What works in Social Work Essay
Discuss and critically analyse the current state of evidence based practice in social work.
There is often a misunderstanding between social work practitioners and social work academics (Rubin and Parrish 2007) about just what Evidence based practice (EBP) actually is, as various explanations of EBP have often omitted some of its core components. However contemporary definitions incorporate reference to professional expertise, ethical values and client’s needs (McNeece an Thyer, 2004). EBP demonstrates a process which involves improving professional judgement through reliable and thoughtful integration of empirical evidence that has been thoroughly researched to evaluate the effectiveness of interventions in improving the practice context for service delivery and professional accountability in relation to service users’ outcomes (Gray et al 2009; Corby, 2006). EBP demands a constant approach to assessment and the reviewing of decision-making, as current information becomes available (Petr 2008; Golightley, 2008). This according to Thompson (2005) implements a framework for analysing various situations and subsequently generates several possible options for practice. Mathews & Crawford (2011) proposed that for practitioners to inform their professional judgement with credibility, they must think critically and reflect on research evidence, as a lack of this could result in implications for policy makers, professionals, communities and service users. EBP therefore combines social workers’ reflexivity of how their values and experiences within the context of practice relates to service users’ viewpoints to provide guidance that informs their practice (Munro, 2002).
Gray, et al (2009) states that EBP is not limited to quantitative research, although the hierarchy of evidence is essential to the standard of knowledge within practice context. The importance of qualitative methods has also been recognised, as it is crucial in providing a substantial understanding of the sociocultural dynamics in the context of practice, which is significant to implement an effective intervention (Upshur, et al 2001).
When implementing EBP it is important to recognise the complexities of realities, as various factors have been noted to influence the implementation of EBP. Mullen and Streiner (2004) stated that for EBP to be effective there needs to be an increased inclusion of socially excluded groups to provide equality within practice and policy initiatives. This requires the professional to have a realistic understanding of the barriers that service users’ face socially, which would lead to a genuine collaboration to balance the power dynamic that is present within social work. It has been stated that there could be a barrier to the implementation of EBP due to a lack of ethical consideration of knowledge (Munro, 2002). It is proposed that the theoretical expectations and principles underpinning practice are imperative for successful implementation (Gray and Schubert 2012).
There are various concrete and psychological barriers that have been found to hinder dissemination and implementation of EBPs. Knowledge barriers in EBP are based on individuals limited knowledge and awareness of available EBPs and the issue with analysing and understanding research upon identification (Anderson, et al, 1999; Mullen & Bacon, 2004). This Includes practitioners’ difficulties with identifying appropriate ways to implement these finding with their clients. Traditional outlets for research findings, such as scholarly journals are rarely accessed by practitioners due to the information being difficult to translate into practice (Kirk & Reid, 2002). Even when evidence is identified in journals, the evidence could be outdated by the publishing date (Thyer, 2004). There is also a misunderstanding of what is established as EBP, which can relate to practitioners’ lack of knowledge of the area. For example, it has been argued that social work is based on the opinion of the practitioner and what they deem as effective within as situation (Gibbs & Gambrill, 2002). Practitioners still have the choice to discredit the value of research even if they are able to identify and understand it. In relation to this, practitioners may take the stance that available evidence or research is not often useful to their practice. Some have a viewpoint that the EBPs are too broad and do not relate to the unique contextual or cultural needs of clients (Bartels, et al, 2002; Gibbs & Gambrill, 2002; Mullen & Bacon, 2004). It has been noted by others that the methodology of treatments may be limited regarding its application to practice. For example, the majority of EBPs are based on short-term treatment, which is not a general format that is appropriate to all clients across settings that are diverse (Mullen & Bacon, 2004).
Lack of resources is also a significant barrier, as even practitioners and agencies that understand and appreciate research evidence in their work may find themselves incapable (Barratt, 2003). Without the essential resources and willingness from staff to research the evidence, EBPs cannot often be applied within practice. Interventions may be formed based on limitations rather than knowledge. A prominent issue is a lack of technology within practice settings as this could cause difficulties in being able to simply access information in a time where the internet is one of the main sources. Therefore, the issue is that access to these resources is limited in various agencies. This is partly due to the lack of inconsistent or limited funding provided to the social work agencies (Barratt, 2003).
Webb (2001) claims that EBP disregards power and politics. It could also be further suggested that it not only ignores power and politics, but it obscures them as well. Regarding formulations of EBP it asserts objectivity, despite claims that human biases prevent this claim from being valid (Foucault, 1995). Recent critiques have questioned the understanding of objectivity, and state that values and biases should be acknowledged, debated and considered (Nagel, 1989; Weeks, 1998). As social workers, we should be concerned with the influence of unbalanced power dynamics on research because it threatens vulnerable populations. As social workers, we are also called to combat this because it compromises research. As in various cases, such biases can both stigmatize and lead to faulty assessments, which may in turn lead to inappropriate interventions. At its core, ignoring the power dynamics in research can lead to, or perpetuate, social injustices.
To integrate EBP more fully into social work, several scholars have challenged social work (Gambrill 2006; Mullen et al. 2008). This challenge has led to some concrete changes in social work education, such as a greater emphasis on practice research. It has been demonstrated within several studies that social work academics continue not to include EBP in their teaching. It was demonstrated within more recent research that social work offered the least training in research-based interventions and fails to integrate the process of EBP into the curriculum in education in comparison to psychology and psychiatry training programs (Weissman et al. 2006; Grady et al. 2010). This leads to a lack of knowledge and experience in EBP. Hence many scholars have stated the importance of being direct in demonstrating EBP as an interactive process requiring substantial critical thinking, as then professionals may be more accepting in using EBP in their practice (Barth et al. 2011; Wike et al. 2014).
Gilgun (2005) points out that neither client preferences nor clinician expertise are well deﬁned or emphasised in the literature on EBP. Therefore, as social workers core values are centred around the client it is important for them as a profession to demonstrate the importance collaborating with clients and supporting their involvement in decision making (National Association of Social Workers, 2008). Gilgun (2005) also notes that the use of fixed lists of approved treatments within interventions directly contradicts client values and preferences as well as clinical expertise as meaningful elements of EBP. This explains the challenges practitioners experience when trying to implement EBP, as it undermines both client choice and clinical expertise (Goldenberg, 2009).
In accordance with social works professional values, practitioners adopt a holistic approach to engaging with clients by integrating all of the aspects of EBP. However, the issue is that there is a lack of evidence as to whether the use of EBP results in better client outcomes when used consistently (Drisko and Grady 2012). EBP does, however, have the potential to demonstrate the breadth and depth of social workers’ capacities, including their empirical knowledge in relation to incorporating contextual factors into their work with clients. Therefore, as a profession, social workers are presented with the ability to integrate multiple sources of information and knowledge into their work. EBP, correctly understood and fully applied, is a source through which the social work profession can highlight their uniqueness and strengths.
A significant critique that has been noted by social workers about EBP is the limited kinds of research that are currently available or valued in EBP. While EBP emphasizes using the most valuable evidence available, what is often summarized is solely experimental research. Which is only beneficial if it is adequately conceptualized and implemented fully and properly to present cause-effect relationships. Hence, it is important to note that there are various types of research that can also provide useful knowledge for practice (Drisko and Grady 2012; Gilgun 2005). Non-experimental research is also crucial to recognizing threats to internal and external validity fully through demonstrating that experiments are well conceptualized. Some social work scholars have advocated for other forms of research to be re-valued, such as quasi-experimental, qualitative, and case studies (Rubin 2014). These allow different forms of knowledge to be included in EBP to present a greater form of inclusion within research and practice. In turn, social work education must address a wide range of practice research methods and issues. Practitioners argue that the available research presents as a limitation in scope and practice relevance. That is, studies are often carried out in artificial settings involving a small, very narrowly deﬁned group of participants (Bellamy et al. 2008). Hence, as Social workers work with multiple, complex clients and in varied settings. It is recommended that social work research should include studies done in ‘real-world’ settings with ‘real-world’ clients as each individual case is different (Nelson et al. 2006).
In relation to EBP in education, it has been acknowledged that EBP is not explicitly demonstrated, therefore by incorporating EBP in every aspect of the curriculum at this stage, students will gain more conﬁdence in their ability to use it later in practice. Making EBP an essential and useful component of their practice. However, the classroom cannot be the only place where EBP is taught and discussed. Practice supervisors and ﬁeld liaisons must reinforce the use of EBP in the ﬁeld. Various experiences, social work skills and knowledge are always strengthened when students are able to integrate their classroom and ﬁeld experiences. Therefore, providing training to practitioners is substantial to their work with clients.
There is a growing literature on the potentially beneficial (and regressive) impact of service user involvement on research processes and outcomes. It has been revealed through systematic reviews on the topic that much of the evidence consists of descriptive, often reflective, accounts of involvement (Oliver et al., 2004). There have been positive reports on service user involvement in identifying research, which suggests their involvement makes the process more direct as it increases the range of research topics and allows issues of importance to the service users to be highlighted (Rhodes et al., 2002; Staniszewska et al., 2007). McCormick et al. (2004) observed people with breast cancer in their study and identified that service user involvement ‘pushed the science forward more quickly’. Service user involvement at the research design stage has been stated to lead to a more ethically acceptable research design, with involvement said to enhance recruitment to the study (Koops and Lindley, 2002).
A significant result has been reported to come from studies that have used service users as co-researchers, as responses from interviews seem to be more open, which influences the quality of data positively (Williamson et al., 2010). There are a few benefits of service user involvement in analysing data that have been suggested through studies, such as modifying researcher’s misinterpretations of service users thoughts (Savage et al., 2006) and questioning the interpretations of researchers to make adjustment to how findings have been reported. Service user involvement was said to increase the power and reliability of findings, which was very beneficial in the dissemination process, which made dissemination more accessible leading to wider and more accessible dissemination (Smith et al., 2008). Some negative effects of service user involvement on research processes and outcomes have been identiﬁed. It was reported within one study that the inexperience of a service user peer interviewer could be remedied by support and training when data collection was negatively impacted (Bryant and Beckett, 2006).
Involving service users in research helps to empower and strengthen their voice (Beresford,2002). Other positive effects described by service users include increased knowledge, skills and conﬁdence, and support from others in user groups (Cotterell et al., 2010). Some negative consequences, such as feeling overburdened from the information they receive (Clark et al., 2004).
Based upon the current trends in social work as a profession, the future of EBP would be shaped by several themes. Including the evolution and clarification of EBP to make the decision-making process more explicit for clients and professionals. As this would allow for social workers to attend to the needs, values and preferences of specific individuals. An increase in the number of practice-relevant research studies conducted by social workers, which would allow social workers who consume research-based knowledge to rely predominantly on findings from studies conducted by other professionals increased ease of access to the research literature, through expanding the number of online databases with full-text accessibility and reducing the cost to access these sources. and a decrease in the gap between research-based knowledge and actual practice is significant as this will provide them with the resources to practice evaluation processes in efforts to improve the quality of service to clients.
Current notions of EBP demonstrate that the concept is flexible and within social work practice, proponents are not static and are open to be reassessed and changed. EBP has been identified to have various challenges with implementing it into practice settings, including factors such as lack of access, funding and limited knowledge and support from the organisation, however through research social work programmes can reduce these challenges by informing the upcoming social workers to be more open and confident in their ability to use EBP. However, it’s important to note that EBP has the capacity to present social work’s strengths, as it is a very holistic profession that centres around implementing various sources to provide a client-centered approach to practice. Therefore, through future experiences and further research, this enhanced knowledge would assist professionals in learning how consideration of such issues can assist in protecting and promoting the interests of programs, clients, practitioners, and policy-makers to reach effective outcomes, as this could be the key in reaching practicing social workers.
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