severalyears in the form of a seminar, open to faculty, doctoral, and master’sstudents. On the basis of this experience, the lead seminar instructor(a full-time faculty member) designed a concentration level course onSDM that is also open to doctoral students. Partly as a result of theseminar, several faculty members have some familiarity with SDM inaddition to the seminar leaders (two full-time faculty members), whohave expertise in using SDM. Several doctoral students, who teachindependently as teaching fellows, have some expertise in SDM, butthere is little penetration into the adjunct faculty member cadre, so theteaching resources at hand for the integration of SDM are far moremodest than for GIS. Nonetheless, there is discussion of seeding thecurriculum with more SDM content in support of macro level EBP.These discussions have led to the integration of SDM content intoseveral foundation courses, including human diversity and researchmethods.

The adoption of GIS and, to a much lesser degree, SDM as tools forEBP have been pursued with careful reflection and planning regardingfaculty supports and resources. In implementing GIS and SDM at the


classroom level, as we have noted, one of the primary challenges liesin developing a sustainable cadre of instructors sufficiently trainedin the technologies to provide students with a basic grounding, whilealso ensuring the availability of a smaller group of expert practitioners(academic and/or field) in the technologies to provide hands-on train-ing and more advanced skills. We are actively involved in problem-solving these resource issues for GIS, in part by identifying anddeliberately partnering with local agencies that use GIS extensively,and with other GIS-expert academic units on campus, to developthe necessary resources to sustain and expand our offerings. At thesame time, there are discussions with faculty about the scope of ourinvestment in social problem modeling technologies, such as GISand SDM, in order to meet the challenges facing macro EBP socialworkers and the client systems they serve.

Lessons Learned

In concluding our discussion of integrating EBP into the macroclasses and across the curriculum, there are four key “lessons learned”that are viewed as critical to developing graduate level education:

1. At the classroom level, presenting and discussing evidence mustbe constantly “refreshed.” Instructors need to not only updatetheir evidence at the beginning of each semester, but must in-corporate methods for examining the state-of-the-art within theindividual semester. The process of updating evidence needsto involve not only the individual instructor, but needs also toinclude other instructors of the same course, lead teachers, CPC,and faculty within the school working on topics relevant to thespecific class. In keeping with the adult learning and reflectivepractitioner models, students are held accountable to the samestandards within reason.

2. At the evidence-acquisition level, research methods must notonly teach students to understand what comprises “good” ev-idence, but must understand the process of examining the ev-idence to identify and be able to explain how evidence is in-terpreted at the policy level. Training must include not justunderstanding research methods, but also the ability to analyzeinterpretation of evidence in policy discussions from variouscontexts, including cultural, societal, political, economic, andeven historical.

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3. At the curriculum level, instruction in EBP needs to include notonly general information necessary to understanding practice,but must provide the context through which students can be-come reflective practitioners at all levels of practice. For macrostudents, this includes not only understanding existing evidenceand specific EBPs, but also the skills to be able to implementthis knowledge into their broader policy, administrative, andcommunity practice.

4. At the curriculum level, macro practice must be able to respondto new technologies to keep students at the cutting edge ofmacro practice. Macro students must develop an appreciationfor how advances in data gathering, data analysis, simulation,and modeling technologies can reveal hitherto fuzzy, or evenundetected underlying patterns, organize data, and empiricallyinform decision-making around highly complex macro systems.They must also be aware of the limiting assumptions under-girding all data-based models and the data themselves in orderto establish the margin of error within which the results can beunderstood.

TOWARD THE FUTURE OF MACROEBP EDUCATION

Throughout our current efforts at incorporating EBP into the macropractice curriculum, we have been faced with a series of challengesto surmount that have provided opportunities to further understandthe demands of the process of educating macro social workers. Whileit would be pleasant to present a series of well-articulated recom-mendations, we would be remiss in characterizing our efforts as ei-ther successfully concluded or even fully articulated. Rather, we willpresent three challenges that we are currently exploring and our cur-rent thoughts on them, in the hope that they will spark additionaldiscussions and potential solutions.

The first challenge is the difficulty in bridging instruction in EBPand instruction in the complexity of real-world practice. Educationaldemands for students to understand the science of macro-level EBPs(for example, model fidelity) stands in stark contrast to the real-world demands of macro-level practice (for example, the need forpracticality in developing community or policy responses). It is notthat these are inherently competing demands; rather, it is the case thatthe field (and ourselves) has to some degree viewed instruction in


science and practice as in competition. Our discussion in surmountingthis challenge has focused on the possibility of reconciliation of thesecompeting demands. We need to educate our students to give fullweight to both scientific and practice considerations, to possess whatSchön and Rein (1994) termed “double vision” in which they act fromone frame—be it scientific or practice—while cultivating an awarenessof the other and how it might inform their next actions differently.

The second challenge emerges out of the need to provide studentswith skills that translate into their post-graduate employment whileremaining true to the process and philosophy of EBP. Basically, EBPeducation in macro practice requires a need to balance a criticalunderstanding of the role of evidence in practice, training in the fewavailable community and policy-relevant EBPs, development of tradi-tional skills in community practice and policy analysis, and exposureto current theory and real-world knowledge. One of the fiercest of ourongoing debates has been the amount of attention and consideration inboth the overall training and specific classroom activities devoted tomeeting each of these demands. In the Curriculum Policy Committee,across classroom evaluations, and in meeting with field agencies andother community partners, the debate around the relative emphasis oneach of these demands continues with no clear resolution.

One learning that has emerged out of the dialogue at the BrownSchool has been the recognition that this balancing act is not necessar-ily a zero-sum game. Creative examination of the macro educationalprocess has led to a series of insights around integration of multipledemands within the educational process. We have already detailed theway that GIS has been integrated into our first-year curriculum as ameans to provide an opportunity for skill development in communitymapping. Across our macro curriculum, we have seen a rise in stu-dent assignments focusing on identifying evidence-based solutions tospecific problems. At this point in time, our (albeit limited) workingconclusion is that creating an EBP macro curriculum requires us to(a) carefully consider the cost-benefit equation of increased studentcompetence specific to macro EBP versus broader education in macropractice knowledge and skills; and (b) consider the weighting of EBPeducation and training in the context of the overall preparation ofa new macro EBP practitioner who may experience any number ofenvironments—and jobs—post graduation.

Finally, perhaps the most tractable challenge lies in our school’sforging an equitable relationship with community agencies providingmacro practice experiences around integration of EBP into the fieldplacement. At all levels of practice, we have found a surprising interest

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and willingness on the part of our community field agencies to partic-ipate in instruction on evidence-based practice (Edmond, Megivern,Williams, Rochman, & Howard, 2006). As part of our developmentof relationships with community partners around EBP, we have beenasked to collaborate with them in creating new evidence to guidepolicy and community development, and partnering in new effortsto develop or implement EBPs. Consequently, classroom educationalmaterials are responsive to the needs of our agencies around current“best” practices, funding contexts, client system demands, and avail-able resources.

EBP is best understood as an emerging paradigm, not as a matureone. This is particularly true in the areas of developing curriculumand in teaching macro practice courses. In examining the first fiveyears of implementing evidence-based education at the macro level,we have learned a few lessons and opened the door for continueddialogue on surmounting the difficult and varied challenges aroundtraining new generations of macro social workers in evidence-basedpractices.

REFERENCES

Adams, P. (2004). Classroom assessment and social welfare policy: Addressingchallenges to teaching and learning. Journal of Social Work Education, 40(1),121–142.

Anderson, L., Brownson, R., Fullilove, M., Teutsch, S., Novick, L., Fielding, J., &Land, G. (2005). Evidence-based public health policy and practice: Promises andlimits. American Journal of Preventive Medicine, 28, 226–230.

Anthony, W., Rogers, E. S., & Farkas, M. (2003). Research on evidence-basedpractices: Future directions in an era of recovery. Community Mental Health

Journal, 39(2), 101–114.Bedregal, P., & Ferlie, E. (2001). Evidence based primary care? A multi-tier, multiple-

stakeholder perspective from Chile. International Journal of Health and Planning

Management, 16, 47–60.Blisker, D., & Goldner, E. M. (2000). Teaching evidence-based practice in mental

health. Research on Social Work Practice, 19, 664–669.Boehm, A. (2003). Managing the life cycle of a community project: A marketing

approach. Administration in Social Work, 27(2), 19–37.Borduas, F., Gagnon, R., Lacoursiere, Y., & Laprise, R. (2001). The longitudinal case

study: From Schön’s model to self-directed learning. The Journal of Continuing

Education in the Health Professions, 21, 103–109.Chaskin, R. J. (2001). Building community capacity: A definitional framework and

case studies from a comprehensive community initiative. Urban Affairs Review,36(3), 291–323.


Council on Social Work Education. (2004, October). Educational policy and accred-itation standards. Alexandria, VA: Author.

Cournoyer, B. (2004). The evidence-based social work skills book. Boston: Allyn &Bacon.

Dirkx, J. M. (2006). Studying the complicated matter of what works: Evidence-basedresearch and the problem of practice. Adult Education Quarterly, 56(4), 273–290.

Donaldson, L. (2004). Toward validating the therapeutic benefits of empowerment-oriented social action groups. Social Work with Groups, 27(2/3), 159–175.

Drake, B., Hovmand, P., Jonson-Reid, M., & Zayas, L. (2007). Adopting and teachingevidence-based practice in masters level social work programs. Journal of SocialWork Education, 43(3), 431–446.

Dobrow, M., Goel, V., & Upshur, R. (2004). Evidence-based health policy: Contextand utilization. Social Science & Medicine, 58, 207–217.

Edmond, T., Megivern, D., Williams, C., Rochman, E., & Howard, M. (2006).Integrating evidence-based practice and social work field education. Journal ofSocial Work Education, 42(2), 377–396.

Fielding, J., & Briss, P. (2006). Promoting evidence-based public health policy: Canwe have better evidence and more action? Health Affairs, 25(4), 969–977.

Finkenflugel, H., Wolffers, I., & Huijsman, R. (2005). The evidence base for commu-nity-based rehabilitation: A literature review. International Journal of Rehabili-tation Research, 28(3), 187–201.

Flybjerg, B. (2001). Making social science matter: Why social inquiry fails and howit can succeed again. Cambridge, UK: Cambridge University Press.

Freddolino, P., & Knaggs, D. (2005). Building a predominantly web-based coursefrom face-to-face and interactive video pilots: Administrative skills for socialwork practice. Journal of Technology in the Human Services, 23(3/4), 201–213.

Freisthler, B., Lery, B., Gruenwald, P. J., & Chow, J. (2006). Methods and challengesof analyzing spatial data for social work problems: The case of examining childmaltreatment geographically. Social Work Research, 30(4), 198–210.

Gambrill, E. (2004). Contributions of critical thinking and evidence-based practiceto the fulfillment of ethical obligations of professionals. In H. E. Briggs & T. L.Rzepnicki (Eds.), Using evidence in social work practice: Behavioral perspectives(pp. 3–19). Chicago: Lyceum.

Gambrill, E. (2006). Evidence-based practice and policy: Choices ahead. Research

on Social Work Practice, 16(3), 338–357.Ghose, R. (2003). Community participation, spatial knowledge production, and GIS

use in inner-city revitalization. Journal of Urban Technology, 10(1), 39–60.Gibbs, L. E. (2003). Evidence-based practice for the helping professions. Pacific

Grove, CA: Thomson Learning.Gold, H. E. (2005). Educating the adult learner. Libraries and the Academy, 5(4),

467–481.Gould, N. (2006). An inclusive approach to knowledge for mental health social work

practice and policy. British Journal of Social Work, 36, 109–125.Greenberg, D., Mandell, M., & Onstott, M. (2000). The dissemination and utilization

of welfare-to-work experiments in state policy making. Journal of Policy Analysis

and Management, 19(3), 367–382.

Bricout et al. 619

Hansman, C. A. (2001). Context-based adult learning. New Directions for Adult andContinuing Education, 89, 43–52.

Hardiman, E., Theriot, M., & Hodges, J. (2005). Evidence-based practice in mentalhealth: Implications and challenges for consumer-run programs. Best Practices

in Mental Health, 1(1), 105–122.Harrigan, M., Fauri, D., & Netting, F. (1998). Termination: Extending the concept

for macro social work practice. Journal of Sociology and Social Welfare, 25(4),61–80.

Hausman, A. J. (2002). Implications of evidence-based practice for communityhealth. American Journal of Community Psychology, 30(3), 453–467.

Hoard, M., Homer, J., Manley, W., Furbee, P., Haque, A., & Helmkamp, J. (2005).Systems modeling in support of evidence-based disaster planning for rural areas.International Journal of Hygiene Environmental Health, 208, 117–125.

Howard, M., Bricout, J., Edmond, T., Elze, D., & Jenson, J. (2003). Evidence-basedpractice guidelines. In R. A. English (Ed.), Encyclopedia of social work (19thed., pp. 48–60). Washington, DC: NASW Press.

Howard, M. O., McMillan, C., & Pollio, D. E. (2003). Teaching evidence-basedpractice: Toward a new paradigm for social work education. Research on SocialWork Practice, 13(2), 234–259.

Jones, R., & Santaguida, P. (2005). Evidence-based practice and health policy de-velopment: The link between knowledge and action. Physiotherapy, 91, 14–21.

Karvinen-Niinikoski, S. (2005). Research orientation and expertise in social work:Challenges for social work education. European Journal of Social Work, 8(3),259–271.

Kellam, S., & Langevin, D. (2003). A framework for understanding “evidence” inprevention research and programs. Prevention Science, 4(3), 137–153.

Kerner, J. F. (2006). Knowledge translation versus knowledge integration: A “fun-der’s” perspective. The Journal of Continuing Education in the Health Profes-

sions, 26(1), 72–80.Kohatsu, N., Robinson, J., & Torner, J. (2004). Evidence-based public health: An

evolving concept. American Journal of Preventive Medicine, 27(5), 417–422.Kotval, Z. (2005). The link between community development practice and theory:

Intuitive or irrelevant? A case study of New Britain, Connecticut. Community

Development Journal, 41(1), 75–88.Laird, D. (1985). Approaches to training and development (2nd ed.). Reading, MA:

Addison-Wesley.Lane, D. C. (1999). Social theory and system dynamics practice. European Journal

of Operational Research, 113, 501–527.Langer, N. (2002). Enhancing adult learning in aging studies. Educational Geron-

tology, 28, 895–904.Langhout, R. D. (2003). Reconceptualizing quantitative and qualitative methods: A

case study dealing with place as an exemplar. American Journal of CommunityPsychology, 32(3/4), 229–244.

Lewis, C. (2004). Microfinance from the point of view of women with disabilities:Lessons from Zambia and Zimbabwe. Gender and Development, 12(1), 28–41.


Loisel, P., Durand, M., Diallo, B., Vachon, B., Charpentier, N., & Labelle, J. (2003).From evidence to community practice in work rehabilitation. The Clinical Journal

of Pain, 19(2), 105–113.Long, D., Tice, C., & Morrison, J. (2006). Macro social work practice: A strengths

perspective. Belmont, CA: Thomson Learning.Luke, D. A. (2005). Getting the big picture in community science: Methods that

capture context. American Journal of Community Psychology, 35(3/4), 185–200.Lynam, M. J. (2005). Health as a socially mediated process. Advances in Nursing

Science, 28(1), 25–37.Mann, K. V. (2004). The role of educational theory in continuing medical education:

Has it helped us? The Journal of Continuing Education in the Health Professions,24, S22–30.

McMichael, C., Waters, E., & Volmink, J. (2005). Evidence-based public health:What does it offer developing countries? Journal of Public Health, 27(2), 215–221.

McQueen, D. V. (2001). Strengthening the evidence base for health promotion.Health Promotion International, 16(3), 261–268.

Mendes, P. (2003). Teaching social policy to social work students: A critical reflec-tion. Australian Social Work, 56(3), 220–233.

Merriam, S. B. (2001). Andragogy and self-directed learning: Pillars of adult learningtheory. New Directions for Adult and Continuing Education, 89, 3–13.

Miller, R., & Shinn, M. (2005). Learning from communities: Overcoming difficul-ties in dissemination of prevention and promotion efforts. American Journal of

Community Psychology, 35(3/4), 169–183.Netting, F. E., & O’Connor, M. K. (2005). Lady boards of managers: Subjugated

legacies of governance and administration. Affilia, 20(4), 448–464.Neugeboren, B. (1996). Environmental practice in the human services. New York:

Haworth Press.O’Brien, C. (2005). Integrated community development/conflict resolution strategies

as peace building potential in South Africa and Northern Ireland. CommunityDevelopment Journal: Advance Access, 40(3), 1–17.

Ogilvie, D., Egan, M., Hamilton, V., & Petticrew, M. (2005). Systematic reviews ofhealth effects of social interventions: Best evidence available evidence: How lowshould you go? Journal of Epidemiological Community Health, 59, 886–892.

Ohmer, M., & Korr, W. (2006). The effectiveness of community practice inter-ventions: A review of the literature. Research on Social Work Practice, 16(2),132–145.

Pollio, D. E. (2002). The evidence-based group worker. Social Work with Groups,25(4), 57–63.

Pollio, D. E. (2006). The art of evidence-based practice. Research on Social Work

Practice, 16(2), 224–232.Proctor, E. K. (2004). The search for social work treatments of choice: What

interventions work better than others? Social Work Research, 28(2), 67–69.Putnam, M., Sherraden, M., Edwards, K., Porterfield, S., Wittenburg, D., Holden,

K., & Saleeby, P. (2005). Building financial bridges to economic developmentand community integration: Recommendations for a research agenda on asset

Bricout et al. 621

development for people with disabilities. Journal of Social Work in Disabilityand Rehabilitation, 4(3), 61–86.

Robards, K. J., & Gillespie, D. F. (2000). Revolutionizing the social work curriculum:Adding modeling to the systems paradigm. Journal of Social Work Education,36(3), 561–572.

Ross-Gordon, J. M. (2003). Adult learners in the classroom. New Directions forStudent Services, 102, 43–52.

Rychetnik, L., Frommer, M., Hawe, P., & Shiell, A. (2002). Criteria for evaluatingevidence on public health interventions. Journal of Epidemiological Community

Health, 56, 119–127.Sackett, D. L. (2002). The arrogance of preventive medicine. Canadian Medical

Association Journal, 167(4), 363–365.Schipper, F. (1999). Phenomenology and the reflective practitioner. Management

Learning, 30(4), 473–485.Schön, D. A. (1983). The reflective practitioner. New York: Basic Books.Schön, D. A (1987). Educating the reflective practitioner. New York: Basic Books.Schön, D. A., & Rein, M. (1994). Frame reflection: Towards the resolution of

intractable policy controversies. New York: Basic Books.Schreiner, M., Ng, G., & Sherraden, M. (2006). Cost-effectiveness in individual

development accounts. Research on Social Work Practice, 16(1), 28–37.Secret, M., Jordan, A., & Ford, J. (1999). Empowerment evaluation as a social work

strategy. Health and Social Work, 24(2), 120–127.Sherraden, M. (1988). Rethinking social welfare: Towards assets. Social Policy,

18(3), 37–43.Slowther, A., Ford, S., & Schofield, T. (2004). Ethics of evidence-based medicine

in the primary care setting. Journal of Medical Ethics, 30, 151–155.Weston, D. R. (2005). Training in infant mental health: Educating the reflective

practitioner. Infants & Young Children, 18(4), 337–348.Zaparanick, T. L., & Wodarski, J. (2004). A curriculum for human behavior in the

social environment. Journal of Human Behavior in the Social Environment, 10(3),1–24.

Zayas, L. H., Gonzalez, M. J., & Hanson, M. (2003). What do I do now? Onteaching evidence-based interventions in social work practice. Journal of Teaching

in Social Work, 23(3/4), 59–71.