The Role of ‘Best Practices’

Over the past decade, the human services sector has become more and more focused on identifying and utilizing ‘best’ or evidence-based practices to achieve better outcomes or improve the cost-benefit ratio.  At face value, this seems like common sense.  That’s part of the attraction of it.  But scratch below the surface a little and you soon realize that it isn’t as straightforward as it seems.

In order to use a ‘best’ or evidence-based practice, you first have to figure out what that is.  Although there are organizations that research and publish information on practices that they believe meet the criteria of ‘evidence-based’, practices haven’t been identified in all areas.  For example, the Campbell Collaboration (one of the organizations that researches evidence-based practices) was not able to affirm a best practice for developing independent living skills in youth.  In other areas, there are a number of practices that could be considered ‘best’ depending on who you talk to or what you read.  To complicate the matter further, not all practices that show promise get subjected to rigorous research that could validate them even though they may be just as effective as those that have been researched.  Research is driven in large part by the interests of those involved, which is why a significant portion of medical research is funded by drug companies and focuses on how well their drugs work.  If you are able to identify a practice that you think fits the need, there’s the practical reality of trying to implement it in a setting that may be very different than the one in which it was researched.  A drug designed to treat a specific condition under specific circumstances won’t work for other conditions or in other circumstances.  Why would we expect that human services practice would be different? All of this should lead us to question whether the starting place should be a search for a ‘best’ or evidence-based practice as a means to improve outcomes.

That leads me to back to a subject I discussed on another blog; Complexity Theory.  As Dave Snowden from Cognitive Edge states in his Harvard Business Review article, “Best practice is, by definition, past practice”.  As such, it works ‘best’ on relatively straightforward, simple problems.  The challenge is that most of what we face in human services is highly complex – complex families, complex personal problems and histories, and complex community circumstances.  These are the kinds of problems that require lots of heads to come together and allow for the appropriate solutions to emerge and be tested.  The solutions that work get amplified.  The ones that don’t are set aside.  That means having a certain tolerance for risk, something that was pointed in an article by Stevens and Cox (2008) that focused on how Complexity Theory could inform Child Welfare and Residential Child Care practice.  But the payoff is having highly customized solutions that are built from the ground up and have much greater buy-in from those involved.

To be clear, I’m not suggesting that we should do away with researching and using ‘best’ or evidence-based practices.  The point is that we should understand them as tools in our toolkit that should be used when and where it makes sense.  As Dave Snowden points out, part of addressing complicated and complex problems can involve breaking them down into constituent parts.  These parts of a problem may be perfect candidates for applying a ‘best practice’, but only after we’ve endeavored to understand and grapple with the bigger picture and feel confident that the practice we have in mind is a good fit.  Using a best practice should never be cooker-cutter because our clients and their circumstances aren’t cookie-cutter.  That means developing solid assessment and critical analysis skills in our front line staff; supporting them to be okay with ambiguity and the unknown; trusting that solutions may already exist if we take the time to bring people together and allow them to emerge; and being willing to take some measured risks to get to real and lasting change.  In this context, I believe that ‘best’ or evidence-based practices play a supporting rather than central role.

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