Evidence-based Practice and Practice-based Evidence

We all love evidence, and everyone’s talking about data-driven decision-making, but what do we really mean when we say that we want to engage in evidence-based practice?  Whose evidence do we use?

I was at the American Public Health Association conference this week and I attended a lot of sessions that touched on evaluation.  But as always, the evidence that we can collect about the impacts of community-level collaborative initiatives within the timescale of a given grant (one year? perhaps three to five years?) are still fairly limited. We can identify new partnerships, identify changes in organizational practice, find out if participants found programming useful, and perhaps look at short-term impacts, but measuring long-term impacts like changes in health outcomes at a population level are still beyond the scope of most evaluation timelines and budgets.

So what do we do?  Do we choose an evidence-based strategy off the shelf because it worked somewhere else where they had the funding and staffing to carry out a rigorous evaluation?  (I must admit, I have a tiny grudge against evidence-based programs after being funded to use programs that had been tested with suburban white youth in an urban Latino youth program.) Do we develop our own initiatives guided by our guts and our own experience in the community? Or do we walk a line between the two, guided by the evidence collected through long-term rigorous evaluation and informed by the knowledge and expertise about our own communities that we’ve developed through years of intimate involvement and careful observation (as well as multiple trials and even more errors)?

At the end of a presentation about readiness for the adoption of evidence-based practices within a school system, I approached the presenter to ask how she thinks about the evidence-base and how she balances wanting schools to use the evidence base with the need to use something that’s appropriate for them.  She said something that finally let me relax about the idea of “evidence-based”.  She said, “There’s evidence-based practice, but there’s also practice-based evidence.”

I love it.  With that in mind I pledge to document practice-based evidence to expand and refine the cache of evidence-based practice.

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