Best PracticesTheory and Research

Chapter 18

Current and Future Social Work Practice

Best PracticeThe Role of Evidence

• Practitioners require skill in accessing systematic reviews and weighing the empirical evidence according to the rigor of the research design.

• Choosing an effective and appropriate intervention for a specific client or situation, requires a review of the evidence that supports one theory-based intervention over another.

• Research is the core of evidence-based practice.

Best PracticesThe Limitations of Empiricism

• Though necessary, empiricism is not sufficient to build knowledge.

• No array of statistical techniques can produce cumulative knowledge.

• Empirical data become knowledge when referred to theory for understanding.

Best PracticesThe Role of Theory

• Theory, as knowledge, is a body of interrelated proposition, statements, and concepts that have been subjected to empirical verification.

• As part of the research process, theories become self-corrective.

• The holistic property of theory (cause-effect) moves the practitioner in an orderly and conceptually consistent manner from declarative knowledge (what is known-procedural knowing) to enactment of a therapeutic process (doing-tacit knowing).

Ways of Knowing

There are three basic ways of knowing:

1. Faith- knowing based on theological or

religious beliefs.

2. Reason-knowing based on rational discourse;

logic, argument, philosophical proof.

3. Science- knowing based on empirical evidence;

assumptions of linearity, probability, & ability

to measure an objective reality

Science As a Way of Knowing

• Scientific knowing differs from knowing based on animal instincts and belief in ideology or magic.

• The scientific paradigm is based on trust in reason (rules of discourse), logic, rigorous research methodology, a belief in progress (new knowledge builds on previous knowledge) and academic freedom (pursuit of truth).

• Science adheres to standards against which comparative evaluation occurs.

Science As A Way of KnowingContinued

• Science holds that a large part of reality is measurable and therefore capable of being known.

• Science produces knowledge stated in such a way as: (a) to make it comparative, (b) to prove or disprove it, (c) to integrate it, (d) to generate and test new knowledge.

• Knowledge is a set of ideas whose acceptability is determined by the criteria of science.

Social Work and Science

• Social work has long subscribed to science as a way of knowing.

• Those who subscribe to science as a way of knowing, maintain that explanation/prediction (cause-effect) makes prevention and intervention possible.

• According to Polansky (1986) there is nothing as practical as a good theory to guide action.

Theory AsSchools of Thought

• Theory and research work together to develop schools of thought (multiple theories).

• Over time, social work has recognized that no single theory, whether narrow (psychodynamic) or grand (general systems theory) can guide practice.

• Generalist practice represents a paradigm shift to open assessment and consideration of multiple theories.

• The profession has gone from a paucity of theory to a plurality of theory.

Multiple TheoriesDecision Tree

• A plurality of theories creates theory choice.• The decision tree helps practitioners navigate

different theories and the evidence for or against them when selecting the best treatment option from among available options for a specific case or situation at hand.

• See case example on “Night Crying” in this chapter. • When practice is theory and evidence-based, the

practitioner asks what works, with whom under what circumstances and at what cost.

Scientific Rigor

• Determining the relevance of research to evidence is dependent on the methodology used to conduct the research (Roberts & Yeager, 2004).

• Levels of evidence help practitioners select treatment options based on the methodological quality of the studies used to generate the empirical evidence.

• The are four levels of evidence ranked by the rigor of the methodology used.

Levels of EvidenceDesigns

1. Experimental designs: random selection (sampling) and random assignment to treatment and control group; replicated;

2. Non-replicated experimental designs and systematic reviews and meta analysis of multiple, well designed controlled studies.

3. Quasi-experimental designs – comparison groups in natural settings

4. Single subject and single group pre-post test

Comparison of Research Methodology:

• Understanding scientific rigor requires familiarity with the differences between quantitative and qualitative research.See exhibit 18.1

• The two methodologies differ in design, sampling, instruments, data gathering techniques, type of data collected, inference, perception of reality, variables (tested or generated) and how results are reported.

Quantitative MethodologyCharacteristics

• Quantitative research tests well-specified, hypotheses concerning pre-determined variables; deductive.

• Sampling is random and therefore representative; findings may be generalized.

• Information is gathered in numeric form, using valid and reliable instruments;

• Findings are produced using statistical procedures and other means of quantification; usually published as articles in professional journals..

Qualitative MethodologyCharacteristics

• There are over 50 approaches to qualitative research from numerous disciplines; inductive.

• Designs rely on participant observation, case studies and the focused interview.

• Sampling is non-random; subjects are recruited; studies cannot be replicated; findings cannot be generalized.

• The researcher - the instrument of data collection. • Data is non-numerical –field notes, audio tapes.

video tapes, photographs, documents/reports.

Qualitative MethodologyAssets

According to Padgett there are several good reasons For engaging in qualitative research:1. It is used in program evaluation (formative

research) and in activist research.2. It is used when little is known about the topic

being explored or the topic is too sensitive (taboo) and/or too emotional.

3. It is used when a researcher reaches an impasse in data collection or interpretation using quantitative methods.

Clinical Research Evidence-Based Practice

• Evidence-based clinical research tilts toward quantitative research and rigorous methodology.

• The focus in clinical social work is on outcome efficacy; group analysis of clinical cases is considered more rigorous than single subject or single group designs. See chapter 6.

• What the clinician does is controlled through empirically supported treatment protocols.

Evidence-based PracticePolicy, Advocacy, Management

• Policy, advocacy, management, and community practice depends on program evaluation (formative and summative research) to determine program process and outcome effectiveness.

• In Macro practice, program evaluation has tilted toward process (formative research) or qualitative research methodology e.g. is the program being implemented in the manner intended?

• Currently the emphasis is on summative/outcome evaluation, i.e., results-oriented. Does it work?

Barriers to Evidence-basedClinical Practice

• Choice, necessitates conscious decision making based on criteria.

• Statistical significance may not equate with clinical significance

• It is difficult to access systematic reviews of meta analyses of multiple, well-designed controlled studies; meta analysis cannot exceed the limits of what is reported by primary researchers.

• It is difficult to implement empirically supported treatments in everyday practice.

Barriers to Evidence-BasedMacro Practice

• Rigor in macro practice, has focused on documenting needs and resources

• The standard of scientific rigor ( multiple, replicated, experimental, controlled, studies) is less feasible when applied to program evaluation

• The desired end-goals of most social programs are value-determined in contrast to the more scientifically-determined (cause-effect) outcomes of clinical practice.

Barriers to Evidence-BasedMacro Practice: Continued

Factors, other than science, influence decision-making in macro practice:1. Science documents needs/resources2. Moral philosophy determines desired end-goals

of social policies and programs3. Politics influences public or political support for

or against a program and its level of funding. 4. Economics Availability of funds and competing

interests for the same monies impact decisions.

The Argument for Evidence-Based Macro Practice

• Policy makers and program managers do improve their practice when they use evidence to guide their decisions.

• Evidence is an antidote to unfounded opinion based on policies and programs that rely on ideology, prejudice, or speculative conjecture.

• Evidence mitigates decisions based on personal gain or organizational politics; evidence promotes the common good.

• Grant Trend (RFPs): Evidence key in proposal

The Argument for Evidence-Based Clinical Practice

• Treatment choice is now a condition of competent practice.

• Client’s benefit when practitioners are aware of the availability of theoretically-sound and empirically-verified diverse treatments.

• Client’s should be involved in making an informed treatment decision based on a review of available options; best practices.

ConclusionsEndings: Theory

• Social work has accepted a plurality of theories

• A uni-theory, mono-theory or mega theory have not come to pass.

• Social work has rejected practice devoid of theory; whether based on relationship only or empiricism only.

ConclusionsEndings: Methods

• Compared to ten years ago, the role of generalist practice has become more clear.

• The profession has avoided adopting generalist practice as a uni-method, mono-method, or mega-method.

• Generalist practice is a framework that is both multi-theory and multi-method.

ConclusionsEndings: Polarizing Debates

• Polarizing debates (either/or positions) over the importance of one theory or one method have been replaced by discussions of the appropriateness or lack of appropriateness of a theory or method for the situation at hand.

• Divisiveness over theory focus ( pathology/deficit vs. resilience/strength) has also diminished.

• Method and theory diversity are more aligned with the multi-cultural and complex world within which social workers practice.

ConclusionsEndings: Polarizing Debates

• Previous attempts to deny or exclude have been replaced by the recognition that all theories and all methods have equal value in themselves and differential value in their proper or improper application.

• The evidence-based movement, despite differences over quantitative or qualitative research methodologies, has strengthened the link between theory, research, and practice.

ConclusionsDecision Tree

• The decision tree provides practitioners with some assurance of competency commensurate with their decision-making responsibilities.

• As a tool, the decision tree adds precision and proof of process when applying theory and evidence to practice.

ConclusionCompetency

• By alternating chapters in clinical and macro practice, the text provides the readers with skill sets consistent with a range of system sizes: individuals, dyads, families, groups, organizations, and communities.

• The text shows the reader how to apply more than one theory and more than one method to complex data in the same case through case-specific model building and the use of the decision tree.