Evidence-Based Assessment in Case Management to Improve Abnormal Cancer Screen Follow-up‪.‬

Expectations for evidence-based professional practice influence health and mental health care delivery for all professions (Hoagwood, Burns, Kiser, Ringelsen, & Schoenwald, 2001; Lohr, Eleazer, & Mauskopf, 1998), although there are important and legitimate debates about the scope, limits, and appropriate applications of evidence-based approaches in social work (Gambrill, 1999; Howard & Jenson, 1999; Richey & Roffman, 1999). At times complicating the professional dialogue and efforts to respond to the evidence-based practice mandate is a lack of clarity about the meaning of the term. In social work the term "evidence-based practice" is often used interchangeably with "evidence-based treatment." Understood in this way, the concept can elicit discomfort for practitioners whose clients and circumstances are diverse and for whom "cookie-cutter" treatments are disdained. The term "treatment" limits the perception of applicability to a more restricted arena of intervention. A more useful and comprehensive definition, generally understood in health care, views evidence-based practice as program services and clinical decision making and service processes grounded on the best available research evidence and standardized through empirically supported practice and program guidelines or protocols, as well as empirically derived quality, indicators for these services and clinical processes (Lohr et al., 1998). This definition suggests imperatives for social work practice that go beyond requiring empirically validated treatments for specified conditions to include other key practice and program processes. From this point of view, a comprehensive approach to building evidence-based practice includes four sets of activities: (1) use of evidence-based strategies to identify target populations for social work services in a given setting; (2) demonstrating the accuracy and validity of case-level assessment processes leading to intervention decisions; (3) use of interventions or treatment of proven effectiveness and practice guidelines derived from systematic inquiry; and (4) examination of practice processes and outcomes for evidence of quality and goal achievement. The first set frequently includes needs assessment; the third set includes what is typically meant by empirical or evidence-based treatment; the fourth represents the concern of the human services movement for outcomes measurement and other data-driven quality monitoring and improvement innovations. The second set of activities--demonstrating accuracy and validity of assessment instruments and processes--is the focus of this article. We describe an assessment protocol developed for a prevention intervention in cancer care, discuss its relevance to concerns of quality, and present three key components composing its evidence base.