Crown Family School of Social Work, Policy, and Practice, University of Chicago, USA; Department of Anthropology, University of Chicago, USA.
Crown Family School of Social Work, Policy, and Practice, University of Chicago, USA.
Soc Sci Med. 2022 Oct;310:115130. doi: 10.1016/j.socscimed.2022.115130. Epub 2022 Jun 12.
Evidence-based practice (EBP) has become a dominant paradigm in North American behavioral health and social service provision. Once a model of expert decision-making that asked practitioners to search through the "best available evidence" to inform their clinical decisions and select interventions, EBP is now better understood as a complex system of legitimation that designates particular methods and-by extension-their practitioners as "evidence-based." While critics worry that EBP forecloses professional discretion by imposing particular epistemic virtues of intervention science, this ethnographic case demonstrates that 1) EBP legitimates professional actors, methods, and organizations at least as much as it hampers them and 2) a wide range of "extra-scientific" actors are involved in producing and legitimating the evidence of evidence-based practice, including policy makers, public and private insurers, state agencies, charitable foundations, registries and clearinghouses, health and human service organizations, and helping professionals themselves. Once we recognize the range of actors and institutions involved in basing and legitimating evidence, and the rhetorical work of tethering scientific terms to resonant political and economic discourses, we learn that there is nothing self-evident about evidence-based practice. Drawing on the social scientific study of expertise and focusing empirically on how one behavioral intervention earns and retains its status as an EBP, this study traces the trans-institutional life of evidence and the continual need to legitimate it as a base for behavioral health practice.
循证实践（EBP）已成为北美行为健康和社会服务提供的主导模式。EBP 曾经是专家决策的一种模式，要求从业者通过搜索“最佳可用证据”来为其临床决策提供信息，并选择干预措施，而现在它被更好地理解为一种合法化的复杂系统，该系统指定了特定的方法，并通过扩展，将其从业者指定为“循证”。虽然批评者担心 EBP 通过强加干预科学的特定认识论美德来限制专业判断，但这种民族志案例表明：1）EBP 至少像阻碍他们一样使专业行为者、方法和组织合法化；2）广泛的“非科学”行为者参与产生和合法化循证实践的证据，包括政策制定者、公共和私人保险公司、州机构、慈善基金会、登记处和信息交换所、健康和人类服务组织以及帮助专业人员本身。一旦我们认识到参与基础和合法化证据的行为者和机构的范围，以及将科学术语与共鸣的政治和经济话语联系起来的修辞工作，我们就会了解到循证实践并没有什么不言而喻的。本研究借鉴了专家知识的社会科学研究，并着重于实证研究一种行为干预措施如何获得并保持其作为 EBP 的地位，从而追溯了证据的跨机构生命以及将其合法化作为行为健康实践基础的持续需求。
