What the clinician said was that while EBP is always looked at and is more and more becoming a part of the mandate of many organizations, the evidence of its efficacy is really lacking in real world terms. The problem is that this evidence is coming out of controlled settings that are funded a lot better than most organizations, and don't take into consideration all of the other variables. So what we're trying to do is fit this ideal into a setting where it won't work. I immediately thought of Dialectical Behavior Therapy when he brought this up, as I'd never heard of pure DBT being used with clients, as it was too time consuming for clinicians, and union rules didn't allow some practices.
What the clinician I was talking with said was something at least they were working towards was PBE. What they mean by this is looking at what works in the actual workplace! Rather than having your practice dictated by academics, policy makers and supervisors, front line workers should be making a major contribution to the research that leads to policy. This would involve feedback and research with clinicians, supervisors and, most importantly, clients of the service!
While I am in favor of this approach, I am the first to admit that I see many barriers. Dynamics are different in all organizations. How do you factor that in? Clinicians are busy enough and now we want to add research onto their plates? It's also a matter of empowerment in getting power to go ahead with this from the ivory tower academics and policy makers. How does that work?
So yeah, there are more questions than answers in this post. I simply wanted to write about it to get it down somewhere so I can think through it further. If I've gotten anything wrong with either of these concepts, please let me know.