Final Report - Social Work Policy Institute

SWPI-RPT-35110.CER-Report:Layout 2

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COMPARATIVE EFFECTIVENESS RESEARCH (CER) AND SOCIAL WORK: STRENGTHENING THE CONNECTION FINAL REPORT FROM THE NOVEMBER 16, 2009 SWPI INAUGURAL SYMPOSIUM


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TABLE OF CONTENTS

Recommended Citation — Social Work Policy Institute (2010). Comparative Effectiveness Research and Social Work: Strengthening the Connection. Washington, DC: National Association of Social Workers

©2010 National Association of Social Workers. All Rights Reserved.

Preface....................................................................................... Executive Summary .................................................................. About the Symposium .............................................................. What is Comparative Effectiveness Research? .......................... Legislative Focus on Comparative Effectiveness Research .... Federal Coordinating Council (FCC) and its Report to the Pr FCC Recommended Definition for CER............................ Prioritization Criteria ........................................................ Research Challenges .......................................................... Strategic Framework ........................................................ Institute of Medicine’s (IOM) Initial National Priorities for C Overarching Federal Strategies for CER Development .............. Building Information Infrastructure for Collection and Disse Focus of Research on Priority Populations and Conditions in Training for Researchers and Practitioners ............................ Collaboration in Research .................................................... Building Public Knowledge and Acceptance of CER.............. Considerations for Economic Evaluations of Interventions.... Social Work and Comparative Effectiveness Research .............. Overview of the General Effectiveness of Social Worker Inter Considerations for CER related to Social Work Interventions Evidence-Based Practice ........................................................ Strengthening the Research-Practice Connection .................. Identifying Methodological Challenges of CER ........................ Social Workers as Members of Interdisciplinary Research Tea Systematic Reviews................................................................ Economic Evaluations of Psychosocial Interventions – Consid Conclusions .............................................................................. Recommended Agenda for Action ............................................ Recommendations for National Organizations...................... Recommendations for Academic Settings .............................. Recommendations for Collaboration with Federal Agencies.. Recommendations to Enhance CER methods ........................ Recommendations to Promote Practice-Research Linkages .. References ................................................................................ Appendix A: List of Symposium Participants ............................ Appendix B: Symposium Agenda ............................................. Appendix C: FCC CER Strategic Framework and Priorities ...... Appendix D: IOM CER Priorities Relevant to Social Workers a Appendix E: Review Articles on Social Work Effectiveness ....... Appendix F: Resources on Evidenced Based Practice and Social Appendix G: NASW SHIFT Model of Moving EBP to Practice Appendix H: Campbell Collaboration Systematic Reviews ...... Appendix I: Resources on CER ................................................

al Work Policy Institute (2010). Comparative Effectiveness engthening the Connection. Washington, DC: Workers

Association of Social Workers. All Rights Reserved.


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TABLE OF CONTENTS Preface..................................................................................................................................................iii Executive Summary ..............................................................................................................................v About the Symposium ..........................................................................................................................1 What is Comparative Effectiveness Research? ......................................................................................2 Legislative Focus on Comparative Effectiveness Research ................................................................2 Federal Coordinating Council (FCC) and its Report to the President and the Congress on CER ......2 FCC Recommended Definition for CER........................................................................................2 Prioritization Criteria ....................................................................................................................3 Research Challenges ......................................................................................................................3 Strategic Framework ....................................................................................................................3 Institute of Medicine’s (IOM) Initial National Priorities for CER ......................................................4 Overarching Federal Strategies for CER Development ..........................................................................5 Building Information Infrastructure for Collection and Dissemination of Research ..........................5 Focus of Research on Priority Populations and Conditions in Real World Environments ..................5 Training for Researchers and Practitioners ........................................................................................5 Collaboration in Research ................................................................................................................6 Building Public Knowledge and Acceptance of CER..........................................................................6 Considerations for Economic Evaluations of Interventions................................................................6 Social Work and Comparative Effectiveness Research ..........................................................................7 Overview of the General Effectiveness of Social Worker Interventions ..............................................7 Considerations for CER related to Social Work Interventions ..........................................................8 Evidence-Based Practice ..................................................................................................................10 Strengthening the Research-Practice Connection ............................................................................11 Identifying Methodological Challenges of CER ..................................................................................13 Social Workers as Members of Interdisciplinary Research Teams ....................................................14 Systematic Reviews..........................................................................................................................14 Economic Evaluations of Psychosocial Interventions – Considerations for CER and Practice..........15 Conclusions ........................................................................................................................................18 Recommended Agenda for Action ......................................................................................................21 Recommendations for National Organizations................................................................................21 Recommendations for Academic Settings ........................................................................................22 Recommendations for Collaboration with Federal Agencies............................................................22 Recommendations to Enhance CER methods ..................................................................................23 Recommendations to Promote Practice-Research Linkages ............................................................24 References ..........................................................................................................................................27 Appendix A: List of Symposium Participants ....................................................................................A-1 Appendix B: Symposium Agenda ......................................................................................................B-1 Appendix C: FCC CER Strategic Framework and Priorities ..............................................................C-1 Appendix D: IOM CER Priorities Relevant to Social Workers and Social Work Research................D-1 Appendix E: Review Articles on Social Work Effectiveness ................................................................E-1 Appendix F: Resources on Evidenced Based Practice and Social Work ..............................................F-1 Appendix G: NASW SHIFT Model of Moving EBP to Practice ........................................................G-1 Appendix H: Campbell Collaboration Systematic Reviews ..............................................................H-1 Appendix I: Resources on CER ..........................................................................................................I-1


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COMPARATIVE EFFECTIVENESS RESEARCH AND SOCIAL WORK FINAL REPORT

COMPARATIVE EFFECTIVENESS RESEARCH AND SOC

A special thank you is extended to Sanofi-Aventis U.S. and A External Relations for the partial support provided to the NA meeting.

PREFACE Social Work Research and Comparative Effectiveness Research (CER): A Research Symposium to Strengthen the Connection was hosted by the Social Work Policy Institute (SWPI) of the NASW Foundation on November 16, 2009. With $1.1 billion set aside for CER in the American Recovery and Reinvestment Act (ARRA) and additional focus on CER in pending health care reform legislation, a symposium on social work’s agenda related to CER was a meaningful way to initiate SWPI. Launched October 1, 2009, the mission of SWPI is: • • •

This report, Comparative Effectiveness Research and Social W can serve as a valuable resource not only to those who partic researchers seeking to engage with agencies and with consum participatory research designs; to practitioners seeking to iden their clients; to consumers seeking to partner with researcher agencies and research funders who are looking to address hea research portfolios in regard to addressing psychosocial need report identifies steps that can be taken by national organizat research funders and by those who are committed to strength If we are to better meet the social work profession’s mission t help meet basic human needs of all people, with particular at empowerment of people who are vulnerable, oppressed and l relationship to CER can be one important avenue.

To strengthen social work’s voice in public policy deliberations. To inform policy-makers through the collection and dissemination of information on social work effectiveness. To create a forum to examine current and future issues in health care and social service delivery.

Convening experts from the research, practice, policy and education arenas to examine how the social work profession might best contribute to the expanding attention to CER and the ensuing action agenda created at the symposium are in keeping with all three aspects of SWPI’s mission. The intent of CER is to better identify what health interventions work best for whom and under what conditions. Of particular priority is furthering research and the analysis of data to best improve the health and psychosocial outcomes for populations with special needs, those that experience health disparities, and those who have co-occurring disorders. These CER priorities are in line with the social work profession’s commitment to social justice and its work to maximize individual, family and community well-being.

Joan Levy Zlotnik, PhD, ACSW Director Social Work Policy Institute February 2010

One critical step in bringing meaning to what social work can contribute to CER and what the implications of CER might be for social work research and practice was creating a dialogue among representatives of federal research and service agencies, national organizations, health care delivery organizations, foundations and academic institutions. Two social workers who have had key roles in the federal agenda related to CER, Peter Delany of the Substance Abuse and Mental Health Services Administration (SAMHSA) and Katie Maslow of the Alzheimer’s Association provided perspective on CER definitions and priorities and provided a perspective on what these can mean for social work. Rear Admiral (USPHS) Peter J. Delany, PhD, LCSW-C, Director of the Office of Applied Studies at the Substance Abuse and Mental Health Services Administration (SAMHSA) served on the CER Federal Coordinating Committee, and Katie Maslow, MSW, Director of Policy Development at the Alzheimer’s Association served on the Institute of Medicine CER Panel. Edward Mullen of Columbia University and Shirley Otis-Green of City of Hope National Medical Center provided important perspectives on social work effectiveness and research-practice connections. Phaedra Corso of the University of Georgia stimulated the discussion by providing valuable information on the place for economic evaluation in research including CER. Sheryl Zimmerman provided her experience and perspective as a social work researcher engaged in many interdisciplinary studies. No meeting would ever be accomplished without efforts by many people. In addition to the presenters and participants, appreciation is expressed to Briana Walters and Jordan Wildermuth who as social work interns became internal experts on CER. The NASW Foundation staff, Bob Arnold, Bonita Davis and Jennifer Watt also played key roles in bringing this to fruition. Betsy Clark, NASW Foundation President and NASW Executive Director provided important vision to plan this inaugural event of SWPI for social work to assert its place in CER from a practice, policy and research perspective.

SOCIAL WORK POLICY INSTITUTE

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SS RESEARCH AND SOCIAL WORK FINAL REPORT

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A special thank you is extended to Sanofi-Aventis U.S. and Annette Schmidt, Director of U.S. External Relations for the partial support provided to the NASW Foundation for this historic meeting.

ive Effectiveness Research (CER): A Research Symposium to d by the Social Work Policy Institute (SWPI) of the NASW With $1.1 billion set aside for CER in the American Recovery dditional focus on CER in pending health care reform rk’s agenda related to CER was a meaningful way to initiate e mission of SWPI is:

This report, Comparative Effectiveness Research and Social Work: Strengthening the Connection can serve as a valuable resource not only to those who participated in the symposium but also to researchers seeking to engage with agencies and with consumers, especially to undertake participatory research designs; to practitioners seeking to identify more effective interventions for their clients; to consumers seeking to partner with researchers and practitioners; and to federal agencies and research funders who are looking to address health disparities and to strengthen their research portfolios in regard to addressing psychosocial needs. The action agenda laid out in this report identifies steps that can be taken by national organizations, by academic institutions, by research funders and by those who are committed to strengthening research and practice linkages. If we are to better meet the social work profession’s mission to “enhance human well-being and help meet basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed and living in poverty,” then our work in relationship to CER can be one important avenue.

ice in public policy deliberations. ugh the collection and dissemination of information on social

current and future issues in health care and social service

practice, policy and education arenas to examine how the tribute to the expanding attention to CER and the ensuing um are in keeping with all three aspects of SWPI’s mission. what health interventions work best for whom and under y is furthering research and the analysis of data to best outcomes for populations with special needs, those that se who have co-occurring disorders. These CER priorities are n’s commitment to social justice and its work to maximize l-being.

Joan Levy Zlotnik, PhD, ACSW Director Social Work Policy Institute February 2010

to what social work can contribute to CER and what the al work research and practice was creating a dialogue arch and service agencies, national organizations, health care nd academic institutions. Two social workers who have had to CER, Peter Delany of the Substance Abuse and Mental HSA) and Katie Maslow of the Alzheimer’s Association ons and priorities and provided a perspective on what these ral (USPHS) Peter J. Delany, PhD, LCSW-C, Director of the ance Abuse and Mental Health Services Administration al Coordinating Committee, and Katie Maslow, MSW, Alzheimer’s Association served on the Institute of Medicine bia University and Shirley Otis-Green of City of Hope portant perspectives on social work effectiveness and a Corso of the University of Georgia stimulated the rmation on the place for economic evaluation in research rovided her experience and perspective as a social work plinary studies.

hed without efforts by many people. In addition to the ion is expressed to Briana Walters and Jordan Wildermuth ternal experts on CER. The NASW Foundation staff, Bob tt also played key roles in bringing this to fruition. Betsy nd NASW Executive Director provided important vision to social work to assert its place in CER from a practice, policy

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outlook, and next steps for CER. Congress also requested tha convene a study to identify the Initial National Priorities for FCC’s report (ARRA, 2009; IOM, 2009). Key priorities cente health disparities for diverse populations and persons with co the existing knowledge of healthcare, and expanding dissemin and IOM reports lay out several strategies to support CER th infrastructure; conducting more robust CER through training and findings are relevant to consumers and practitioners; and translation of CER findings (DHHS, 2009; IOM, 2009).

EXECUTIVE SUMMARY

SOCIAL WORK AND COMPARATIVE E RESEARCH Social Work’s Role in CER

ABOUT THE SYMPOSIUM

Leadership by the social work profession is critical to ensure stakeholders in CER efforts. Researchers, practitioners, consu should come together to address how CER will be most mean practitioners. Such discussions should articulate how the soci meeting the established CER priorities that encourage researc

Social Work Research and Comparative Effectiveness Research (CER): A Research Symposium to Strengthen the Connection was hosted by the Social Work Policy Institute (SWPI) of the NASW Foundation on November 16, 2009. It brought together experts from the research, practice, policy, and education arenas to examine how the social work profession might best contribute to the expanding attention to CER. Participants included representatives of federal research and service agencies, national organizations, health care delivery organizations, foundations, and academic institutions.

Social work research engagement in CER may have two disti pathways:

Presentations covered the federal agenda and definitions for CER, current knowledge about outcomes of social work effectiveness research, economic analysis of psychosocial interventions, strengthening the research-practice relationship, and the implications of CER for social work. The symposium resulted in an action plan to address further social work research, training of researchers and practitioners, interdisciplinary collaborations, research/practice connections, and communication and outreach efforts with the purpose of increasing social work’s capacity to engage in CER.

PATHWAY ONE relates to the expertise and perspect cultural competence, and communities that a social w inter-disciplinary research team.

•

PATHWAY TWO relates more specifically to research implementation and comparative effectiveness of spec workers.

General Effectiveness of Social Work Interventions and C

There is current research that shows the effectiveness of socia Volland, & Shuluk, 2008). However, for CER, not only does social work practice, but there also needs to be more rigorou research include small sample size, homogeneous samples, lac and publication bias, and lack of attention to attrition. Issues need further exploration might include the uniqueness of soci efficacy studies in social work research; the use of manualized of common elements of effective interventions (e.g., understa worker-client relationship).

WHAT IS COMPARATIVE EFFECTIVENESS RESEARCH? The intent of CER is to determine which health and health care delivery interventions work best for whom and under what conditions. The American Recovery and Reinvestment Act (ARRA) of 2009 provided $1.1 billion for CER to be divided among the National Institutes of Health (NIH), the Office of the Secretary of the Department of Health and Human Services (DHHS), and the Agency for Healthcare Research and Quality (AHRQ). These funds are to be used to conduct and synthesize research that assesses the comparative effectiveness of health care treatments and strategies of health care delivery, and to stimulate the development and use of clinical registries, data networks, and other forms of electronic health data that can be used for research on intervention outcomes (ARRA, 2009).

Strengthening Research-Practice Connections

Both the CER agenda and the social work profession’s comm evidence-based practice (EBP) (IASWR, 2007) call for stronge enhance the relevance of research in practice. Practitioners n observe and test the impact of interventions and share the les

ARRA (2009) directed DHHS to create a Federal Coordinating Council (FCC) charged with constructing a recommended definition, prioritization criteria, strategic framework, a long term


•

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outlook, and next steps for CER. Congress also requested that the Institute of Medicine (IOM) convene a study to identify the Initial National Priorities for CER, giving consideration to the FCC’s report (ARRA, 2009; IOM, 2009). Key priorities center on identifying and addressing health disparities for diverse populations and persons with complex conditions, identifying gaps in the existing knowledge of healthcare, and expanding dissemination of CER outcomes. The FCC and IOM reports lay out several strategies to support CER through developing information infrastructure; conducting more robust CER through training and collaboration; ensuring research and findings are relevant to consumers and practitioners; and enhancing dissemination and translation of CER findings (DHHS, 2009; IOM, 2009).

TIVE SUMMARY

SOCIAL WORK AND COMPARATIVE EFFECTIVENESS RESEARCH Social Work’s Role in CER

M

Leadership by the social work profession is critical to ensure that social workers are key stakeholders in CER efforts. Researchers, practitioners, consumers, academics, and policy-makers should come together to address how CER will be most meaningful for consumers and practitioners. Such discussions should articulate how the social work perspective can add value to meeting the established CER priorities that encourage research on psychosocial needs.

ve Effectiveness Research (CER): A Research Symposium to d by the Social Work Policy Institute (SWPI) of the NASW t brought together experts from the research, practice, ne how the social work profession might best contribute to icipants included representatives of federal research and ns, health care delivery organizations, foundations, and

Social work research engagement in CER may have two distinct or potentially overlapping pathways:

nda and definitions for CER, current knowledge about research, economic analysis of psychosocial interventions, ationship, and the implications of CER for social work. The to address further social work research, training of ciplinary collaborations, research/practice connections, and with the purpose of increasing social work’s capacity to

•

PATHWAY ONE relates to the expertise and perspective on clients, systems, ethics, cultural competence, and communities that a social work researcher brings to the inter-disciplinary research team.

•

PATHWAY TWO relates more specifically to research on the development and implementation and comparative effectiveness of specific interventions used by social workers.

General Effectiveness of Social Work Interventions and Considerations for CER There is current research that shows the effectiveness of social work interventions (Mullen, Melly, Volland, & Shuluk, 2008). However, for CER, not only does there need to be more research on social work practice, but there also needs to be more rigorous research. Current limitations of research include small sample size, homogeneous samples, lack of comparison groups, investigator and publication bias, and lack of attention to attrition. Issues related to social work practice that need further exploration might include the uniqueness of social work interventions; the place for efficacy studies in social work research; the use of manualized interventions; and the identification of common elements of effective interventions (e.g., understanding the qualities of the worker-client relationship).

E EFFECTIVENESS RESEARCH?

ich health and health care delivery interventions work best The American Recovery and Reinvestment Act (ARRA) of o be divided among the National Institutes of Health (NIH), artment of Health and Human Services (DHHS), and the Quality (AHRQ). These funds are to be used to conduct and omparative effectiveness of health care treatments and to stimulate the development and use of clinical registries, ctronic health data that can be used for research on .

Strengthening Research-Practice Connections Both the CER agenda and the social work profession’s commitment to pursuing the process of evidence-based practice (EBP) (IASWR, 2007) call for stronger research-practice connections to enhance the relevance of research in practice. Practitioners need encouragement and incentives to observe and test the impact of interventions and share the lessons learned from practice in a

te a Federal Coordinating Council (FCC) charged with n, prioritization criteria, strategic framework, a long term

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variety of environments. Research can be normalized and demystified by integrating it into professional education and by teaching clinicians that they have opportunities to conduct research in daily practice and should be life-long learners. Further, encouraging practitioners to engage in research should be coupled with health and human service organizations’ efforts to partner with research teams at universities and other research groups.

Building Infrastructure and Methodological Capacity of CER The proposed research priorities and intent of CER presents multiple methodological challenges to researchers. Expanding the scope of research to test interventions on heterogeneous samples in complex environments means that greater efforts will be needed to engage different populations in research studies. Using randomized designs, and qualitative and mixed methods studies as well as community-based participatory research designs will help to mitigate these methodological challenges. Engaging consumers in planning research and identifying questions that need further study will be important aspects of building CER capacity. Social workers commonly use these diverse research methods and also have insight about how to navigate multiple delivery systems. These are skills that social workers can contribute to interdisciplinary research teams. Therefore, it is essential to train social work researchers in CER methodologies so that they can conduct CER in a variety of environments and work together with other disciplines and community stakeholders. Systematic reviews will be an important aspect of CER in determining the differential effectiveness of interventions. Current limitations of social work research diminish the capacity to conduct systematic reviews of many social work practices. High quality rigorous research is needed for relevant systematic reviews to be conducted that can increase social work’s inclusion in future CER databases. For practitioners and researchers, understanding and using meaningful economic evaluation methods when conducting intervention research studies should be an essential. Such tools can be valuable to program decision-making and for setting health and mental health policy when attempting to comparatively maximize outcomes and minimize costs. So often in delivering psychosocial services, resources are limited and hard choices about care need to be made. Economic evaluation strategies can assist in demonstrating the value provided from the resources expended. This is particularly relevant for CER, because a key public concern about this new emphasis on CER is that decisions might be made based solely on cost. Review panels, foundations, federal agencies, academic institutions, and national organizations should stress the importance of including relevant methods of economic evaluation in research.

Recommended Agenda for Action The intent of CER is to determine what works best, for whom, and under what conditions. Both the FCC and IOM CER reports call for increased efforts to develop and understand intervention outcomes specifically for diverse populations with co-occurring diagnoses and an array of psychosocial needs. This has great relevance for social work, since social work research deals with complex person-in-environment contexts, and studies how to address psychosocial needs from an individual, family, community, organization, and systems perspective. Furthermore, social workers’ ethical commitment to social justice can be translated into addressing issues of diversity and cultural competence in designing and implementing research. The following highlights actions that can be taken to enhance social work’s involvement with and contributions to CER.


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n be normalized and demystified by integrating it into g clinicians that they have opportunities to conduct research ng learners. Further, encouraging practitioners to engage in h and human service organizations’ efforts to partner with er research groups.

ological Capacity of CER

ntent of CER presents multiple methodological challenges to esearch to test interventions on heterogeneous samples in ater efforts will be needed to engage different populations in esigns, and qualitative and mixed methods studies as well as ch designs will help to mitigate these methodological anning research and identifying questions that need further lding CER capacity. Social workers commonly use these ve insight about how to navigate multiple delivery systems. n contribute to interdisciplinary research teams. Therefore, it chers in CER methodologies so that they can conduct CER k together with other disciplines and community

nt aspect of CER in determining the differential effectiveness of social work research diminish the capacity to conduct rk practices. High quality rigorous research is needed for ducted that can increase social work’s inclusion in future

erstanding and using meaningful economic evaluation n research studies should be an essential. Such tools can be and for setting health and mental health policy when e outcomes and minimize costs. So often in delivering mited and hard choices about care need to be made. sist in demonstrating the value provided from the resources t for CER, because a key public concern about this new ght be made based solely on cost. Review panels, ic institutions, and national organizations should stress the hods of economic evaluation in research.

at works best, for whom, and under what conditions. Both or increased efforts to develop and understand intervention ulations with co-occurring diagnoses and an array of evance for social work, since social work research deals with xts, and studies how to address psychosocial needs from an zation, and systems perspective. Furthermore, social l justice can be translated into addressing issues of diversity and implementing research. The following highlights actions ork’s involvement with and contributions to CER.

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Recommendations for National Organizations •

Convene a large-scale social work-led summit with consumers, practitioners, and researchers on how social work can enhance its role in CER.

•

Continue to build social work membership and research organizations’ relationships with NIH and AHRQ and other research entities.

•

Educate practitioners on CER through continuing education strategies.

•

Explore establishing awards and events that would link practitioners to researchers, and encourage replication of effective interventions and translation of research to practice by endorsing practices that are extensively evaluated through CER.

•

Explore establishing field of practice specific clearinghouses for researchers and practitioners as a membership incentive.

•

Increase efforts to expand the link between social work research and practice including using new technologies in both research and dissemination activities.

Recommendations for Collaboration with Federal Agenc •

Encourage NIH and AHRQ to enhance social work r value of social workers on interdisciplinary CER team workers on scientific review committees.

•

Ensure inclusion of existing databases of social work scanning” efforts, and increase dissemination of alrea social work interventions (e.g. Campbell Collaboratio

•

Encourage NIH and AHRQ to promote economic eva design and to expand the knowledge-base of scientific economic evaluation.

Recommendations to Enhance CER Methods •

Develop methodologies for researchers to compare in of effectiveness including addressing short and long-te effectiveness across multiple study sites.

Recommendations for Academic Settings

•

Regarding research excellence • Train faculty to expand their research capacity to include CER methodologies including encouraging social work research centers to serve as models for multi-site CER.

Consider new techniques for data collection that can dissemination of research findings, and compare data implementing the same interventions.

•

Include economic evaluation and considerations of do effectiveness research.

•

Promote community-based participatory research (CB CBPR researchers to get involved with NIH, AHRQ,

•

Continue to build the research base of “effective socia

•

Add CER methodologies to the social work curriculum.

•

Train researchers and practitioners to include economic evaluation in intervention research.

Regarding practice excellence • Reinforce the importance of remaining up to date on research outcomes in BSW and MSW curricula materials, including in practice classes. •

Recommendations to Promote Practice-Research Linkage

Encourage collaboration between health and human service agencies and university-based researchers.

Regarding academic publications • Review tenure, promotion, and academic reward structures in social work to encourage researchers to seek interdisciplinary publication opportunities. •

Consider the revision of the structure of social work journal articles to present the limitations’ section in a more constructive way, and include a section in each article on the relevance of the research to practice.


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•

Further develop researcher/practitioner/client linkages

•

Train practitioners about how research can be used to collaborations in real world settings.

•

Encourage organizations to support practitioners’ use integrating research skills into clinical training progra and encourage practitioners to publish results of evalu




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ganizations

Recommendations for Collaboration with Federal Agencies

ork-led summit with consumers, practitioners, and k can enhance its role in CER.

membership and research organizations’ relationships with search entities.

•

Encourage NIH and AHRQ to enhance social work research including recognition of the value of social workers on interdisciplinary CER teams and engagement of more social workers on scientific review committees.

•

Ensure inclusion of existing databases of social work research in the CER “horizon scanning” efforts, and increase dissemination of already available systematic reviews of social work interventions (e.g. Campbell Collaboration reviews).

•

Encourage NIH and AHRQ to promote economic evaluation as part of the research study design and to expand the knowledge-base of scientific review committees regarding economic evaluation.

through continuing education strategies.

nd events that would link practitioners to researchers, and ive interventions and translation of research to practice by tensively evaluated through CER.

ractice specific clearinghouses for researchers and incentive.

Recommendations to Enhance CER Methods •

Develop methodologies for researchers to compare interventions to make determinations of effectiveness including addressing short and long-term effectiveness outcomes and effectiveness across multiple study sites.

ettings

•

esearch capacity to include CER methodologies including rch centers to serve as models for multi-site CER.

Consider new techniques for data collection that can expedite data collection, promote dissemination of research findings, and compare datasets from multiple sites that are implementing the same interventions.

•

Include economic evaluation and considerations of dosage, duration, and rigor in effectiveness research.

•

Promote community-based participatory research (CBPR) methodologies and encourage CBPR researchers to get involved with NIH, AHRQ, and DHHS’s CER efforts.

•

Continue to build the research base of “effective social work” interventions.

link between social work research and practice including h research and dissemination activities.

e social work curriculum.

oners to include economic evaluation in intervention

emaining up to date on research outcomes in BSW and MSW n practice classes.

Recommendations to Promote Practice-Research Linkages

een health and human service agencies and university-based

d academic reward structures in social work to encourage inary publication opportunities.

ructure of social work journal articles to present the constructive way, and include a section in each article on the actice.

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•

Further develop researcher/practitioner/client linkages as a standard of practice.

•

Train practitioners about how research can be used to inform practice and foster research collaborations in real world settings.

•

Encourage organizations to support practitioners’ use and production of research by integrating research skills into clinical training programs within universities and agencies, and encourage practitioners to publish results of evaluations and outcomes of practice.


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The social work profession and especially the social work research enterprise is well-positioned to be fully engaged with Comparative Effectiveness Research efforts based on the definitions, priorities, strategies, and challenges laid out by the federal government. Attention needs to be given to continuing to build social work effectiveness research; involving social workers as part of interdisciplinary research teams; ensuring that findings from social work research are included in data and research repositories and systematic reviews; encouraging participatory research efforts that fully engage service providers and consumers; encouraging economic evaluation as an integral part of research studies; facilitating innovative research dissemination strategies and strengthening research/practice/policy linkages. Professional and scientific societies, universities, service provider agencies, consumers and funders of research and services all have important roles to play in ensuring the health and well-being of our society, especially those at highest risk to experience health disparities.

FINAL REPO

ABOUT THE SYMPOSIUM

With growing attention to how Comparative Effectiveness Re identify which medical and psychosocial interventions work b conditions, the Social Work Policy Institute (SWPI) of the Na (NASW) Foundation convened a think tank meeting on Nove inaugural event of the new Institute, which was launched in O

Social Work Research and Comparative Effectiveness Resear Strengthen the Connection brought together experts from the education arenas to examine how the social work profession expanding attention to CER. Participants included representa agencies, national organizations, health care delivery organiz institutions (see Participant List, Appendix A). The think tan expert presentations (see Presenters’ Biographies, Appendix C leading to the development of an action agenda. The presenta •

Definitions and federal agenda for CER and the impli

•

What is known about outcomes of social work resear

•

Economic analysis of effectiveness of psychosocial int

•

Strengthening the research-practice relationship.

Following the presentations, symposium participants identifie CER and psychosocial research. Issues discussed included the work interventions; methods for conducting effectiveness rese populations and people with complex needs; researcher train strengthening research-practice linkages. As a culmination to opportunities, the participants identified an action plan to ad training of researchers, interdisciplinary collaborations, resea communication and outreach efforts.


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ally the social work research enterprise is well-positioned to fectiveness Research efforts based on the definitions, id out by the federal government. Attention needs to be rk effectiveness research; involving social workers as part of ring that findings from social work research are included in tematic reviews; encouraging participatory research efforts d consumers; encouraging economic evaluation as an integral novative research dissemination strategies and strengthening fessional and scientific societies, universities, service provider search and services all have important roles to play in our society, especially those at highest risk to experience

FINAL REPORT

ABOUT THE SYMPOSIUM With growing attention to how Comparative Effectiveness Research (CER) might be utilized to identify which medical and psychosocial interventions work best, for whom and under what conditions, the Social Work Policy Institute (SWPI) of the National Association of Social Workers (NASW) Foundation convened a think tank meeting on November 16, 2009. This was the inaugural event of the new Institute, which was launched in October 2009.

Social Work Research and Comparative Effectiveness Research (CER): A Research Symposium to Strengthen the Connection brought together experts from the research, practice, policy and education arenas to examine how the social work profession might best contribute to the expanding attention to CER. Participants included representatives of federal research and service agencies, national organizations, health care delivery organizations, foundations and academic institutions (see Participant List, Appendix A). The think tank agenda (see Appendix B) included expert presentations (see Presenters’ Biographies, Appendix C) and small group discussions leading to the development of an action agenda. The presentations covered: •

Definitions and federal agenda for CER and the implications for social work

•

What is known about outcomes of social work research

•

Economic analysis of effectiveness of psychosocial interventions, and

•

Strengthening the research-practice relationship.

Following the presentations, symposium participants identified gaps and challenges for conducting CER and psychosocial research. Issues discussed included the current status of research on social work interventions; methods for conducting effectiveness research in complex systems with special populations and people with complex needs; researcher training and capacity building; and strengthening research-practice linkages. As a culmination to the discussions of challenges and opportunities, the participants identified an action plan to address further social work research, training of researchers, interdisciplinary collaborations, research/practice connections, and communication and outreach efforts.

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WHAT IS COMPARATIVE EFFECTIVENESS RESEARCH? Legislative Focus on Comparative Effectiveness Research The American Recovery and Reinvestment Act (ARRA) of 2009 provided $1.1 billion for Comparative Effectiveness Research (CER) 1. These funds are designed to support research assessing the comparative effectiveness of health care treatments and strategies of health care delivery through efforts that: 1.

Conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions.

2.

Encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data” (ARRA, 2009, Sec. 804).

$400 million for the National Institutes of Health (NIH)

•

$400 million for the Office of the Secretary of the Department of Health and Human Services (DHHS)

•

Defined interventions compared may include medicat assistive devices and technologies, diagnostic testing, system strategies.

3.

This research necessitates the development, expansion and methods to assess comparative effectiveness and a (DHHS, 2009, p.16).

Prioritization Criteria The report suggests focusing on research that addresses the n such as racial and ethnic minorities, persons with disabilities, patients with co-morbidities (DHHS, 2009).

Research Challenges The report highlights several research challenges related to pr

ARRA (2009) provides: •

2.

$300 million for the Agency for Healthcare Research and Quality (AHRQ)

Federal Coordinating Council (FCC) and its Report to the President and the Congress on CER To help coordinate CER across the federal government, the ARRA directed DHHS to create a 15 member Federal Coordinating Council (FCC) (ARRA, 2009, Sec. 804)2. After conducting three public listening sessions and gathering input from a variety of stakeholders, the FCC for CER released its Report to the President and the Congress on June 30, 2009 (U.S. DHHS, 2009). The FCC report specifically focuses on recommendations for ARRA funds allocated to the DHHS Office of the Secretary. Dr. Carolyn Clanay, who chaired the FCC, has emphasized that the goal of CER is to provide “tools, not rules” for CER. The report includes a recommended definition, prioritization criteria, strategic framework, a long term outlook, and next steps.

•

Evaluating and identifying interventions that are tailo

•

Creating and enhancing potential databases looking a populations

•

Increasing the number of community-based studies

•

Increasing cultural competency

•

Building workforce capacity

•

Developing and implementing outreach strategies to v disparity populations for participation in research pro

Strategic Framework The report specifies four core categories for prioritizing how activities and investments, with the primary DHHS focus on the CER data infrastructure (DHHS, 2009). For more inform Appendix C.

FCC Recommended Definition for CER “Comparative Effectiveness Research is the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat, and monitor health care conditions in “real world” settings. The purpose of this research is to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances. 1.

To provide this information, comparative effectiveness research must assess a comprehensive array of health-related outcomes for diverse patient populations and sub-groups.

1

Text of ARRA related to CER funding can be found at www.hhs.gov/recovery/programs/cer/recoveryacttext.html

2

The FCC includes social worker Peter J. Delany, PhD, LCSW-C, a Rear Admiral in the United State States Public Health Service, and Director of the Substance Abuse and Mental Health Services Administration’s Office of Applied Studies. Dr. Delany presented at the SWPI CER Symposium.


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E EFFECTIVENESS RESEARCH?

Effectiveness Research

2.

Defined interventions compared may include medications, procedures, medical and assistive devices and technologies, diagnostic testing, behavioral change, and delivery system strategies.

3.

This research necessitates the development, expansion, and use of a variety of data sources and methods to assess comparative effectiveness and actively disseminate the results” (DHHS, 2009, p.16).

ment Act (ARRA) of 2009 provided $1.1 billion for CER) 1. These funds are designed to support research s of health care treatments and strategies of health care

Prioritization Criteria The report suggests focusing on research that addresses the needs of underrepresented populations such as racial and ethnic minorities, persons with disabilities, children, veterans, the elderly, and patients with co-morbidities (DHHS, 2009).

ze research that compares the clinical outcomes, ness of items, services, and procedures that are used to eases, disorders, and other health conditions.

Research Challenges The report highlights several research challenges related to priority populations:

nd use of clinical registries, clinical data networks, and other a that can be used to generate or obtain outcomes data”

•

Evaluating and identifying interventions that are tailored for priority populations

•

Creating and enhancing potential databases looking at interventions for priority populations

•

Increasing the number of community-based studies

•

Increasing cultural competency

•

Building workforce capacity

•

Developing and implementing outreach strategies to various racial, ethnic, and health disparity populations for participation in research protocols

Institutes of Health (NIH)

the Secretary of the Department of Health and Human

or Healthcare Research and Quality (AHRQ)

and its Report to the President and the Congress on CER

deral government, the ARRA directed DHHS to create a 15 l (FCC) (ARRA, 2009, Sec. 804)2. After conducting three g input from a variety of stakeholders, the FCC for CER d the Congress on June 30, 2009 (U.S. DHHS, 2009). The ommendations for ARRA funds allocated to the DHHS lanay, who chaired the FCC, has emphasized that the goal of or CER. The report includes a recommended definition, work, a long term outlook, and next steps.

Strategic Framework The report specifies four core categories for prioritizing how DHHS funds should address CER activities and investments, with the primary DHHS focus on the development and enhancement of the CER data infrastructure (DHHS, 2009). For more information on the proposed framework see Appendix C.

ER is the conduct and synthesis of research comparing the entions and strategies to prevent, diagnose, treat, and al world” settings. The purpose of this research is to improve sseminating evidence-based information to patients, responding to their expressed needs, about which hich patients under specific circumstances.

omparative effectiveness research must assess a -related outcomes for diverse patient populations and

nd at www.hhs.gov/recovery/programs/cer/recoveryacttext.html

hD, LCSW-C, a Rear Admiral in the United State States Public Health Service, and h Services Administration’s Office of Applied Studies. Dr. Delany presented at the

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Institute of Medicine’s (IOM) Initial National Priorities for CER

OVERARCHING FEDERAL STRATEGIES F

Congress, through the ARRA, also requested that the Institute of Medicine (IOM)3 convene a study to identify the Initial National Priorities for CER, giving consideration to the FCC’s report (ARRA, 2009; IOM, 2009).

The FCC and IOM reports lay out several strategies to better the United States to engage in CER that is meaningful to both to develop long-lasting and sustainable CER using federal age through developing information infrastructure; conducting m collaboration; ensuring research and findings are relevant to enhancing dissemination and translation of CER findings. Th CER are highlighted from the symposium presentations and d

As with the FCC, the IOM committee obtained stakeholder input and then created a definition on which the priorities would be based. The IOM report defines CER as follows: “Comparative effectiveness research (CER) is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels” (IOM, 2009, p.41).

Building Information Infrastructure for Collection and Dis

The committee went through three rounds of voting and arrived at 100 top priorities that were drawn from the original 2,600 suggested. The top 100 priorities (see Appendix D for priorities most relevant to social work) are intended as a starting point for CER efforts and should evolve as the research initiative progresses. The selected research priorities were divided into condition-level criteria and priority-topic level criteria. Condition-level criteria includes burden of disease, cost, variability, and appropriateness for CER; priority-topic level criteria include gaps in existing knowledge and the likelihood that the results would improve health. It should be noted that the 100 priorities address many areas related to populations and health factors for which there is currently very little research.

•

The science of CER will require the development of a large-scale data networks to analyze health outcomes research. While some CER is already conducted and s picture of effectiveness of interventions across popula primarily focus its allocated CER funding to build the the current CER landscape and identifies gaps needed

•

DHHS, AHRQ and NIH will also dedicate funding to disseminate and translate CER from research to pract

Focus of Research on Priority Populations and Condition •

The FCC and IOM reports call for CER focusing on p research comparing the effectiveness of interventions intended to help patients make more informed care de cost of care and minimizing the use of less effective tr

•

Research in controlled environments helps determine seeks to eliminate other influencing factors. It may ha generalizability. CER policy seeks to build the impact practitioners and diverse populations of consumers by be evaluated for their effectiveness in real world settin

Training for Researchers and Practitioners

3

CER presents many methodological challenges to rese especially because it calls for research in real world se hard to reach populations. Therefore, researchers nee research methods and for analyzing multiple data sou comparative outcomes.

•

Practitioners need training opportunities on the impor complete case information that can be analyzed, unde the context of practice, and collaboration with researc relevant and meaningful to practice.

•

Researchers need training in how to present data that practitioners need training in how to interpret researc

4

For example, AHRQ has developed a Citizen Forum on Effective Health Care to ta practice - http://effectivehealthcare.ahrq.gov

The IOM group developing the top 100 priorities included Katie Maslow, MSW of the Alzheimer’s Association. Ms. Maslow presented at the SWPI CER Symposium.


•

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National Priorities for CER

OVERARCHING FEDERAL STRATEGIES FOR CER DEVELOPMENT

quested that the Institute of Medicine (IOM)3 convene a Priorities for CER, giving consideration to the FCC’s report

The FCC and IOM reports lay out several strategies to better position the research community in the United States to engage in CER that is meaningful to both practice and policy. The intention is to develop long-lasting and sustainable CER using federal agencies (NIH, AHRQ, and DHHS) through developing information infrastructure; conducting more robust CER through training and collaboration; ensuring research and findings are relevant to consumers and practitioners; and enhancing dissemination and translation of CER findings. The following strategies for enhancing CER are highlighted from the symposium presentations and discussions.

obtained stakeholder input and then created a definition on The IOM report defines CER as follows:

search (CER) is the generation and synthesis of evidence that ms of alternative methods to prevent, diagnose, treat, and r to improve the delivery of care. The purpose of CER is to urchasers, and policy makers to make informed decisions at both the individual and population levels” (IOM, 2009,

Building Information Infrastructure for Collection and Dissemination of Research

unds of voting and arrived at 100 top priorities that were ted. The top 100 priorities (see Appendix D for priorities nded as a starting point for CER efforts and should evolve as selected research priorities were divided into condition-level a. Condition-level criteria includes burden of disease, cost, ER; priority-topic level criteria include gaps in existing results would improve health. It should be noted that the ted to populations and health factors for which there is

•

The science of CER will require the development of a supporting infrastructure and large-scale data networks to analyze health outcomes and to disseminate findings of research. While some CER is already conducted and synthesized, there is not a complete picture of effectiveness of interventions across populations or conditions. DHHS will primarily focus its allocated CER funding to build the data infrastructure that establishes the current CER landscape and identifies gaps needed to fulfill research priorities.

•

DHHS, AHRQ and NIH will also dedicate funding to develop formal mechanisms to disseminate and translate CER from research to practice.4

Focus of Research on Priority Populations and Conditions in Real World Environments •

The FCC and IOM reports call for CER focusing on populations and conditions for which research comparing the effectiveness of interventions is currently lacking. This research is intended to help patients make more informed care decisions, thereby reducing the overall cost of care and minimizing the use of less effective treatments.

•

Research in controlled environments helps determine the efficacy of an intervention and seeks to eliminate other influencing factors. It may have strong internal validity, but limited generalizability. CER policy seeks to build the impact of research’s relevance to practitioners and diverse populations of consumers by stressing that interventions should be evaluated for their effectiveness in real world settings.

Training for Researchers and Practitioners •

CER presents many methodological challenges to research (see discussion below), especially because it calls for research in real world settings with diverse and sometimes hard to reach populations. Therefore, researchers need training in using participatory research methods and for analyzing multiple data sources and research studies to develop comparative outcomes.

•

Practitioners need training opportunities on the importance of keeping accurate and complete case information that can be analyzed, understanding research methodologies in the context of practice, and collaboration with researchers to produce research that is relevant and meaningful to practice.

•

Researchers need training in how to present data that is useful for practice and practitioners need training in how to interpret research findings for practice.

4

For example, AHRQ has developed a Citizen Forum on Effective Health Care to take on the discussion of CER issues in research and practice - http://effectivehealthcare.ahrq.gov

ncluded Katie Maslow, MSW of the Alzheimer’s Association. Ms. Maslow

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Collaboration in Research •

Efforts to coordinate between public and private sector CER projects are needed to build a better CER infrastructure.

•

Bringing together multiple disciplines in planning and implementing CER will help ensure that the researchers consider the environment of the consumer and other social and cultural factors that may influence the outcome of an intervention.

•

Engaging communities in designing research, data collection, and dissemination of findings can aid in developing interventions that will be more useful to and used by that population. It can also lead to a better understanding of the complexities of how an individual or group’s environment, culture or values might effect the intervention’s applicability and outcomes, as well as addressing adoption, adaptation and fidelity issues.

SOCIAL WORK AND COMPARATIVE E RESEARCH Social Work Code of Ethics

“The primary mission of the social work profession is to enh the basic human needs of all people, with particular attention people who are vulnerable, oppressed, and living in poverty. A social work is the profession’s focus on individual well-being of society. Fundamental to social work is attention to the env contribute to, and address problems in living.” (NASW, 1999

The FCC and IOM reports call for research on interventions determine outcomes for diverse populations with complex an social and cultural attributes. Since social workers are engage are targets for CER, social workers can be important resourc disciplines to develop CER studies. Furthermore, social work thinking about multiple environmental and systems variables when determining an appropriate treatment plan. This shou of a robust social work practice-based research enterprise.

Building Public Knowledge and Acceptance of CER •

•

Many believe treatments are already clinically tested before being put into practice. In actuality, fewer than half of the interventions and tests prescribed by clinicians are supported by scientific evidence of their effectiveness (IOM, 2009). Clinicians and consumers are not able to make research-informed care decisions because the information is simply not available. Building public knowledge about the use of research in practice can help educate consumers about the value of tested interventions, what is currently known about best practices, and areas where further studies are needed to determine which practices are most effective.

Social work engagement in CER may have two distinct or po

CER is a political issue with considerable attention being paid to building CER capacity both within the ARRA and in health care reform legislation. The perception that CER will result in rationing and limits to choices for ourselves, our families, and our clients is a concern that needs to be addressed. To overcome skepticism about CER findings and applicability in practice, the value of CER needs to be marketed to the public, to practitioners, to researchers, and to policy-makers. Researchers also need to be trained in CER methods.

PATHWAY ONE relates to the expertise and perspect cultural competence, and communities that a social w inter-disciplinary research team.

•

PATHWAY TWO relates more specifically to research implementation and comparative effectiveness of spec workers.

Overview of the General Effectiveness of Social Worker

Considerations for Economic Evaluations of Interventions •

•

On-going questions relate to the extent to which the interven have been proven to be effective and the extent to which ther interventions. With this new attention to CER, another quest profession – Is there sufficient research available on social wo findings in order to guide practitioners and consumers on wh for which individuals and in what settings? Furthermore, are practice outcomes that can contribute to CER data sets and r

Diligence should be given to discovering what works best, not what is the cheapest. Cost effectiveness is important when considering the implementation of an intervention, but should not be the sole determinant regarding health decision making. When costs are considered, they should be appropriately compared to measures of effectiveness.

One attempt to address the question related to social work in York Academy of Medicine’s Social Work Leadership Institut Evidence Database on Aging Care (EDAC) (http://socialworkleadership.org/nsw/cap/topics.php?item=soc Atlantic Philanthropies.

EDAC is a database designed to include articles that report fi psychosocial interventions relevant to social workers who wo in this process was to examine research on social work interv


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SOCIAL WORK AND COMPARATIVE EFFECTIVENESS RESEARCH

public and private sector CER projects are needed to build a

ciplines in planning and implementing CER will help ensure he environment of the consumer and other social and ence the outcome of an intervention.

Social Work Code of Ethics “The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty. A historic and defining feature of social work is the profession’s focus on individual well-being in a social context and the well-being of society. Fundamental to social work is attention to the environmental forces that create, contribute to, and address problems in living.” (NASW, 1999, p. 1)

gning research, data collection, and dissemination of findings tions that will be more useful to and used by that a better understanding of the complexities of how an ment, culture or values might effect the intervention’s well as addressing adoption, adaptation and fidelity issues.

The FCC and IOM reports call for research on interventions in real world conditions to better determine outcomes for diverse populations with complex and multiple diagnoses and a range of social and cultural attributes. Since social workers are engaged with the priority populations that are targets for CER, social workers can be important resources to researchers from other disciplines to develop CER studies. Furthermore, social workers’ ethical standards require critical thinking about multiple environmental and systems variables when selecting an intervention and when determining an appropriate treatment plan. This should then set the stage for development of a robust social work practice-based research enterprise.

ceptance of CER

lready clinically tested before being put into practice. In e interventions and tests prescribed by clinicians are ce of their effectiveness (IOM, 2009). Clinicians and ke research-informed care decisions because the information ng public knowledge about the use of research in practice can the value of tested interventions, what is currently known s where further studies are needed to determine which

Social work engagement in CER may have two distinct or potentially overlapping pathways:

onsiderable attention being paid to building CER capacity health care reform legislation. The perception that CER will o choices for ourselves, our families, and our clients is a essed. To overcome skepticism about CER findings and alue of CER needs to be marketed to the public, to nd to policy-makers. Researchers also need to be trained in

•

PATHWAY ONE relates to the expertise and perspective on clients, systems, ethics, cultural competence, and communities that a social work researcher brings to the inter-disciplinary research team.

•

PATHWAY TWO relates more specifically to research on the development and implementation and comparative effectiveness of specific interventions used by social workers.

ations of Interventions

Overview of the General Effectiveness of Social Worker Interventions

iscovering what works best, not what is the cheapest. Cost n considering the implementation of an intervention, but nant regarding health decision making. When costs are propriately compared to measures of effectiveness.

On-going questions relate to the extent to which the interventions provided by social workers have been proven to be effective and the extent to which there is available research on social work interventions. With this new attention to CER, another question arises for the social work profession – Is there sufficient research available on social work interventions to compare the findings in order to guide practitioners and consumers on what interventions are most effective, for which individuals and in what settings? Furthermore, are there data sources about social work practice outcomes that can contribute to CER data sets and repositories? One attempt to address the question related to social work intervention effectiveness is the New York Academy of Medicine’s Social Work Leadership Institute’s development of a web resource, Evidence Database on Aging Care (EDAC) (http://socialworkleadership.org/nsw/cap/topics.php?item=social#social) with support from Atlantic Philanthropies. EDAC is a database designed to include articles that report findings on the outcomes of psychosocial interventions relevant to social workers who work with older adults. An initial step in this process was to examine research on social work intervention effectiveness more broadly.

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Therefore, EDAC analyzed reviews (published after 1990) that evaluate what is known about overall effectiveness of social work interventions (Mullen, Melly, Volland, & Shuluk, 2008). A total of 375 studies were examined in 7 reviews (See Appendix E for the list of review articles) and yielded the following conclusions:

Office of Behavioral and Social Sciences Research (OBSSR) (N NIH grants have been awarded to social work researchers sin contributions from social work research are more fully recog community.

•

There is a large body of evidence supporting the effectiveness of many social work interventions for a variety of social problems and populations. However, many of these determinations of effectiveness must be qualified due to the limitations of the research studies themselves (Mullen et al., 2008).

Building on the great strides that have been made in social w the University of Southern California in partnership with the Social Work Research (IASWR) sponsored the Los Angeles C in Social Work (http://sowkweb.usc.edu/research/events/index research on social work interventions across the areas of serio criminal justice, substance abuse, dealing with trauma in the youth. The research presentations highlighted rigorous studi to those identified in the CER priorities. Discussions focused research including strategies for engagement of appropriate s impact of the research on practice change.

•

Overall, an average of 2/3 of clients served by social workers benefit in measureable ways, even when controlling for publication and investigator bias of the research (Mullen et al., 2008).

•

Many studies contrast alternative interventions using a comparison group design, which allows for conclusions about the relative effectiveness of an intervention to usual care or an offered alternative intervention (Mullen et al., 2008).

•

Theoretical orientations of an intervention do not account for differential outcomes (Reid, 1997; Gorey, Thyer, & Pawluck, 1998).

•

Interventions are shown to have different outcomes when implemented with different populations and conditions (Reid, 1997; Reid, Kenaley, & Colvin, 2004) or target system (Gorey, Thyer, & Pawluck, 1998).

•

Are the interventions provided by social workers uniq unique – then what special qualities does a social wor intervention?

•

Future research is needed on cost-effectiveness and cost-benefits of interventions as few of the reviews addressed such questions (Mullen et al., 2008).

•

In implementing research-based interventions, do the If interventions are manualized, what skills and know appropriately adopt and adapt the interventions and t

•

Reviews of social work effectiveness since 1990 differ from pre-1990 reviews in that the more recent reviews are more likely to use meta-analysis; examine moderator variables; explore publication bias; examine investigator bias; question differential effects due to intervention method, social problem and population characteristics; cast a wider net to include studies of a wide range of designs; and include more RCTs using comparative effectiveness designs (Mullen et al., 2008).

•

What can be understood related to the dosage and du expectations of differential outcomes? For example, d clinical intervention is provided for 1 hour, once a we and how might dosing and duration determinations e transportation and ability to access services?

•

Are there common elements to effective interventions professional staff, interdisciplinary team strategies, us techniques?

•

Is research underway in the services where social wor would develop a better understanding of the intrinsic client or in studying case management, care coordinat populations, service settings and age groups.

•

What is understood about the key components of effe core aspects of care coordination that always need to

•

Are there ethical concerns that must be addressed in c work interventions?

•

Are efficacy trials a necessary first phase for social wo most frequently have complex needs and co-occurring

•

In comparing the effectiveness of social work interven compared (e.g., to interventions by non-social worker treatment as usual).

Many of the issues that emerged from the USC conference ov SWPI CER Symposium. These include:

To determine differential effectiveness the following questions should be considered: •

What interventions are being evaluated?

•

For what problem, condition, and/or population are the intervention targeted?

•

Under what circumstances is the intervention implemented?

•

What are the likely effects (both benefits and harms) of the intervention?

•

Can a quality systematic review be undertaken across multiple studies?

Considerations for CER related to Social Work Interventions Since the early 1990s, increasing attention has been targeted toward strengthening practice-focused social work research. Both the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) supported centers at schools of social work to build research infrastructure and enhance social work researchers’ competitiveness in applying for National Institutes of Health (NIH) research funding. In addition, numerous workshops targeted to social work researchers focused on these same goals. In 2003, NIH developed a plan to further advance social work research that engaged additional NIH institutes under the leadership of the


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ublished after 1990) that evaluate what is known about terventions (Mullen, Melly, Volland, & Shuluk, 2008). A 7 reviews (See Appendix E for the list of review articles) and

Office of Behavioral and Social Sciences Research (OBSSR) (NIH, 2003). As a result, over 600 NIH grants have been awarded to social work researchers since 1993 (IASWR, 2009) and contributions from social work research are more fully recognized in the national scientific community.

nce supporting the effectiveness of many social work ocial problems and populations. However, many of these s must be qualified due to the limitations of the research al., 2008).

Building on the great strides that have been made in social work intervention research, in 2009, the University of Southern California in partnership with the Institute for the Advancement of Social Work Research (IASWR) sponsored the Los Angeles Conference on Intervention Research in Social Work (http://sowkweb.usc.edu/research/events/index.html). The conference featured research on social work interventions across the areas of serious mental illness, chronic disease, criminal justice, substance abuse, dealing with trauma in the military and preventive services for youth. The research presentations highlighted rigorous studies that engaged populations similar to those identified in the CER priorities. Discussions focused on future steps in intervention research including strategies for engagement of appropriate samples, sample selection, ethics, and impact of the research on practice change.

lients served by social workers benefit in measureable ways, lication and investigator bias of the research (Mullen et al.,

ive interventions using a comparison group design, which he relative effectiveness of an intervention to usual care or tion (Mullen et al., 2008).

Many of the issues that emerged from the USC conference overlap with considerations at the SWPI CER Symposium. These include:

intervention do not account for differential outcomes (Reid, ck, 1998).

ve different outcomes when implemented with different eid, 1997; Reid, Kenaley, & Colvin, 2004) or target system 98).

•

Are the interventions provided by social workers unique? If the actual intervention is not unique – then what special qualities does a social work perspective bring to the intervention?

ost-effectiveness and cost-benefits of interventions as few of estions (Mullen et al., 2008).

•

In implementing research-based interventions, do the interventions need to be manualized? If interventions are manualized, what skills and knowledge do practitioners need to appropriately adopt and adapt the interventions and to maintain fidelity?

•

What can be understood related to the dosage and duration of the interventions and the expectations of differential outcomes? For example, does a different outcome occur if a clinical intervention is provided for 1 hour, once a week or two hours every other week, and how might dosing and duration determinations effect considerations of the client’s transportation and ability to access services?

•

Are there common elements to effective interventions – e.g., low caseload, high level of professional staff, interdisciplinary team strategies, use of cognitive-behavioral treatment techniques?

•

Is research underway in the services where social workers thrive? For example, studies that would develop a better understanding of the intrinsic relationship between practitioner and client or in studying case management, care coordination, and clinical interventions across populations, service settings and age groups.

•

What is understood about the key components of effective interventions, e.g., what are the core aspects of care coordination that always need to be part of the model.

•

Are there ethical concerns that must be addressed in carrying out clinical trials of social work interventions?

•

Are efficacy trials a necessary first phase for social work research since social work clients most frequently have complex needs and co-occurring conditions?

•

In comparing the effectiveness of social work interventions – to what should they be compared (e.g., to interventions by non-social workers, to alternative interventions, to treatment as usual).

veness since 1990 differ from pre-1990 reviews in that the likely to use meta-analysis; examine moderator variables; mine investigator bias; question differential effects due to oblem and population characteristics; cast a wider net to e of designs; and include more RCTs using comparative t al., 2008). the following questions should be considered:

evaluated?

and/or population are the intervention targeted?

he intervention implemented?

th benefits and harms) of the intervention?

w be undertaken across multiple studies?

Social Work Interventions

ntion has been targeted toward strengthening Both the National Institute of Mental Health (NIMH) and (NIDA) supported centers at schools of social work to build ocial work researchers’ competitiveness in applying for esearch funding. In addition, numerous workshops targeted these same goals. In 2003, NIH developed a plan to further aged additional NIH institutes under the leadership of the

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•

How might multi-site (including multiple jurisdictions and states) research in real world delivery systems support CER capacity-building? Social work engagement in such research can contribute to translational and implementation research methods and increase the availability of study findings that can be translated into practice.

•

What can social workers teach researchers regarding community and client engagement and addressing issues of cultural competence, dealing with diversity and disparities in research?


NASW (2009), in collaboration with IASWR and with suppo Foundation, undertook a project to look at the intersection o practices and how professional associations might play a role The example used for the project was evidence-based adolesc implementation strategy included development of research-to NASW chapters. The NASW Making the Shift: Suicide Preve is available at www.socialworkers.org/practice/adolescent_he G for a diagram that depicts the steps of getting an EBP into

Evidence-Based Practice

Strengthening the Research-Practice Connection

A clinician’s inattention to competently reviewing and using research to inform practice may both diminish accountability and respect for the professional. Social work ethics call for a commitment to lifelong learning, continual enhancement of skills and critical reflection on practice. Practitioners should use their skill and knowledge base to educate clients on resources and options and provide guidance and support through the treatment decision-making process. Increasingly, social workers are called upon to use evidence-based practices (may also be termed evidence-informed interventions or evidence-based treatments). Identifying such practices requires critical thinking, a commitment to professional development, and an understanding of the evidence-based practice process.

Healthcare practitioners, including social workers often do n practice and may mostly rely on informed intuition (practice benefits of using clinical research that may increase the qualit

Definition of Evidence-Based Practice (EBP)

•

Continually striving to locate best practices and evide up with the latest research findings

•

Providing care based on established standards and gu

•

Continually engaging in outcomes research to guide o

However, despite these benefits, practitioners often argue tha

EBP is a process in which the practitioner combines well-researched interventions with clinical experience, ethics and client preferences and culture to guide and inform the delivery of treatments and services. EBP is an approach to clinical practice in which the practitioner becomes an educated surveyor, consumer and user of viable scientific knowledge to guide practice decisions (IASWR, 2007). Practitioners and program planners may not regularly review and synthesize the research literature (e.g. journals) in their field of practice. Too often, therefore research is not integrated into practice. To aid service providers, several on-line resources have been developed to help programs and practitioners identify evidence-based practices. Examples include the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Effective Programs and Practices (NREPP) and the California Evidence-Based Clearinghouse for Child Welfare (see Appendix F for additional examples). While these resources can serve as guides, it should be noted that different EBP databases use differing definitions of what should be considered an evidence-based practice. Comparisons of effective interventions may be inhibited by inconsistent definitions about what constitutes “effectiveness” or levels of evidence. Thus, the user must keep these variations in mind when comparing evidence-based interventions to address similar problems. Examining the populations that were involved in the studies that support the evidence-base is also critical – since those populations may have different characteristics from the practitioner’s clients.

•

Using research findings is difficult because it is hard t environments, agencies and clients’ needs.

•

Using tools developed from research studies may not specific practice. Implementation of research-based in the uniqueness of the individual’s situation, culture, en complex needs.

•

Applicability of research findings may be limited due homogenous nature of the sample, differing from the consumers with whom social workers work.

•

The nuances of the relationship between the practition outcomes but difficult to measure.

•

Practitioners often do not have access to research jour incentive and opportunity to regularly consume and in

In summary, research is too often viewed as “optional” rathe settings.

Beyond identifying relevant evidence-based practices, there are also well-researched strategies to most effectively move research into practice.5 This requires assessment of the adaptability and adoptability of the EBP, administrative buy-in, staff training and attention to issues such as funding, staffing patterns, workload/caseload capacity, cultural congruence, and policy considerations.

5

See National Implementation Research Network (www.fpg.unc.edu/~nirn/)


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ng multiple jurisdictions and states) research in real world capacity-building? Social work engagement in such research and implementation research methods and increase the hat can be translated into practice.

NASW (2009), in collaboration with IASWR and with support from the Leon Lowenstein Foundation, undertook a project to look at the intersection of implementation of evidence-based practices and how professional associations might play a role as an intermediary and catalyst. The example used for the project was evidence-based adolescent suicide prevention for girls. The implementation strategy included development of research-to-practice teams convened through NASW chapters. The NASW Making the Shift: Suicide Prevention for Adolescent Girls Tool-Kit is available at www.socialworkers.org/practice/adolescent_health/shift/default.asp. See Appendix G for a diagram that depicts the steps of getting an EBP into practice.

h researchers regarding community and client engagement al competence, dealing with diversity and disparities in

Strengthening the Research-Practice Connection

y reviewing and using research to inform practice may both or the professional. Social work ethics call for a commitment ement of skills and critical reflection on practice. d knowledge base to educate clients on resources and options ough the treatment decision-making process. Increasingly, evidence-based practices (may also be termed idence-based treatments). Identifying such practices requires ofessional development, and an understanding of the

Healthcare practitioners, including social workers often do not use clinical research to guide their practice and may mostly rely on informed intuition (practice wisdom) when providing care. Some benefits of using clinical research that may increase the quality of services provided include:

Practice (EBP)

•

Continually striving to locate best practices and evidence-informed treatments by keeping up with the latest research findings

•

Providing care based on established standards and guidelines

•

Continually engaging in outcomes research to guide one’s own practice.

However, despite these benefits, practitioners often argue that:

oner combines well-researched interventions with clinical es and culture to guide and inform the delivery of treatments linical practice in which the practitioner becomes an of viable scientific knowledge to guide practice decisions

ay not regularly review and synthesize the research literature . Too often, therefore research is not integrated into practice. ne resources have been developed to help programs and practices. Examples include the Substance Abuse and Mental MHSA) National Registry of Effective Programs and Evidence-Based Clearinghouse for Child Welfare (see

des, it should be noted that different EBP databases use e considered an evidence-based practice. Comparisons of d by inconsistent definitions about what constitutes Thus, the user must keep these variations in mind when ns to address similar problems. Examining the populations support the evidence-base is also critical – since those cteristics from the practitioner’s clients.

•

Using research findings is difficult because it is hard to adapt the findings to different environments, agencies and clients’ needs.

•

Using tools developed from research studies may not adequately measure the practitioner’s specific practice. Implementation of research-based interventions may not fully consider the uniqueness of the individual’s situation, culture, environment, family system and complex needs.

•

Applicability of research findings may be limited due to the small sample size or homogenous nature of the sample, differing from the more complex make up of most consumers with whom social workers work.

•

The nuances of the relationship between the practitioner and the patient are critical to outcomes but difficult to measure.

•

Practitioners often do not have access to research journals and have little institutional incentive and opportunity to regularly consume and integrate research into practice.

In summary, research is too often viewed as “optional” rather than “expected” in most clinical settings.

based practices, there are also well-researched strategies to actice.5 This requires assessment of the adaptability and e buy-in, staff training and attention to issues such as aseload capacity, cultural congruence, and policy

www.fpg.unc.edu/~nirn/) 10


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Figure 1: Ideal Model for Developing Research-Informed Practice:

IDENTIFYING METHODOLOGICAL CH

The CER agenda calls for research that focuses on priority po for result is that such research findings will lead to the ability personalized interventions. However, the proposed research p multiple methodological challenges to researchers. To determ populations, diversification of samples is needed, including en have multiple co-occurring conditions and also ethnic, age, ge differences. In addition, the IOM report calls for evaluations settings to identify aspects of service delivery that may influen of research to test multiple interventions on heterogeneous sa means that greater efforts will need to be made to engage diff Less homogeneity also opens up the possibility that observed related to the intervention itself.

In the typical course of healthcare research, studies have usua taking place in very controlled clinical environments with hom effectiveness studies that more closely resemble real world set intervention within a controlled environment helps to determ spurious effects on outcomes. However, efficacy studies have is equally important to evaluate an intervention’s effectivenes settings.

Clinically relevant research is essential for this model of research-informed practice to function. This can be assisted by an increase in the number of researchers with clinical experience and clinicians with research experience. There is a lot of attention and support for this in the medical field. However, research funding that targets clinicians seeking training as researchers has been more limited in social work. Furthermore, social work education has not sufficiently prioritized the integration of research with clinical training.

Since many clients of social workers have complex needs, soc occur in real world settings and thus is often seen as methodo there are fewer efficacy studies in social work. From a social effectiveness and implementation studies are priorities to dete and its relevance for the populations and communities that th

Practitioners need encouragement to observe and test the impact of interventions and share the lessons learned from practice in a variety of environments (e.g., supervision, mentorship, professional presentations, and publications). Yet, practitioners lack incentives and opportunity to consume and participate in research. Benefits of linking research to practice can include: • • • •

Randomized Designs

Greater allocation of resources, Increased credibility within social work and across disciplines, Increased professional influence, and Enhanced critical thinking and quality improvement skills.

Randomized controlled trials (RCTs) have increased in many disciplines since the 1990s, establishing interventions that can methodologies (Shlonsky, Fuller-Thomson, & Baker, n.d.). W social work, there are still only a limited number of such stud the optimum design in determining effectiveness. Attention to careful examination of RCT methods and their applicability t Randomization might occur at the group, setting or commun level to strengthen applicability to real world settings. In add may need to be considered as part of CER.

Research can be normalized and demystified by integrating it into professional education and by teaching clinicians that they have opportunities to conduct research in daily practice. Performance reviews can keep staff accountable to these efforts. Organizations must also be encouraged and held accountable for promoting research/practice linkages. Furthermore, practice knowledge combined with research knowledge can be useful in advocating for increased client access to quality care at multiple levels (individual, community, state, and federal) and in addressing health disparities.

Qualitative and Quantitative Methods Research

Findings from qualitative research studies can make importan research can help to identify how to best engage hard to reac to further our understanding of why some interventions work some groups than others. Including qualitative and mixed m researchers have exposure to multiple methodologies and the bring to answering - what works best, for whom, under what


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for Developing Research-Informed Practice:

IDENTIFYING METHODOLOGICAL CHALLENGES OF CER The CER agenda calls for research that focuses on priority populations and conditions. The hoped for result is that such research findings will lead to the ability to choose more individually personalized interventions. However, the proposed research priorities and intent of CER presents multiple methodological challenges to researchers. To determine effectiveness for priority populations, diversification of samples is needed, including engaging study participants who may have multiple co-occurring conditions and also ethnic, age, gender, linguistic and cultural differences. In addition, the IOM report calls for evaluations of interventions across delivery care settings to identify aspects of service delivery that may influence outcomes. Expanding the scope of research to test multiple interventions on heterogeneous samples in complex environments means that greater efforts will need to be made to engage different populations in research studies. Less homogeneity also opens up the possibility that observed outcomes may not be as reliable or related to the intervention itself. In the typical course of healthcare research, studies have usually moved from efficacy studies taking place in very controlled clinical environments with homogeneous populations - to effectiveness studies that more closely resemble real world settings. Establishing efficacy of an intervention within a controlled environment helps to determine causal outcomes and minimizes spurious effects on outcomes. However, efficacy studies have limited generalizability. Therefore it is equally important to evaluate an intervention’s effectiveness by implementation in more realistic settings.

l for this model of research-informed practice to function. the number of researchers with clinical experience and here is a lot of attention and support for this in the medical targets clinicians seeking training as researchers has been more, social work education has not sufficiently prioritized al training.

Since many clients of social workers have complex needs, social work research is more likely to occur in real world settings and thus is often seen as methodologically challenging. In addition there are fewer efficacy studies in social work. From a social work perspective, translational, effectiveness and implementation studies are priorities to determine the impact of an intervention and its relevance for the populations and communities that the practitioner is serving.

observe and test the impact of interventions and share the ety of environments (e.g., supervision, mentorship, ations). Yet, practitioners lack incentives and opportunity to Benefits of linking research to practice can include:

Randomized Designs

s, cial work and across disciplines, ce, and d quality improvement skills.

Randomized controlled trials (RCTs) have increased in many behavioral and social sciences disciplines since the 1990s, establishing interventions that can be compared using CER methodologies (Shlonsky, Fuller-Thomson, & Baker, n.d.). While there also are increased RCTs in social work, there are still only a limited number of such studies. RCTs are often considered to be the optimum design in determining effectiveness. Attention to CER will require that there be a careful examination of RCT methods and their applicability to the established CER priorities. Randomization might occur at the group, setting or community-level, rather than at the individual level to strengthen applicability to real world settings. In addition, research designs beyond RCTs may need to be considered as part of CER.

ystified by integrating it into professional education and by ortunities to conduct research in daily practice. Performance these efforts. Organizations must also be encouraged and rch/practice linkages. Furthermore, practice knowledge an be useful in advocating for increased client access to ual, community, state, and federal) and in addressing health

Qualitative and Quantitative Methods Research Findings from qualitative research studies can make important contributions to CER. Qualitative research can help to identify how to best engage hard to reach populations in research studies and to further our understanding of why some interventions work better and are more appropriate for some groups than others. Including qualitative and mixed methods studies requires that researchers have exposure to multiple methodologies and the differential perspectives that they bring to answering - what works best, for whom, under what conditions.

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Participatory Research Designs

UNDERSTANDING CAMPBELL COLLABORATION SYSTEM www.campbellcollaboration.org/what_is_a_systematic_

It is critical that researchers regularly engage with service delivery. This will help ensure that research is more relevant to practice from the start. Increased attention to community-based participatory research (CBPR) designs may be of particular value in CER. Such methods deal with the complexity of settings and relationships and help to sustain the impact of research over time.

The purpose of a systematic review is to sum up the best available research on a spe results of several studies.

A systematic review uses transparent procedures to find, evaluate and synthesize th explicitly defined in advance, in order to ensure that the exercise is transparent and to minimize bias.

COMMUNITY-BASED PARTICIPATORY RESEARCH (CBPR) is a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities (Community-Campus Partnerships for Health, 2008)

Studies included in a review are screened for quality, so that the findings of a large is a key part of the process; qualified independent researchers control the author’s

A systematic review must have: • An explicit search strategy • Systematic coding and analysis of included studies • Meta-analysis (where possible) How do Campbell systematic reviews differ from other systematic reviews? • Campbell reviews must include a systematic search for unpublished reports ( • Campbell reviews are usually international in scope. • A protocol (project plan) for the review is developed in advance and undergo • Study inclusion and coding decisions are accomplished by at least two review • Campbell reviews undergo peer review and editorial review.

In designing studies, researchers should consider whether or not the study will: •

Impact the populations evaluated by the research

•

Engage communities in research design, data collection, and dissemination of findings

•

Address clinical health and psychosocial care practices that remain unstudied and are important to practitioners and consumers.

Social Workers as Members of Interdisciplinary Research Teams Social workers are valuable members of interdisciplinary research teams and have potential to reach clients and communities that are targets of the research studies. They offer insight to cultural competency of care at an individual and community level. Further, their ability to navigate multiple delivery systems can broaden research questions to examine impediments and catalysts to accessing care.

Although there are studies that do support the effectiveness o limitations that threaten the strength of many of the studies ( comparison group, homogeneous sample, lack of attention to publication bias). To better establish social work’s capacity t standards for conducting systematic reviews, such as those de Collaboration. In addition, there is also a need to carry-out h can be included in systematic reviews. Thus, the developmen multi-year process.

When participating as a member of an interdisciplinary research team, however, the social worker must be mindful of the values and ethical perspective that they bring to the development of research protocols. Social workers have an ethical duty to advocate for improved research designs. There may be research study designs that could violate social work ethics. This could occur in developing a comparative effectiveness study when the comparison might be to an unethical practice or there may be unfair exclusion of persons with particular characteristics.

Economic Evaluations of Psychosocial Interventions – Co

Systematic Reviews

For practitioners and researchers, understanding and using m methods when conducting intervention research studies shou valuable to program decision-making and for setting health a attempting to comparatively maximize outcomes and minimi psychosocial services, resources are limited and hard choices Economic evaluation strategies can assist in demonstrating th expended. This is particularly relevant for CER, because a ke on CER is that decisions might be made based solely on cost.

An important aspect of CER will be the use of systematic reviews of research in order to determine the differential effectiveness of interventions. Established in 2000, the Campbell Collaboration (www.campbellcollaboration.org) conducts high quality, comprehensive, and unbiased systematic reviews in the domains of social welfare, education, and criminal justice. Campbell is an international organization modeled on the Cochrane Collaboration in health care. The Campbell Collaboration’s social welfare domain includes psychosocial interventions in areas such as mental health, aging, substance abuse, housing and disabilities. The intent is for such reviews to be informative to practitioners, consumers, policy-makers and researchers. Thus far, a total of 148 reviews have been completed, with 27 focusing on the area of social welfare. For more information on the outcomes of the Campbell Collaboration Social Welfare systematic reviews see Appendix H.


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UNDERSTANDING CAMPBELL COLLABORATION SYSTEMATIC REVIEWS www.campbellcollaboration.org/what_is_a_systematic_review/index.shtml

engage with service delivery. This will help ensure that rom the start. Increased attention to community-based may be of particular value in CER. Such methods deal with nships and help to sustain the impact of research over time.

The purpose of a systematic review is to sum up the best available research on a specific question. This is done by synthesizing the results of several studies.

A systematic review uses transparent procedures to find, evaluate and synthesize the results of relevant research. Procedures are explicitly defined in advance, in order to ensure that the exercise is transparent and can be replicated. This practice is also designed to minimize bias.

TICIPATORY RESEARCH (CBPR) is a

at equitably involves all partners in the research process and ach brings. CBPR begins with a research topic of aim of combining knowledge with action and achieving mes and eliminate health disparities (Community-Campus

Studies included in a review are screened for quality, so that the findings of a large number of studies can be combined. Peer review is a key part of the process; qualified independent researchers control the author’s methods and results.

A systematic review must have: • An explicit search strategy • Systematic coding and analysis of included studies • Meta-analysis (where possible) How do Campbell systematic reviews differ from other systematic reviews? • Campbell reviews must include a systematic search for unpublished reports (to avoid publication bias). • Campbell reviews are usually international in scope. • A protocol (project plan) for the review is developed in advance and undergoes peer review. • Study inclusion and coding decisions are accomplished by at least two reviewers who work independently and compare results. • Campbell reviews undergo peer review and editorial review.

d consider whether or not the study will:

ted by the research

ch design, data collection, and dissemination of findings

ychosocial care practices that remain unstudied and are consumers.

rdisciplinary Research Teams

of interdisciplinary research teams and have potential to e targets of the research studies. They offer insight to vidual and community level. Further, their ability to navigate research questions to examine impediments and catalysts to

Although there are studies that do support the effectiveness of social work practice, there are some limitations that threaten the strength of many of the studies (e.g., small sample size, lack of a comparison group, homogeneous sample, lack of attention to attrition, investigator bias, publication bias). To better establish social work’s capacity to conduct CER, it is useful to use standards for conducting systematic reviews, such as those developed by the Campbell Collaboration. In addition, there is also a need to carry-out high quality rigorous research that can be included in systematic reviews. Thus, the development of reviews will be a multi-step, multi-year process.

n interdisciplinary research team, however, the social worker ical perspective that they bring to the development of ve an ethical duty to advocate for improved research designs. hat could violate social work ethics. This could occur in s study when the comparison might be to an unethical ion of persons with particular characteristics.

Economic Evaluations of Psychosocial Interventions – Considerations for CER and Practice For practitioners and researchers, understanding and using meaningful economic evaluation methods when conducting intervention research studies should be an essential. Such tools can be valuable to program decision-making and for setting health and mental health policy when attempting to comparatively maximize outcomes and minimize costs. So often in delivering psychosocial services, resources are limited and hard choices about care need to be made. Economic evaluation strategies can assist in demonstrating the value provided from the resources expended. This is particularly relevant for CER, because a key concern about this new emphasis on CER is that decisions might be made based solely on cost.

he use of systematic reviews of research in order to s of interventions. Established in 2000, the Campbell ration.org) conducts high quality, comprehensive, and mains of social welfare, education, and criminal justice. tion modeled on the Cochrane Collaboration in health care. welfare domain includes psychosocial interventions in areas ce abuse, housing and disabilities. The intent is for such ners, consumers, policy-makers and researchers. Thus far, a eted, with 27 focusing on the area of social welfare. For the Campbell Collaboration Social Welfare systematic

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Cost-Utility Analysis (CUA) Cost-utility analysis (CUA) is used when an intervent when quality is the focus of the evaluation, and when and mortality. It evaluates impact of interventions on quality of life (e.g., quality-adjusted life years or disab summary measure in a CUA is the cost per quality-ad

Definition of Economic Evaluation Economic evaluation is applying analytic methods to identify, measure, value, and compare the costs and consequences of treatment and prevention programs, interventions, and policies. There are multiple types of economic evaluation that are useful for decisions at various levels of practice (agency, local, state, national levels).

Cost-Effectiveness Analysis (CEA) Cost-effectiveness analysis (CEA) estimates the costs a looks at outcomes in natural units (e.g., cases prevent the results to other interventions impacting the same is that outcomes must be evaluated separately, which outcomes of an intervention.

Figure 2: Where Cost Analysis and Economic Evaluation Should Occur:

Many of the IOM priorities stress the evaluation of comparat interventions. This need for economic evaluation is a challeng that considerations of cost will lead to rationing of care to th influenced lack of attention to economic evaluation in ARRA review panels, foundations, and federal agencies may still enc innovative methods that include economic evaluations of inte is of great importance when agencies are making decisions ab world settings. Issues of cost and budget are often key consid particular program design. Therefore, having high quality co essential, however, it is often lacking.

As programs and policies are developed to address identified problems within communities or populations, economic evaluation and cost analysis should be included in the initial planning of the research and program design. As part of the dissemination and implementation process, economic evaluation should also be a factor. After programs and policies have been implemented, further economic evaluation should occur to continually inform program and policy decisions. As noted above, there is currently insufficient attention in social work research to cost factors. In addition, cost issues are often only examined at the end of a study, rather than included and evaluated throughout the study process. When evaluating costs, often only budget figures are taken into account. Several types of economic evaluation can be relevant to the various types of policy decisions that are made. Examples of cost analysis methods and their potential applicability are described below. Benefit-Cost Analysis (BCA) Benefit-cost analysis (BCA) is best used to compare the costs and benefits of an intervention over time, in monetary terms. This is most often used at the federal level with regulatory policies such as the Clean Water and Clean Air Acts, but is increasingly applied to public health and social work interventions. BCA is very popular among stakeholders and tells the amount of money saved for every dollar spent in a program.


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Cost-Utility Analysis (CUA) Cost-utility analysis (CUA) is used when an intervention has a wide range of outcomes, when quality is the focus of the evaluation, and when a program affects both morbidity and mortality. It evaluates impact of interventions on length of life (survival) adjusted for quality of life (e.g., quality-adjusted life years or disability-adjusted life years). The summary measure in a CUA is the cost per quality-adjusted life year saved.

Evaluation

ng analytic methods to identify, measure, value, and uences of treatment and prevention programs, interventions, le types of economic evaluation that are useful for decisions gency, local, state, national levels).

Cost-Effectiveness Analysis (CEA) Cost-effectiveness analysis (CEA) estimates the costs and outcomes of interventions and looks at outcomes in natural units (e.g., cases prevented, lives saved, etc.) and compares the results to other interventions impacting the same outcome. One disadvantage of CEA is that outcomes must be evaluated separately, which prevents evaluation of more than two outcomes of an intervention.

nalysis and Economic Evaluation Should Occur:

Many of the IOM priorities stress the evaluation of comparative and cost effectiveness of interventions. This need for economic evaluation is a challenge to the public because of concerns that considerations of cost will lead to rationing of care to the cheapest interventions. This has influenced lack of attention to economic evaluation in ARRA’s funding of CER. Nonetheless, review panels, foundations, and federal agencies may still encourage scientifically sound and innovative methods that include economic evaluations of interventions studied. This information is of great importance when agencies are making decisions about what intervention to use in real world settings. Issues of cost and budget are often key considerations in the selection of a particular program design. Therefore, having high quality cost information available should be essential, however, it is often lacking.

ed to address identified problems within communities or d cost analysis should be included in the initial planning of part of the dissemination and implementation process, factor. After programs and policies have been implemented, ccur to continually inform program and policy decisions. As cient attention in social work research to cost factors. In amined at the end of a study, rather than included and ss. When evaluating costs, often only budget figures are

can be relevant to the various types of policy decisions that methods and their potential applicability are described below.

best used to compare the costs and benefits of an netary terms. This is most often used at the federal level with Clean Water and Clean Air Acts, but is increasingly applied rk interventions. BCA is very popular among stakeholders y saved for every dollar spent in a program.

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Table 1: Addressing Methodological Challenges Ca

CONCLUSIONS

Usual RCT Standard

Social Work and CER

1. Homogeneous samples

The social work profession and social work researchers should be well-positioned to participate in the burgeoning CER efforts. It is important to recognize that social workers can play a dual role in research. One role more specifically focuses on research related to interventions administered by social workers. The second critical role relates to the contributions that social workers make as members of interdisciplinary research teams. Awareness of this duality is essential when considering CER capacity building efforts.

2. Tests only one intervention

The intent of CER is to determine what works best, for whom, and under what conditions. Both the FCC and IOM CER reports call for increased efforts to develop and understand intervention outcomes specifically for diverse populations with co-occurring diagnoses and an array of psychosocial needs. This has great relevance for social work, since social work research deals with complex person-in-environment contexts, and studies how to address psychosocial needs from an individual, family, community, organization and systems perspective. Furthermore, social workers’ ethical commitment to social justice can be translated into addressing issues of diversity and cultural competence in designing and implementing research.

3. Rigorously controlled research setting

Building CER Infrastructure and Methodological Capacity There are a number of challenges to be addressed and steps to be taken to build CER capacity. Leadership by the social work profession is critical to ensure that social workers are key stakeholders. Education among researchers, practitioners, academics and policy-makers is needed about CER and how it will be useful for consumers and practitioners. These discussions should include identification of the valuable perspective social work can bring, especially related to the established CER priorities that address many gaps related to psychosocial needs (see Appendix D).

IOM Priorities

Methodological C

Samples should include diverse populations and include people with complex needs

Determining if outco interventions in the are spurious or relat intervention

Research should focus on comparing multiple interventions to find answers that are needed to make decisions about care at both the individual level and population level Research should focus on interventions within the context of the complex systems and populations in which they are to be delivered

Accurately examinin interventions – findi that accurately mea compare interventio

Accurately evaluatin and effectiveness in environment

Considering the ethi of evaluating an inte does not have a ben outcomes that outwe detrimental outcome

Considering the ethi of comparing an inte group that requires t or delaying of treatm

Social workers are the largest providers of mental health services in the country (SAMHSA, 2002) and have expertise in many areas of case management, care coordination and clinical interventions. Current research indicates the effectiveness of social work interventions. However, much of social work research has not been comprehensive or rigorous enough to maximally contribute to CER efforts in many areas of practice. While RCTs have increased in social work, there are still limitations to what populations and services that they cover and they cannot be used in all situations to determine effectiveness. Therefore, further research is needed and using methods in addition to or other than RCTs may be more applicable and appropriate.

The use of intervention guides and manuals by social worker translational and dissemination research efforts that will take only might new interventions be studied, but there is also a n interventions that social workers use, especially in additional populations. Furthermore, in undertaking effectiveness and im the model needs to be assessed.

The following chart addresses how social work involvement might be useful in addressing the CER established priorities and the potential methodological challenges that must be addressed when moving away from the usual RCT standard practices.

It is essential to train social work researchers in CER method in a variety of environments and work together with other di to be on the forefront of methodological innovation in CER.

Practitioners and consumers need a stronger voice in the rese usefulness and relevance. Historically, there has been a discon which prevents the feedback loop that should continually inf practitioners want studied, and inform practice about the effe

Models of CBPR and the use of qualitative methodologies wi especially relevant in strategies to include the targeted priorit


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Table 1: Addressing Methodological Challenges Can Involve Social Work Input Usual RCT Standard 1. Homogeneous samples

work researchers should be well-positioned to participate in ortant to recognize that social workers can play a dual role y focuses on research related to interventions administered by e relates to the contributions that social workers make as teams. Awareness of this duality is essential when orts.

2. Tests only one intervention

at works best, for whom, and under what conditions. Both or increased efforts to develop and understand intervention ulations with co-occurring diagnoses and an array of evance for social work, since social work research deals with xts, and studies how to address psychosocial needs from an zation and systems perspective. Furthermore, social workers’ an be translated into addressing issues of diversity and implementing research.

3. Rigorously controlled research setting

thodological Capacity

e addressed and steps to be taken to build CER capacity. ion is critical to ensure that social workers are key chers, practitioners, academics and policy-makers is needed or consumers and practitioners. These discussions should perspective social work can bring, especially related to the s many gaps related to psychosocial needs (see Appendix D).

IOM Priorities

Methodological Challenges

Social Work Involvement

Samples should include diverse populations and include people with complex needs

Determining if outcomes of interventions in the real world are spurious or related to the intervention

Social work clients have multiple problems and differ from each other in ways that are relevant to outcomes

Research should focus on interventions within the context of the complex systems and populations in which they are to be delivered

Accurately evaluating efficacy and effectiveness in a complex environment

Research should focus on comparing multiple interventions to find answers that are needed to make decisions about care at both the individual level and population level

Accurately examining/comparing interventions – finding constructs that accurately measure and compare intervention outcomes

Social workers are looking at clients in the context of environment and are evaluating the potential outcomes of multiple interventions when treating multiple needs simultaneously

Social work interventions occur in the complex “real world” and requires consideration of environmental factors as well as Considering the ethical implications ethical implications for of evaluating an intervention that treatment. does not have a beneficial outcomes that outweigh the detrimental outcomes Considering the ethical implications of comparing an intervention with a group that requires the withholding or delaying of treatment

rs of mental health services in the country (SAMHSA, 2002) ase management, care coordination and clinical tes the effectiveness of social work interventions. However, been comprehensive or rigorous enough to maximally as of practice.

The use of intervention guides and manuals by social workers need further testing and can aid translational and dissemination research efforts that will take interventions to a larger scale. Not only might new interventions be studied, but there is also a need to further test current interventions that social workers use, especially in additional settings or with different client populations. Furthermore, in undertaking effectiveness and implementation research, fidelity to the model needs to be assessed.

work, there are still limitations to what populations and ot be used in all situations to determine effectiveness. and using methods in addition to or other than RCTs may be

It is essential to train social work researchers in CER methodologies so that they can conduct CER in a variety of environments and work together with other disciplines. Social workers should strive to be on the forefront of methodological innovation in CER.

cial work involvement might be useful in addressing the tential methodological challenges that must be addressed CT standard practices.

Practitioners and consumers need a stronger voice in the research process in order to increase its usefulness and relevance. Historically, there has been a disconnect between research and practice, which prevents the feedback loop that should continually inform researchers of questions practitioners want studied, and inform practice about the effectiveness of interventions. Models of CBPR and the use of qualitative methodologies will be important in CER. These will be especially relevant in strategies to include the targeted priority populations.

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Increased collaboration is needed between health and human service organizations and research teams. This can help streamline the process of applying research to practice. Organizations often collect relevant client data, but may have no process for analyzing these data. Strengthening collaboration between service delivery entities and researchers can increase the use of data to understand the effectiveness of specific interventions. Regular reporting of intervention outcomes and data analysis can lead to expanded funding opportunities and can also influence policy and practice decision-making.

RECOMMENDED AGENDA FOR ACTIO

New technologies should be explored related to the collection and dissemination of research findings and creation of tools to help clinicians and consumers understand what CER is and how to draw appropriate and meaningful conclusions from it. Limitations exist in the extent to which research findings are disseminated both within social work and across disciplines. Dissemination can be as important as the research itself. Getting the information to researchers and practitioners in social work and to other professions can establish the impact and relevance of the research.

Recommendations for National Organizations

CER is intended to be a tool for determining appropriate ind health care. It is not intended to establish rules that will deny social services. The following action steps are intended to hel and involvement with CER.

It is critical to have economic evaluation of interventions in order to consider cost, cost-effectiveness, and cost utility. Economic evaluation has yet to be a regular aspect of research designs. The absence of economic evaluations results in human service agencies and organizations struggling with selecting interventions. Such data can also address questions raised by policy-makers, funders, administrators and perhaps the public. The concerns that interventions will be selected because they are the cheapest option must also be addressed, as the focus should be on maximizing intervention effectiveness. Social workers can be responsible stewards of limited public funding to ensure that interventions are effective and cost efficient.

•

Convene a large-scale social work-led summit with co researchers to explore how to best facilitate translatin further explore how social work should be involved in CER projects.

•

Continue to build social work membership and resear NIH and AHRQ and other research entities in order t social work researchers as valuable members of comp enhance recognition of social work research’s role in s priorities.

•

Educate practitioners on CER through continuing edu use of systematic reviews and research on evidenced-b improved partnerships with universities and other age

•

Explore establishing awards and events that would lin encourage collaboration.

•

Explore establishing a clearinghouse for researchers a access to field of practice specific journals might be in levels.

•

Promote replication of effective interventions and tran endorsing practices that are extensively evaluated thro for replication.

•

Educate researchers on new technologies through soci of special journal issues, conference presentations, an

•

Increase efforts to expand the link between social wor

◊ ◊ ◊

◊


20

Enhancing social workers competency in reviewin findings into their own practice.

Using new technologies and social media to disse

Promoting use of CER tools through initiatives am societies (including social work organizations), di American Cancer Society, American Diabetes Ass and universities, including schools of social work

Recommending professional organizations recogn collaborations.




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ween health and human service organizations and research ocess of applying research to practice. Organizations often ave no process for analyzing these data. Strengthening y entities and researchers can increase the use of data to c interventions. Regular reporting of intervention outcomes d funding opportunities and can also influence policy and

RECOMMENDED AGENDA FOR ACTION

related to the collection and dissemination of research clinicians and consumers understand what CER is and how conclusions from it. Limitations exist in the extent to which th within social work and across disciplines. Dissemination self. Getting the information to researchers and practitioners ns can establish the impact and relevance of the research.

Recommendations for National Organizations

CER is intended to be a tool for determining appropriate individualized and population-based health care. It is not intended to establish rules that will deny options to consumers of health and social services. The following action steps are intended to help build social work’s contribution to and involvement with CER.

on of interventions in order to consider cost, onomic evaluation has yet to be a regular aspect of research luations results in human service agencies and organizations . Such data can also address questions raised by s and perhaps the public. The concerns that interventions heapest option must also be addressed, as the focus should veness. Social workers can be responsible stewards of limited tions are effective and cost efficient.

•

Convene a large-scale social work-led summit with consumers, practitioners, and researchers to explore how to best facilitate translating research into practice, and to further explore how social work should be involved in CER and in setting priorities for CER projects.

•

Continue to build social work membership and research organizations’ relationships with NIH and AHRQ and other research entities in order to further facilitate recognition of social work researchers as valuable members of comprehensive research teams and to enhance recognition of social work research’s role in studying many of the CER established priorities.

•

Educate practitioners on CER through continuing education strategies, including making use of systematic reviews and research on evidenced-based practices as well as promoting improved partnerships with universities and other agencies to conduct and use CER.

•

Explore establishing awards and events that would link practitioners to researchers and encourage collaboration.

•

Explore establishing a clearinghouse for researchers and practitioners and consider how access to field of practice specific journals might be incorporated into various membership levels.

•

Promote replication of effective interventions and translation of research to practice by endorsing practices that are extensively evaluated through CER and have been manualized for replication.

•

Educate researchers on new technologies through social work research organizations’ use of special journal issues, conference presentations, and membership newsletters.

•

Increase efforts to expand the link between social work research and practice by:

◊ ◊ ◊

◊

20

Enhancing social workers competency in reviewing and implementing research findings into their own practice. Using new technologies and social media to disseminate research to practice. Promoting use of CER tools through initiatives among professional and scientific societies (including social work organizations), disease-focused organizations (e.g. American Cancer Society, American Diabetes Association, Mental Health America), and universities, including schools of social work. Recommending professional organizations recognize and support clinical/research collaborations.


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Recommendations for Academic Settings Regarding research excellence • Add CER methodologies, including CBPR methods to the curriculum at the social work doctorate and possibly at the master’s levels. This will help social work researchers be on the forefront of methodological innovation in CER. •

Train faculty to expand their research capacity to include CER methodologies.

•

Train researchers and practitioners to include economic evaluation techniques in intervention research. This will increase practitioners’ ability to select interventions that best fit populations and organizations’ needs and resources and will add to the usefulness of research findings.

•

Encourage the 15 university-based social work research centers that were initially funded by NIDA and NIMH to serve as models for multi-site CER.

Regarding practice excellence • Reinforce the importance of remaining up to date on research outcomes of relevant interventions that are expected to be used in practice through the development of BSW and MSW curriculum materials. •

•

•

•

•

Expand the knowledge-base of scientific review teams evaluation should be included appropriately in researc

•

Encourage NIH and AHRQ to work with social work funding for research on social work- specific practices understand the nature of social work practice and dem collaborations within the research design.

•

Encourage NIH and AHRQ to promote social work r evaluation in the research design.

•

Encourage NIH and AHRQ to expand its recognition workers on interdisciplinary CER teams.

•

Include more social workers on scientific review team consider complex populations and complex diagnoses

Research across disciplines • Develop methodologies for researchers to examine ho interventions is defined and how interventions might usual, or a different intervention, to make relevant de

Encourage collaboration between health and human service agencies and researchers in universities to carry out research and effectively analyze and use data to enhance practice.

Consider the revision of the structure of social work journal articles to present the limitations’ section in a constructive way so as not to leave a take home message that may void or diminish the impact of the research findings themselves.

•

Undertake efforts to compare datasets from the multi same interventions. This can then guide future practic utilizing the plethora of available data.

•

Include economic evaluation and considerations of do effectiveness research.

•

Promote community-based participatory research (CB current CBPR researchers to get involved with NIH, A

•

Consider methods and research funding so that both can be considered in effectiveness research.

•

Consider new techniques for data collection, such as c (e.g., Twitter, Facebook, etc.) that can expedite data c research findings and can also give new depth to ethn

Include a section in journal articles on the relevance of the research for practice. This can enhance the value of research to practitioners.

Research by social workers • Continue to build the research base of “effective socia move toward sufficient research for CER.

Recommendations for Collaboration with Federal Agencies •

Provide input to the development of the CER infrastru data available includes information that will be useful that takes into account a range of cultural, communit differences.

Recommendations to Enhance CER methods

Focus on consumption of research in practice classes in order to help make CER valuable to social work practitioners. For example, REACH-SW is a curriculum enhancement tool developed with funding from NIMH that helps faculty integrate the use of research in practice classes (www.danya.com/reach).

Regarding academic publications • Revise tenure, promotion and academic reward structures in social work to encourage researchers to seek diverse publication opportunities, further fostering inter-disciplinary collaboration. Currently social workers may be rewarded more for publishing in social work journals, which inhibits the visibility of social work research contributions to a broader audience. This can limit other disciplines consideration of social work research outcomes related to similar populations or problems. •

•

Increase dissemination of already available systematic reviews of social work interventions. Systematic reviews by the Campbell Collaboration (www.campbellcollaboration.org) and other reviews that examine social work and psychosocial CER should be brought to the attention of agencies gathering information on current CER.

•

Enhance validation and generalization of social work greater number of multi-site research studies.

Ensure inclusion of existing databases of social work research in the CER “horizon scanning” efforts, e.g. Directory of NIH-funded Social Work Researchers (IASWR, 2009).


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ettings

uding CBPR methods to the curriculum at the social work master’s levels. This will help social work researchers be on al innovation in CER.

esearch capacity to include CER methodologies.

•

Provide input to the development of the CER infrastructure, including ensuring that the data available includes information that will be useful in guiding psychosocial care and that takes into account a range of cultural, community, ethnic, gender, age and geographic differences.

•

Expand the knowledge-base of scientific review teams regarding ways that economic evaluation should be included appropriately in research studies.

•

Encourage NIH and AHRQ to work with social work researchers to continue to assign funding for research on social work- specific practices and interventions to further understand the nature of social work practice and demonstrate researcher/clinician collaborations within the research design.

•

Encourage NIH and AHRQ to promote social work research studies that include economic evaluation in the research design.

•

Encourage NIH and AHRQ to expand its recognition of the value of inclusion of social workers on interdisciplinary CER teams.

•

Include more social workers on scientific review teams to ensure research questions consider complex populations and complex diagnoses in real world settings.

oners to include economic evaluation techniques in ll increase practitioners’ ability to select interventions that izations’ needs and resources and will add to the usefulness

ased social work research centers that were initially funded as models for multi-site CER.

emaining up to date on research outcomes of relevant d to be used in practice through the development of BSW and

Recommendations to Enhance CER methods

arch in practice classes in order to help make CER valuable For example, REACH-SW is a curriculum enhancement tool NIMH that helps faculty integrate the use of research in om/reach).

Research across disciplines • Develop methodologies for researchers to examine how relative effectiveness of interventions is defined and how interventions might be compared to no care, care as usual, or a different intervention, to make relevant determinations of effectiveness.

een health and human service agencies and researchers in ch and effectively analyze and use data to enhance practice.

academic reward structures in social work to encourage blication opportunities, further fostering inter-disciplinary al workers may be rewarded more for publishing in social the visibility of social work research contributions to a mit other disciplines consideration of social work research pulations or problems.

ructure of social work journal articles to present the uctive way so as not to leave a take home message that may the research findings themselves.

•

Undertake efforts to compare datasets from the multiple sites that are implementing the same interventions. This can then guide future practice and policy enhancements by utilizing the plethora of available data.

•

Include economic evaluation and considerations of dosage, duration, and rigor in effectiveness research.

•

Promote community-based participatory research (CBPR) methodologies and encourage current CBPR researchers to get involved with NIH, AHRQ, and DHHS’s CER efforts.

•

Consider methods and research funding so that both short and long-term outcomes of cost can be considered in effectiveness research.

•

Consider new techniques for data collection, such as cell phone and picture messaging (e.g., Twitter, Facebook, etc.) that can expedite data collection, promote dissemination of research findings and can also give new depth to ethnographic studies.

ticles on the relevance of the research for practice. This can to practitioners.

Research by social workers • Continue to build the research base of “effective social work” interventions in order to move toward sufficient research for CER.

n with Federal Agencies

ady available systematic reviews of social work interventions. mpbell Collaboration (www.campbellcollaboration.org) and cial work and psychosocial CER should be brought to the g information on current CER.

•

Enhance validation and generalization of social work interventions by undertaking a greater number of multi-site research studies.

atabases of social work research in the CER “horizon ry of NIH-funded Social Work Researchers (IASWR, 2009).

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Recommendations to Promote Practice-Research Linkages

REFERENCES

•

Further develop researcher/practitioner/client linkages as a standard of practice by building support from administrators, universities, and advocacy organizations for such linkages.

American Recovery and Reinvestment Act of 2009, Pub. L. N

•

Train current practitioners about how research can be used to inform practice, including strategies for adopting and adapting interventions.

Community-Campus Partnerships for Health. (2008). Definiti research. Retrieved August 31, 2008 from http://depts.w

•

Expand practitioners’ knowledge of research to foster collaborations for more research in real world settings.

Gorey, K. M., Thyer, B. A., & Pawluck, D. E. (1998). Differe work practice models: A meta-analysis. Social Work, 43

•

Encourage practitioners to pursue publishing results of evaluations and outcomes of practice. Many practitioners evaluate the outcomes of practice, but do not disseminate the research. Dissemination of practice research could enhance the knowledge base needed to build or establish an intervention’s effectiveness.

Institute for the Advancement of Social Work Research (IASW Work Research Grants Awarded by the National Institut from INSERT WEB ADDRESS

•

Integrate research skills into clinical training programs within universities and agencies so that practitioners can be taught to use and produce research.

•

Encourage organizations to support practitioners’ use of and production of research by allocating time and resources to establish research as a component of employment. Strategies could include adding research expectations in job descriptions and by recognizing and rewarding research activities in annual employee evaluations.

•

Institute for the Advancement of Social Work Research (IASW Evidence-Based Mental Health Practices into Social Wor from April 12, 2007 Symposium. Retrieved from http://login.npwebsiteservices.com/iaswr/EvidenceBasedP

Institute of Medicine [IOM]. (2009). Initial National Prioritie Research. Washington, DC: The National Academies Pre htt://books.nap.edu/openbook.php?record_id=12648&p

Consider both cost and cost effectiveness in selecting and evaluating interventions. Less effective, yet cheaper interventions may end up costing the agency more money in the long run in addition to the personal implications for patients when less effective interventions are used.

Mullen, E. J., Melly, J., Volland, P., & Shuluk, J. (2008, Septe from General Reviews of Social Work Effectiveness? Pre Annual Inter-Centre Network for the Evaluation of Soci of Jyväskylä, Finland. Retrieved from http://socialworkle Social_Work_Effectiveness_Findings.pdf

The social work profession and especially the social work research enterprise is well-positioned to be fully engaged with Comparative Effectiveness Research efforts, based on the definitions, priorities, strategies and challenges laid out by the federal government. Attention needs to be given to continuing to build social work effectiveness research; involving social workers as part of interdisciplinary research teams; ensuring that findings from social work research are included in data and research repositories and systematic reviews; encouraging participatory research efforts that fully engage service providers and consumers; encouraging economic evaluation as an integral part of research studies; facilitating innovative research dissemination strategies and strengthening research/practice/policy linkages. Professional and scientific societies, universities, service provider agencies, consumers and funders of research and services all have important roles to play in ensuring the health and well-being of our society, especially those at highest risk to experience health disparities.

National Association of Social Workers (1999). NASW Code

National Association of Social Workers (2009). The NASW S adolescent girls. National Association of Social Workers http://socialworkers.org/practice/adolescent_health/shift/

National Institutes of Health (2003). NIH Plan for Social Wo Retrieved from http://obssr.od.nih.gov/pdf/SWR_Report

Reid, W. J. (1997). Evaluating the dodo’s verdict: Do all inter Social Work Research, 21(1), 5-16.

Reid, W. J., Kenaley, B. D., & Colvin, J. (2004). Do some int A review of comparative social work experiments. Socia

Substance Abuse and Mental Health Services Administration Washington, D.C.: U.S. Department of Health and Hum

Shlonsky, A., Fuller-Thomson, E. and Baker, T. (n.d.). Avoidin Strategies for Evidence through the Use of Methodologic Factor-Inwentash Faculty of Social Work.

U.S. Department of Health and Human Services [DHHS]. (20 for Comparative Effectiveness Research: Report to the P Washington, DC: Author. Retrieved from www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf


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tice-Research Linkages

REFERENCES

actitioner/client linkages as a standard of practice by building universities, and advocacy organizations for such linkages.

American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5 § 804, 123 Stat. 188 (2009).

out how research can be used to inform practice, including apting interventions.

Community-Campus Partnerships for Health. (2008). Definition of community-based participatory research. Retrieved August 31, 2008 from http://depts.washington.edu/ccph/commbas.html

dge of research to foster collaborations for more research in

Gorey, K. M., Thyer, B. A., & Pawluck, D. E. (1998). Differential effectiveness of prevalent social work practice models: A meta-analysis. Social Work, 43(3), 269-278

rsue publishing results of evaluations and outcomes of valuate the outcomes of practice, but do not disseminate the ctice research could enhance the knowledge base needed to on’s effectiveness.

Institute for the Advancement of Social Work Research (IASWR). (2009). Directory of Social Work Research Grants Awarded by the National Institutes of Health: 1993-2009 Retrieved from INSERT WEB ADDRESS Institute for the Advancement of Social Work Research (IASWR). (2007). Partnerships to Integrate Evidence-Based Mental Health Practices into Social Work Education and Research: Report from April 12, 2007 Symposium. Retrieved from http://login.npwebsiteservices.com/iaswr/EvidenceBasedPracticeFinal.pdf

inical training programs within universities and agencies so ht to use and produce research.

pport practitioners’ use of and production of research by o establish research as a component of employment. g research expectations in job descriptions and by earch activities in annual employee evaluations.

Institute of Medicine [IOM]. (2009). Initial National Priorities for Comparative Effectiveness Research. Washington, DC: The National Academies Press. Retrieved from htt://books.nap.edu/openbook.php?record_id=12648&page=R1

fectiveness in selecting and evaluating interventions. Less ions may end up costing the agency more money in the long l implications for patients when less effective interventions

Mullen, E. J., Melly, J., Volland, P., & Shuluk, J. (2008, September 24). What Can Be Concluded from General Reviews of Social Work Effectiveness? Presentation presented at the 11th Annual Inter-Centre Network for the Evaluation of Social Work Practice Meeting, University of Jyväskylä, Finland. Retrieved from http://socialworkleadership.org/nsw/cap/resources/ Social_Work_Effectiveness_Findings.pdf

ally the social work research enterprise is well-positioned to fectiveness Research efforts, based on the definitions, d out by the federal government. Attention needs to be rk effectiveness research; involving social workers as part of ring that findings from social work research are included in tematic reviews; encouraging participatory research efforts d consumers; encouraging economic evaluation as an integral novative research dissemination strategies and strengthening fessional and scientific societies, universities, service provider search and services all have important roles to play in our society, especially those at highest risk to experience

National Association of Social Workers (1999). NASW Code of Ethics, Preamble National Association of Social Workers (2009). The NASW Shift Project: Suicide prevention for adolescent girls. National Association of Social Workers: Washington DC. Retrieved from: http://socialworkers.org/practice/adolescent_health/shift/ National Institutes of Health (2003). NIH Plan for Social Work Research. Bethesda, MD: Author. Retrieved from http://obssr.od.nih.gov/pdf/SWR_Report.pdf Reid, W. J. (1997). Evaluating the dodo’s verdict: Do all interventions have equivalent outcomes? Social Work Research, 21(1), 5-16. Reid, W. J., Kenaley, B. D., & Colvin, J. (2004). Do some interventions work better than others? A review of comparative social work experiments. Social Work Research, 28(2), 71-81 Substance Abuse and Mental Health Services Administration [SAMHSA]. (2002). Mental Health. Washington, D.C.: U.S. Department of Health and Human Services. Shlonsky, A., Fuller-Thomson, E. and Baker, T. (n.d.). Avoiding the Avalanche: Improving Search Strategies for Evidence through the Use of Methodological Filters. University of Toronto, Factor-Inwentash Faculty of Social Work. U.S. Department of Health and Human Services [DHHS]. (2009). Federal Coordinating Council for Comparative Effectiveness Research: Report to the President and the Congress. Washington, DC: Author. Retrieved from www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf

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Page A-1



APPENDIX A: LIST OF SYMPOSIUM PARTICIPANTS Robert Arnold, MPS

Cathleen Lewandowski, PhD

Director National Association of Social Workers Foundation

Chair and Professor Department of Social Work College of Health and Human Services George Mason University

Christine Bachrach, PhD Acting Director Office of Behavioral and Social Sciences Research National Institutes of Health

Melissa Lim Brodowski, MSW Prevention Specialist Office on Child Abuse and Neglect Children’s Bureau, ACYF, ACF, HHS

Katie Maslow, MSW

Director Center for Workforce Studies & Social Work Practice National Association of Social Workers

Wilma & Albert Musher Professor School of Social Work Columbia University

Director External Relations National Association of Social Workers

Ann Nichols-Casebolt, PhD

Elizabeth Hoffler, MSW Special Assistant to the Executive Director National Association of Social Workers

Asua Ofosu, JD

Deborah Gioia, PhD, MSSW

Senior Government Relations Associate National Association of Social Workers

Shirley Otis-Green, MSW, ACSW, LCSW, OSW-C Senior Research Specialist Division of Nursing & Research Education Department of Population Sciences City of Hope National Medical Center

Annette Schmidt

Dorothy Jeffress, MA, MSW, MBA

Director, U.S. External Affairs Sanofi-Aventis U.S.

Executive Director Center for the Advancement of Health

Charles A. Smith, PhD

Stuart Kaufer, LMSW, ACSW

Evaluation and Planning Montgomery County Health and Human Services

Director of Waiver Services Center for Independence of Disabled of New York Traumatic Brain Injury and Nursing Home Transition Waivers


Tracy Whitaker, DSW, ACSW

Rebecca S. Myers, LSW, ACSW

Interim Dean of the School of Social Work Associate Vice President for Research and Development Virginia Commonwealth University

Senior Advisor to the Deputy Director Office of the Director National Institutes of Health

Kenan Flagle School of So University of

Director Social Work National Ass

Phaedra Corso, PhD

Suzanne Heurtin-Roberts, PhD, MSW

Sheryl Zimm

MSW Intern Social Work Policy Institute National Association of Social Workers Foundation

Joan Levy Z

Edward J. Mullen, DSW

Associate Professor School of Social Work University of Maryland Baltimore

Briana Walters

Assistant Director National Association of Social Workers Foundation

Executive Director National Association of Social Workers

Director Office of Applied Studies Substance Abuse and Mental Health Services Administration

Director of C National Ass

Jennifer Watt, BSC

Elizabeth J. Clark, PhD, MPH, ACSW

Peter J. Delany, PhD, LCSW-C, RADM, USPHS

Gail Woods

Co-Chair NASW Pioneers

Health Scientist Administrator National Institute on Drug Abuse National Institutes of Health

Jacqueline Lloyd, PhD, MSW

Director of Policy Development Advocacy and Public Policy Division Alzheimer’s Association

Associate Professor and Department Head School of Public Health University of Georgia

Betsy Vourlekis, PhD

Timothy Tunner, PhD, MSW Project Coordinator National Association of State Mental Health Program Directors Research Institute, Inc.

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rch

PHS

York ansition

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YMPOSIUM PARTICIPANTS

dation

3/22/10

Cathleen Lewandowski, PhD Chair and Professor Department of Social Work College of Health and Human Services George Mason University

Betsy Vourlekis, PhD

Gail Woods-Waller, MS

Co-Chair NASW Pioneers

Director of Communications National Association of Social Workers

Briana Walters

Sheryl Zimmerman, PhD

MSW Intern Social Work Policy Institute National Association of Social Workers Foundation

Kenan Flagler Bingham Distinguished Professor School of Social Work University of North Carolina at Chapel Hill

Jennifer Watt, BSC

Joan Levy Zlotnik, PhD, ACSW

Health Scientist Administrator National Institute on Drug Abuse National Institutes of Health

Assistant Director National Association of Social Workers Foundation

Director Social Work Policy Institute National Association of Social Workers Foundation

Katie Maslow, MSW

Director Center for Workforce Studies & Social Work Practice National Association of Social Workers

Jacqueline Lloyd, PhD, MSW

Tracy Whitaker, DSW, ACSW

Director of Policy Development Advocacy and Public Policy Division Alzheimer’s Association

Edward J. Mullen, DSW Wilma & Albert Musher Professor School of Social Work Columbia University

Rebecca S. Myers, LSW, ACSW Director External Relations National Association of Social Workers

Ann Nichols-Casebolt, PhD Interim Dean of the School of Social Work Associate Vice President for Research and Development Virginia Commonwealth University

Asua Ofosu, JD Senior Government Relations Associate National Association of Social Workers

Shirley Otis-Green, MSW, ACSW, LCSW, OSW-C Senior Research Specialist Division of Nursing & Research Education Department of Population Sciences City of Hope National Medical Center

Annette Schmidt Director, U.S. External Affairs Sanofi-Aventis U.S.

Charles A. Smith, PhD Evaluation and Planning Montgomery County Health and Human Services

Timothy Tunner, PhD, MSW Project Coordinator National Association of State Mental Health Program Directors Research Institute, Inc.

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PART 2: IDENTIFYING CHALLENGES AND G

APPENDIX B: SYMPOSIUM AGENDA 12:15-1:15

Social Work Research and Comparative Effectiveness Research: A Research Symposium to Strengthen the Connection November 16, 2009 NASW National Office 750 First Street, NE, Suite 700, Washington, DC 7th Floor Conference Center – A, B, C 9:30

Continental Breakfast

10:00

Welcome & Introductions Symposium Purpose and Outcomes

1:30

PART 3: DEVELOPING AN ACTION PLAN 1:45

Action Planning Work Groups • Interdisciplinary Behavioral and Social Scie • Training CER researchers • Linking CER to dissemination and impleme • Researcher/Funder relations • Implications and recommendations for poli

2:45

Break

3:00

Report Out and Identification of Action Steps

Social Work Outcomes Research – What Do We Know About Outcomes of Social Work Interventions Edward Mullen, DSW, Columbia University

3:45

Next Steps

4:00

Adjourn

Economic Analysis of Effectiveness of Psychosocial Interventions – Considerations for CER Phaedra Corso, PhD, U of Georgia

4:00-5:00

TEA and INFORMAL RECEPTION

PART 1: FRAMING THE ISSUES 10:20

Roundtable Facilitated Working Lunch CER and Psychosocial Research – Identifying Current status of research on social work inte Effectiveness research in complex systems with complex needs Researcher training and capacity building Research/Practice linkages Report out on gaps and challenges for CER to

Comparative Effectiveness Research – Definitions, Federal Agenda, Implications for Social Work Peter Delany, PhD, LMSW, RADM, SAMHSA (member of Federal Coordinating Council) Katie Maslow, MSW, Alzheimer’s Association (member of IOM Panel)

A View from the Trenches: Perspectives from a Clinician- Researcher Shirley Otis-Green, MSW, LCSW, OSW-C, City of Hope Discussant Sheryl Zimmerman, PhD, University of North Carolina-Chapel Hill Next Steps Joan Levy Zlotnik, PhD, ACSW, Social Work Policy Institute, NASW Foundation


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PART 2: IDENTIFYING CHALLENGES AND GAPS

UM AGENDA 12:15-1:15

rative Effectiveness Research: hen the Connection

et, NE, Suite 700, Washington, DC 1:30

Roundtable Facilitated Working Lunch CER and Psychosocial Research – Identifying the Gaps and Challenges Current status of research on social work interventions Effectiveness research in complex systems with special populations and people with complex needs Researcher training and capacity building Research/Practice linkages Report out on gaps and challenges for CER to address psychosocial issues

PART 3: DEVELOPING AN ACTION PLAN

ons nd Outcomes

1:45

Action Planning Work Groups • Interdisciplinary Behavioral and Social Science CER • Training CER researchers • Linking CER to dissemination and implementation research • Researcher/Funder relations • Implications and recommendations for policy

2:45

Break

Alzheimer’s Association (member of IOM Panel)

3:00

Report Out and Identification of Action Steps and Targets

s Research – What Do We Know About Outcomes of Social

3:45

Next Steps

4:00

Adjourn

4:00-5:00

TEA and INFORMAL RECEPTION

HE ISSUES

ness Research – Definitions, Federal Agenda, Implications

MSW, RADM, SAMHSA (member of Federal Coordinating

Columbia University

Effectiveness of Psychosocial Interventions – Considerations

U of Georgia

ches: Perspectives from a Clinician- Researcher SW, LCSW, OSW-C, City of Hope

hD, University of North Carolina-Chapel Hill

D, ACSW, Social Work Policy Institute, NASW Foundation

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Page C-1



APPENDIX C: FCC CER STRATEGIC FRAMEWORK AND PRIORITIES (DHHS, 2009)

APPENDIX D: IOM CER PRIORITIES REL WORKERS AND SOCIAL WORK RESEA

A. These first quartile priorities pertinent to social wo the effectiveness of:*

The report specifies four core categories for prioritizing how DHHS funds should address CER activities and investments: 1. 2.

3.

4.

Comparative Effectiveness Research – Primary or meta-analysis (supporting investment) Human and Scientific Capital – Enhance U.S.’s capacity for CER by strengthening relevant research skills or advancing CER approaches and methodologies (e.g., training and workforce development) (supporting investment) CER Data Infrastructure – Creation of research data sets and repositories, aggregation of existing data sources, development of new tools to query and analyze existing data sets, or creation of standards for new data collection (primary investment) Dissemination and Translation of CER – improving processes for distribution and developing relevant practice guidelines (secondary investment)

2. 3.

Dissemination and translation techniques to facilitate clinicians, payers, and others.

2.

Comprehensive care coordination programs, such as t managing children and adults with severe chronic dise known health disparities.

3.

Effectiveness and costs of alternative detection and m community dwelling individuals and their caregivers.

4.

Pharmacologic and non-pharmacologic treatments in people with Alzheimer’s disease and other dementias i

5.

School-based interventions involving meal programs, education, at different levels of intensity, in preventing in children and adolescents.

6.

Various strategies to prevent obesity, hypertension, di populations such as the urban poor and American Ind

7.

Various primary care treatment strategies for attentio (ADHD) in children.

8.

Wraparound home and community-based services and serious emotional disorders in children and adults.

9.

Interventions to reduce health disparities in cardiovas musculoskeletal diseased, and birth outcomes.

10. Literacy-sensitive disease management programs and children and adults with low literacy and chronic dise

11. Clinical interventions to reduce incidences of infant m birth rates, especially among African-American wome

Themes for the research that cut across all core categories should focus on: 1.

1.

12. Innovative strategies for preventing unintended pregn

Priority Populations – Focus on populations outlined in the prioritization criteria (e.g., ethnic minorities, persons with disabilities, children, veterans, the elderly, and patients with comorbidities) (secondary investment) Conditions – Focus on specific conditions highlighted in the IOM’s 100 priorities (see Appendix X) (supporting investment) Types of interventions – Focus on medications, medical and assistive devices, procedures, behavioral change, diagnostic testing, and delivery system strategies (secondary investment)


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STRATEGIC FRAMEWORK AND 9)

APPENDIX D: IOM CER PRIORITIES RELEVANT TO SOCIAL WORKERS AND SOCIAL WORK RESEARCH A. These first quartile priorities pertinent to social work call for researchers to compare the effectiveness of:*

es for prioritizing how DHHS funds should address CER

search – Primary or meta-analysis (supporting investment) – Enhance U.S.’s capacity for CER by strengthening relevant ER approaches and methodologies (e.g., training and porting investment) eation of research data sets and repositories, aggregation of ment of new tools to query and analyze existing data sets, or data collection (primary investment) n of CER – improving processes for distribution and uidelines (secondary investment)

1.

Dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others.

2.

Comprehensive care coordination programs, such as the medical home, and usual care in managing children and adults with severe chronic disease, especially in populations with known health disparities.

3.

Effectiveness and costs of alternative detection and management strategies for dementia in community dwelling individuals and their caregivers.

4.

Pharmacologic and non-pharmacologic treatments in managing behavioral disorders in people with Alzheimer’s disease and other dementias in homes and institutions.

5.

School-based interventions involving meal programs, vending machines, and physical education, at different levels of intensity, in preventing and treating overweight and obesity in children and adolescents.

6.

Various strategies to prevent obesity, hypertension, diabetes, and heart disease in at-risk populations such as the urban poor and American Indians.

7.

Various primary care treatment strategies for attention deficit hyperactivity disorder (ADHD) in children.

8.

Wraparound home and community-based services and residential treatment in managing serious emotional disorders in children and adults.

9.

Interventions to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseased, and birth outcomes.

10. Literacy-sensitive disease management programs and usual care in reducing disparities in children and adults with low literacy and chronic disease. 11. Clinical interventions to reduce incidences of infant mortality, pre-term births, and low birth rates, especially among African-American women.

ss all core categories should focus on:

12. Innovative strategies for preventing unintended pregnancies.

n populations outlined in the prioritization criteria (e.g., h disabilities, children, veterans, the elderly, and patients with estment) conditions highlighted in the IOM’s 100 priorities (see stment) on medications, medical and assistive devices, procedures, testing, and delivery system strategies (secondary

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B. These second quartile priorities pertinent to social work call for researchers to compare the effectiveness of:*

C. These third quartile priorities pertinent to social wo the effectiveness of:*

1.

Therapeutic strategies for different autism spectrum disorders (ASD) at different levels of severity and stages of intervention.

1.

Effectiveness and cost-effectiveness of conventional m in adolescents and adults, versus conventional therapy or programs incorporating support groups and educa

2.

The co-location model (psychological and primary care practitioners practicing together) and usual care (identification by primary care practitioner and referral to community-based mental health services) in identifying and treating social-emotional and developmental disorders in children ages 0-3.

2.

Alternative redesign strategies-using decision support records, and person health records- for increasing hea evidence based guidelines and patients’ adherence to g disease care.

Diverse models of comprehensive support services for infants and their families following discharge from a neonatal intensive care unit.

3.

Different quality improvement strategies in disease pr care, and rehabilitation services for diverse population

Mindfulness-based interventions (e.g., yoga, meditation, etc.) and usual care in treating anxiety and depression, pain, cardiovascular risk factors, and chronic diseases.

4.

Different benefit design, utilization management, and health care access and quality in patients with chronic

Shared decision making and usual care on decision outcomes in children and adults with chronic disease such as stable angina and asthma.

5.

HIV screening strategies based on recent CDC recomm in primary care settings with significant prevention co

6.

Comprehensive, coordinated care and usual care on o patient-reported outcomes, and costs to care for peop

7.

Management strategies (e.g., inpatient psychiatric hos partial hospitalization, intensive outpatient care) for a suicide attempt.

8.

Different strategies to engage and retain patients in ca especially for members of populations that experience

3.

4.

5.

6.

Strategies for enhancing patients’ adherence to medication regimens.

7.

Patient decision support tools on informing diagnostic and treatment decisions for elective surgical and nonsurgical procedures-especially in patients with limited English-language proficiency, limited education, hearing or visual impairments, or mental health problems

8.

New remote patient monitoring and management technologies and usual care in managing chronic disease, especially in rural settings.

9.

Diverse models of transition support services for adults with complex health care needs after hospital discharge.

10. Accountable care systems and usual care on costs, processes of care, and outcomes for geographically defined populations of patients with one or more chronic diseases. 11. Different residential settings in caring for elderly patients with functional impairments. 12. Coordinated care (supported by reimbursement innovations) and usual care in long-term and end-of-life care of the elderly. 13. Pharmacologic treatment and behavioral interventions in managing major depressive disorders in adolescents and adults in diverse treatment settings. 14. An integrated approach (combining counseling, environmental mitigation, chronic disease management, and legal assistance) with a non-integrated episodic care model in managing asthma in children. 15. Treatment strategies for Post-Traumatic Stress Disorder stemming from diverse sources of trauma.


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es pertinent to social work call for researchers to

C. These third quartile priorities pertinent to social work call for researchers to compare the effectiveness of:*

erent autism spectrum disorders (ASD) at different levels of tion.

1.

Effectiveness and cost-effectiveness of conventional medical management of type 2 diabetes in adolescents and adults, versus conventional therapy plus intensive educational programs or programs incorporating support groups and educational resources.

2.

Alternative redesign strategies-using decision support capabilities, electronic health records, and person health records- for increasing health professionals’ compliance with evidence based guidelines and patients’ adherence to guideline-based regimens for chronic disease care.

ive support services for infants and their families following nsive care unit.

3.

Different quality improvement strategies in disease prevention, acute care, chronic disease care, and rehabilitation services for diverse populations of children and adults.

ns (e.g., yoga, meditation, etc.) and usual care in treating cardiovascular risk factors, and chronic diseases.

4.

Different benefit design, utilization management, and cost-sharing strategies in improving health care access and quality in patients with chronic diseases.

sual care on decision outcomes in children and adults with angina and asthma.

5.

HIV screening strategies based on recent CDC recommendations and traditional screening in primary care settings with significant prevention counseling.

6.

Comprehensive, coordinated care and usual care on objective measures of clinical status, patient-reported outcomes, and costs to care for people with multiple sclerosis.

7.

Management strategies (e.g., inpatient psychiatric hospitalization, extended observation, partial hospitalization, intensive outpatient care) for adolescents and adults following a suicide attempt.

8.

Different strategies to engage and retain patients in care and to delineate barriers to care, especially for members of populations that experience health disparities.

ological and primary care practitioners practicing together) by primary care practitioner and referral to th services) in identifying and treating social-emotional and ldren ages 0-3.

nts’ adherence to medication regimens.

on informing diagnostic and treatment decisions for elective dures-especially in patients with limited English-language hearing or visual impairments, or mental health problems

ng and management technologies and usual care in managing ural settings.

upport services for adults with complex health care needs

usual care on costs, processes of care, and outcomes for tions of patients with one or more chronic diseases.

n caring for elderly patients with functional impairments.

by reimbursement innovations) and usual care in long-term rly.

behavioral interventions in managing major depressive dults in diverse treatment settings.

bining counseling, environmental mitigation, chronic disease nce) with a non-integrated episodic care model in managing

Traumatic Stress Disorder stemming from diverse sources of

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D. These fourth quartile priorities pertinent to social work call for researchers to compare the effectiveness of:*

APPENDIX E: REVIEW ARTICLES ON SO EFFECTIVENESS (Mullen, Melly, Volland, & Shuluk

1.

Smoking cessation strategies in smokers from understudied populations such as minorities, individuals with mental illness, and adolescents.

2.

Care coordination with and without clinical decision supports in producing good health outcomes in chronically ill patients, including children with special health care needs.

Gorey, K. M. (1996). Effectiveness of social work interventio external evaluations. Social Work Research.

3.

Coordinated, physician-led, interdisciplinary care provided in the patient’s residence usual care in managing advanced chronic disease in community-dwelling patients with significant functional impairments.

Gorey, K. M., Thyer, B. A., & Pawluck, D. E. (1998). Differe social work practice models: A meta-analysis. Social W

4.

Traditional behavioral interventions versus economic incentives in motivating behavior changes in children and adults.

Grenier, A. M., & Gorey, K. M. (1998). The effectiveness of and their families: A meta-analysis of conference proc 22(1), 60-64.

5.

Different techniques (e.g., audio, visual, written) for informing patients about proposed treatments during the process of informed consent.

Macdonald, G. M., Sheldon, B., Gillespie, J. (1992). Contem of social work. British Journal of Social Work.

6.

Different disease management strategies for activating patients with chronic disease.

Reid, W. J. (1997). Evaluating the dodo’s verdict: Do all inter outcomes? Social Work Research, 21(1), 5-16.

7.

Different treatment strategies in the prevention of progression and disability from osteoarthritis.

8.

Different treatment strategies on the frequency and lost productivity in people with chronic, frequent migraine headaches.

9.

Different treatment approaches in avoiding early mortality and comorbidity among people with serious and persistent mental illness.

Reid, W. J., Kenaley, B. D., & Colvin, J. (2004). Do some int others? - A review of comparative social work experim 28(2), 71-81

de Smidt, G. A., & Gorey, K. M. (1997). Unpublished social replication of a recent meta-analysis of published inte Social Work Research.

10. Different treatment strategies for depression after myocardial infarction on medication adherence, cardiovascular events, hospitalization, and death. 11. Different strategies for promoting breastfeeding among low-income African American women. *Note: Numerical indicators to not indicate level of priority within a quartile and are strictly for reference purposes within this document Source: IOM, 2009


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s pertinent to social work call for researchers to

APPENDIX E: REVIEW ARTICLES ON SOCIAL WORK EFFECTIVENESS (Mullen, Melly, Volland, & Shuluk, 2008)

n smokers from understudied populations such as minorities, , and adolescents.

ithout clinical decision supports in producing good health ients, including children with special health care needs.

Gorey, K. M. (1996). Effectiveness of social work intervention research: Internal versus external evaluations. Social Work Research.

terdisciplinary care provided in the patient’s residence usual ronic disease in community-dwelling patients with ents.

Gorey, K. M., Thyer, B. A., & Pawluck, D. E. (1998). Differential effectiveness of prevalent social work practice models: A meta-analysis. Social Work, 43(3), 269-278

ntions versus economic incentives in motivating behavior .

Grenier, A. M., & Gorey, K. M. (1998). The effectiveness of social work with older people and their families: A meta-analysis of conference proceedings. Social Work Research, 22(1), 60-64.

io, visual, written) for informing patients about proposed of informed consent.

Macdonald, G. M., Sheldon, B., Gillespie, J. (1992). Contemporary studies of the effectiveness of social work. British Journal of Social Work.

strategies for activating patients with chronic disease.

Reid, W. J. (1997). Evaluating the dodo’s verdict: Do all interventions have equivalent outcomes? Social Work Research, 21(1), 5-16.

n the prevention of progression and disability from Reid, W. J., Kenaley, B. D., & Colvin, J. (2004). Do some interventions work better than others? - A review of comparative social work experiments. Social Work Research, 28(2), 71-81

on the frequency and lost productivity in people with adaches.

de Smidt, G. A., & Gorey, K. M. (1997). Unpublished social work research: Systematic replication of a recent meta-analysis of published intervention effectiveness research. Social Work Research.

s in avoiding early mortality and comorbidity among people ntal illness.

for depression after myocardial infarction on medication nts, hospitalization, and death.

ting breastfeeding among low-income African American

dicate level of priority within a quartile and are strictly for ent

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APPENDIX F: RESOURCES ON EVIDENCED BASED PRACTICE AND SOCIAL WORK

The resource includes worksheets that help agencies evaluate and implementation planning along with resources for progra evidence-based programs and practices. http://friendsnrc.org

California Evidence-Based Clearinghouse for Child Welfare - The California Evidence-Based

Matrix of Children’s Evidence-Based Interventions - The

Quality and Accountability synthesized key literature reviews of prevention, intervention, and/or treatment programs that c mental health services. The purpose was not to redefine or cr constitutes an evidence-based practice vs. a promising practic compile a comprehensive list of interventions or programs th rigorously tested, and found to have varying degrees of evide www.nri-inc.org/reports_pubs/2006/EBPChildrensMatrix20

Clearinghouse for Child Welfare provides up-to-date information on evidence-based child welfare practices and facilitates the utilization of evidence-based practices as a method of achieving improved outcomes of safety, permanency and well-being for children and families involved in the California public child welfare system. www.cachildwelfareclearinghouse.org

Cancer Control P.L.A.N.E.T. - The Cancer Control PLANET portal, which stands for Plan, Link, Act, Network with Evidence-based Tools, provides access to data and resources that can help planners, program staff, and researchers to design, implement, and evaluate evidence-based cancer control programs. http://cancercontrolplanet.cancer.gov/

Social Care Institute for Excellence (SCIE) - The United Kin

disseminate knowledge-based good practice guidance; involve providers, and policymakers in advancing and promoting goo enhance the skills and professionalism of social care workers user-friendly resources. www.scie.org.uk

Campbell Collaboration - The Campbell Collaboration is an international, nonprofit organization, which reviews the effectiveness of behavioral, social and psychological interventions in the fields of social welfare, criminal justice, and education. www.campbellcollaboration.org

Social Programs That Work - This site summarizes the find controlled trials that, in their view, have particularly importa show, for example, that a social intervention has a major effe has little or no effect. They limit the discussion to well-design based on persuasive evidence that they are superior to other s intervention’s true effect. www.evidencebasedprograms.org/

CDC: The Community Guide - The Guide to Community Preventive Services (Community Guide) serves as a filter for scientific literature on specific health problems that can be large, inconsistent, uneven in quality, and even inaccessible. The Community Guide summarizes what is known about the effectiveness, economic efficiency, and feasibility of interventions to promote community health and prevent disease. The Task Force on Community Preventive Services makes recommendations for the use of various interventions based on the evidence gathered in the rigorous and systematic scientific reviews of published studies conducted by the review teams of the Community Guide. The findings from the reviews are published in peer-reviewed journals and also made available on this Internet website. www.thecommunityguide.org/

Suicide Prevention Research Center: Best Practice Registr

Registry is to identify, review, and disseminate information ab specific objectives of the National Strategy for Suicide Preven www.sprc.org/featured_resources/bpr/index.asp

EBP Substance Abuse Database - The EBP Substance Abuse Database is a small, but growing, database of evidence-based interventions for treating substance use disorders. Interventions were selected according to criteria described on the About EBP page. Each record in the database includes a description of the intervention and its implementation, populations for which it has been shown to be effective, references to supporting literature, the availability of instructional manuals, and author/developer notes and other useful information. http://lib.adai.washington.edu/ebpsearch.htm

Substance Abuse and Mental Health Services Administra of Evidence-Based Programs and Practices (NREPP).

The recently redesigned NREPP is a system designed to suppo disseminate timely and reliable information about interventio and substance use disorders. The NREPP is a searchable onlin access descriptive information about interventions as well as outcome-specific evidence across several dimensions. NREPP audiences, including service providers, policy makers, progra and researchers. www.nrepp.samhsa.gov/

Evaluation Center at Human Services Research Institute - The Evaluation Center@HSRI is a national technical assistance center dedicated to adult mental health systems change. The Evaluation Center provides technical assistance in the area of evaluation to states and nonprofit public entities for improving the planning, development, and operation of adult mental health services. The toolkits give users access to some of the most current approaches and instructions on how to implement sound evaluation studies. Toolkits are available in the areas of Outcomes Measurement, Evaluation Methodology and Statistics, Managed Care, Performance Measurement & Quality, Internet Evaluation Issues, Multicultural Issues in Evaluation, and Evidence-based Practices. www.tecathsri.org

Substance Abuse and Mental Health Services Administra Mental Health Services’ (CMHS) Evidence-Based Practice

SAMHSA/CMHS has developed six toolkits to guide the imp evidence-based practices. The toolkits contain information sh introductory videos, practice demonstration videos, and a wo The toolkits cover Illness Management and Recovery; Asserti Psychoeducation; Supported Employment; and Integrated Du http://mentalhealth.samhsa.gov/cmhs/communitysupport/to

Integrating Evidence-Based Practices into CBCAP - The “Discussion Tool” was produced by FRIENDS to help State Lead Agencies work with their funded programs to facilitate appropriate conversations when considering implementing evidence-based or evidence-informed programs and practices. The Discussion Tool is divided into 7 sections that cover 4 paths programs can follow. SOCIAL WORK POLICY INSTITUTE

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ES ON EVIDENCED BASED PRACTICE

The resource includes worksheets that help agencies evaluate capacity, templates for evaluation and implementation planning along with resources for programs to use while they explore existing evidence-based programs and practices. http://friendsnrc.org/resources/evidence.htm

ghouse for Child Welfare - The California Evidence-Based

Matrix of Children’s Evidence-Based Interventions - The NRI Center for Mental Health Quality and Accountability synthesized key literature reviews which summarized the effectiveness of prevention, intervention, and/or treatment programs that can be applied to child and adolescent mental health services. The purpose was not to redefine or create another hierarchy of what constitutes an evidence-based practice vs. a promising practice or emerging practice, but rather to compile a comprehensive list of interventions or programs that have been evaluated or more rigorously tested, and found to have varying degrees of evidence as to their effectiveness. www.nri-inc.org/reports_pubs/2006/EBPChildrensMatrix2006.pdf

ides up-to-date information on evidence-based child welfare of evidence-based practices as a method of achieving ency and well-being for children and families involved in the . www.cachildwelfareclearinghouse.org

ancer Control PLANET portal, which stands for Plan, Link, ools, provides access to data and resources that can help ers to design, implement, and evaluate evidence-based cancer olplanet.cancer.gov/

Social Care Institute for Excellence (SCIE) - The United Kingdom-based SCIE works to disseminate knowledge-based good practice guidance; involve service users, carers, practitioners, providers, and policymakers in advancing and promoting good practice in social care; and enhance the skills and professionalism of social care workers through tailored, targeted and user-friendly resources. www.scie.org.uk

pbell Collaboration is an international, nonprofit iveness of behavioral, social and psychological interventions justice, and education. www.campbellcollaboration.org

Social Programs That Work - This site summarizes the findings from well-designed randomized controlled trials that, in their view, have particularly important policy implications — because they show, for example, that a social intervention has a major effect, or that a widely-used intervention has little or no effect. They limit the discussion to well-designed randomized controlled trials based on persuasive evidence that they are superior to other study designs in measuring an intervention’s true effect. www.evidencebasedprograms.org/

Guide to Community Preventive Services (Community Guide) e on specific health problems that can be large, inconsistent, le. The Community Guide summarizes what is known about and feasibility of interventions to promote community Force on Community Preventive Services makes us interventions based on the evidence gathered in the ews of published studies conducted by the review teams of rom the reviews are published in peer-reviewed journals and ebsite. www.thecommunityguide.org/

Suicide Prevention Research Center: Best Practice Registry - The purpose of the Best Practice Registry is to identify, review, and disseminate information about best practices that address specific objectives of the National Strategy for Suicide Prevention. www.sprc.org/featured_resources/bpr/index.asp

The EBP Substance Abuse Database is a small, but growing, ons for treating substance use disorders. Interventions were d on the About EBP page. Each record in the database ion and its implementation, populations for which it has to supporting literature, the availability of instructional and other useful information. arch.htm

Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-Based Programs and Practices (NREPP). The recently redesigned NREPP is a system designed to support informed decision-making and to disseminate timely and reliable information about interventions that prevent and/or treat mental and substance use disorders. The NREPP is a searchable online registry which allows users to access descriptive information about interventions as well as peer-reviewed ratings of outcome-specific evidence across several dimensions. NREPP provides information to a range of audiences, including service providers, policy makers, program planners, purchasers, consumers, and researchers. www.nrepp.samhsa.gov/

es Research Institute - The Evaluation Center@HSRI is a dicated to adult mental health systems change. The assistance in the area of evaluation to states and nonprofit ning, development, and operation of adult mental health s to some of the most current approaches and instructions n studies. Toolkits are available in the areas of Outcomes gy and Statistics, Managed Care, Performance Measurement Multicultural Issues in Evaluation, and Evidence-based

Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Mental Health Services’ (CMHS) Evidence-Based Practice Implementation Resource Kits. SAMHSA/CMHS has developed six toolkits to guide the implementation of mental health evidence-based practices. The toolkits contain information sheets for all stakeholder groups, introductory videos, practice demonstration videos, and a workbook or manual for practitioners. The toolkits cover Illness Management and Recovery; Assertive Community Treatment; Family Psychoeducation; Supported Employment; and Integrated Dual Diagnosis Treatment. http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits

es into CBCAP - The “Discussion Tool” was produced by

work with their funded programs to facilitate appropriate menting evidence-based or evidence-informed programs and ded into 7 sections that cover 4 paths programs can follow. F-1


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APPENDIX G: NASW SHIFT MODEL OF MOVING EBP TO PRACTICE

APPENDIX H: CAMPBELL COLLABORAT REVIEWS (Mullen et al., 2008)

Outcomes of Campbell Collaboration Systematic Review

Examples of interventions proven effective, but with qua Intervention

Limitation

Cognitive behavioral treatment for antisocial behavior in youth in residential treatment

Only compared

Work programs for welfare recipients –

Limited generali

Kinship care for the safety, permanency, and well-being of children removed from home Parent-training programs for improving maternal psychosocial health

http://socialworkers.org/practice/adolescent_health/shift/shift.asp


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Insufficient evid theoretically dif



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HIFT MODEL OF MOVING

APPENDIX H: CAMPBELL COLLABORATION SYSTEMATIC REVIEWS (Mullen et al., 2008) Outcomes of Campbell Collaboration Systematic Reviews

Examples of interventions proven effective, but with qualifications (Qualified Yes): Intervention

Limitation

Cognitive behavioral treatment for antisocial behavior in youth in residential treatment

Only compared with usual care and not alternative treatments

Work programs for welfare recipients –

Limited generalizability and small effect size

Kinship care for the safety, permanency, and well-being of children removed from home Parent-training programs for improving maternal psychosocial health

Weak methodologies

Insufficient evidence to compare differential outcomes among theoretically different programs

rs.org/practice/adolescent_health/shift/shift.asp

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Examples of interventions that are shown to be effective, but studies have significant limitations to allow for the determination of effectiveness (Maybe Yes): Intervention

Limitation

Cognitive-behavioral interventions for children who have been sexually abused

Small effect sizes

Personal assistance for adults with both physical & intellectual impairments; for adults with physical impairments; for children & adolescents with intellectual impairments; for non-dementedolder adults (65+) with impairments (4 reviews) Exercise to improves self-esteem in children and young people

Probably has some benefits for some recipients, but some prefer other models of care; cost savings is unknown

Little long term outcome data available to support primary prevention

School feeding for improving physical and psychosocial health of disadvantaged elementary school children

Outcomes varied by income level of countries studied

Intervention

Limitation

Behavioral and cognitive behavioral training interventions for assisting foster carers in the management of difficult behavior

Small effect size

Example of intervention that might be effective, but stud limitations to allow for the determination of effectivenes

No long term outcome measures and trials are on a small scale

Group-based parent training programs for improving emotional and behavioral adjustment in 3-year old children Individual and group based parenting for improving psychosocial outcomes for teenage parents and their small children

Example of intervention that is shown to not be effective

Intervention

Limitation

Multi-systemic therapy for social, emotional, and behavioral problems in children and adolescents aged 10-17

Small number o across studies a

Small number of included studies, use of a restricted number of outcomes measures, methodological deficiencies

Example of intervention that show mixed results for effectiveness (Mixed): Intervention

Limitation

Interventions intended to reduce pregnancy-related outcomes among adolescents

Results varied by intervention type, population, relative death of evidence regarding comparative effectiveness

School-based education programs for prevention of child sexual abuse

Short-term gains reported but harms also reported and lack of evidence regarding long term outcomes

Treatment foster care for improving outcomes in children and young people

Issues of generalizability, investigator bias, costs, and lack of comparative effectiveness data

Speech and language therapy interventions for children with primary speech and language delay or disorder


Outcomes vary by area of difficulty and method of delivery

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&

Probably has some benefits for some recipients, but some prefer other models of care; cost savings is unknown

lectual with

oung

Little long term outcome data available to support primary prevention

ng eir

Small number of included studies, use of a restricted number of outcomes measures, methodological deficiencies

social en

Outcomes varied by income level of countries studied

Intervention

Limitation

Behavioral and cognitive behavioral training interventions for assisting foster carers in the management of difficult behavior

Small effect sizes

Example of intervention that might be effective, but studies have significant limitations to allow for the determination of effectiveness (Maybe No):

No long term outcome measures and trials are on a small scale

ing d

Page H-3

Example of intervention that is shown to not be effective (No):

Limitation Small effect sizes

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shown to be effective, but studies have significant nation of effectiveness (Maybe Yes):

o have

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Intervention

Limitation

Multi-systemic therapy for social, emotional, and behavioral problems in children and adolescents aged 10-17

Small number of studies, only RCTs. Results are inconsistent across studies and vary in quality and context

mixed results for effectiveness (Mixed): Limitation d

of child

ildren der

hildren

Results varied by intervention type, population, relative death of evidence regarding comparative effectiveness

Short-term gains reported but harms also reported and lack of evidence regarding long term outcomes Outcomes vary by area of difficulty and method of delivery

Issues of generalizability, investigator bias, costs, and lack of comparative effectiveness data

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Articles on CER

APPENDIX I: RESOURCES ON CER Federal Resources on CER CER Reports and Documentation • DHHS CER Website - At the home site for the Department of Health and Human Services (DHHS) there are links to direct you to the Federal Coordinating Council for CER and the draft documents that they released containing the Draft Definition, Prioritization Criteria, and Strategic Framework. www.hhs.gov/recovery/programs/cer/index.html •

Federal Coordinating Council’s Report to the President and Congress on Comparative Effectiveness Research - June 30, 2009 www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf

•

I ns t it u t e o f Me d ic in e ’s Re po rt of 1 00 N at i on al P ri o rit i e s f o r CER http://books.nap.edu/openbook.php?record_id=12648&page=R1

Recovery.gov Information on CER • AHRQ www.recovery.gov/transparency/agency/reporting/agency_reporting5program.aspx? agency_code=75&progplanid=7610 •

NIH www.recovery.gov/transparency/agency/reporting/agency_reporting5program.aspx? agency_code=75&progplanid=7719

•

DHHS - Office of the Secretary www.recovery.gov/transparency/agency/reporting/agency_reporting5program.aspx? agency_code=75&progplanid=7724

•

Health Care Reform and the Need for Comparative-E 2010 – This article discusses the effects of proposed C on the health care industry. (Article by Alvin I. Mishli PhD, MPH) http://healthcarereform.nejm.org/?p=2719&query=h

•

The Hastings Center Report: Would Better Medical E – November-December 2009 – The articles in this issu and concerns of comparative effectiveness research. (N subscription for viewing) (Articles by Susan Gilbert, R Nancy Berlinger and Anne Lederman Flamm, and Ha www.thehastingscenter.org/Publications/HCR/Defaul

•

History of CER Legislation - August 2008 – This arti have been made to push for CER legislation. Further, discussion of whether CER’s ultimate purpose is to in cost-effectiveness, or both. This debate has plagued le article highlights IOM and AHRQ’s involvement in C private and international efforts to develop CER. (Art www.allhealth.org/Publications/Quality_of_care/Com Value_for_the_Money_84.pdf

CER Operating Plans for AHRQ and NIH • AHRQ Operation Plan for CER www.aapmr.org/zdocs/hpl/ARRA_CER_funding.pdf •

NIH Spending Plan for CER http://askican.com/pdf/NIHCERSpendPlan.pdf

Examples of Federal CER Projects • AHRQ Effective Health Care Forum AHRQ has used a portion of its funding from ARRA to further develop its Effective Health Care Forum to include CER. The goal is to create a mechanism for disseminating funded CER and practice guide developed based on research outcomes. Even during the research process, a summary of the study and process is available so as to inform practitioners and researchers of current research and anticipated research outcomes. http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=all CER Grant Announcements • AHRQ Grant Announcements for CER-Related Funds www.ahrq.gov/fund/cefarra.htm •

NIH Grant Annnouncements for CER-Related Funds http://grants.nih.gov/grants/funding/challenge_award/


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ESS RESEARCH AND SOCIAL WORK FINAL REPORT

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Articles on CER

ES ON CER

home site for the Department of Health and Human Services ct you to the Federal Coordinating Council for CER and the ased containing the Draft Definition, Prioritization Criteria, w.hhs.gov/recovery/programs/cer/index.html

•

Health Care Reform and the Need for Comparative-Effectiveness Research – January 6, 2010 – This article discusses the effects of proposed CER efforts in health care reform on the health care industry. (Article by Alvin I. Mishlin, M.D., and Hassan Ghomrawi, PhD, MPH) http://healthcarereform.nejm.org/?p=2719&query=home

•

The Hastings Center Report: Would Better Medical Evidence Lead to Better Health Care? – November-December 2009 – The articles in this issue highlight the benefits, challenges, and concerns of comparative effectiveness research. (Note: some of the articles require a subscription for viewing) (Articles by Susan Gilbert, Richard Payne, Pauline W. Chen, Nancy Berlinger and Anne Lederman Flamm, and Harald Schmidt and Julia Kreis) www.thehastingscenter.org/Publications/HCR/Default.aspx?id=4104

•

History of CER Legislation - August 2008 – This article catalogs the many efforts that have been made to push for CER legislation. Further, it also addresses the continuing discussion of whether CER’s ultimate purpose is to inform treatment, to determine cost-effectiveness, or both. This debate has plagued legislative developments. Lastly, the article highlights IOM and AHRQ’s involvement in CER prior to ARRA funding as well as private and international efforts to develop CER. (Article by Alliance for Health Reform) www.allhealth.org/Publications/Quality_of_care/Comparative_Effectiveness_Better_ Value_for_the_Money_84.pdf

’s Report to the President and Congress on Comparative 30, 2009 ams/cer/cerannualrpt.pdf

r t of 1 00 N a t i on a l P r i o r i t i e s f o r C E R ok.php?record_id=12648&page=R1

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and NIH ER RRA_CER_funding.pdf

ERSpendPlan.pdf

s Forum ts funding from ARRA to further develop its Effective CER. The goal is to create a mechanism for disseminating e developed based on research outcomes. Even during the of the study and process is available so as to inform of current research and anticipated research outcomes. .gov/healthInfo.cfm?infotype=all

s for CER-Related Funds tm

for CER-Related Funds unding/challenge_award/

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ABOUT THE SOCIAL WORK POLICY INSTITUTE

The Social Work Policy Institute was established in Octo NASW Foundation. Its mission is:

• To strengthen social work’s voice in public policy delib • To inform policy-makers through the collection and d work effectiveness. • To create a forum to examine current and future issues

Social Work Policy Institute / NASW Foundation 750 First Street NE, Suite 700 • Washington, DC 200 Director: Joan Levy Zlotnik, PhD, ACSW www.SocialWorkPolicy.org • [email protected]


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ABOUT THE SOCIAL WORK POLICY INSTITUTE The Social Work Policy Institute was established in October 2009 and is a division of the NASW Foundation. Its mission is: • To strengthen social work’s voice in public policy deliberations. • To inform policy-makers through the collection and dissemination of information on social work effectiveness. • To create a forum to examine current and future issues in health care and social service delivery. Social Work Policy Institute / NASW Foundation 750 First Street NE, Suite 700 • Washington, DC 20002-4241 Director: Joan Levy Zlotnik, PhD, ACSW www.SocialWorkPolicy.org • [email protected]


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750 First Street NE, Suite 700 Washington, DC 20002-4241 www.SocialWorkPolicy.org

COMPARATIVE EFFECTIVENES AND SOCIAL WO STRENGTHENING THE C

FINAL REPORT FROM THE NOVE

SWPI INAUGURAL SYMP