Evidence-based practice and management-by-knowledge of disability care: rigid constraint or fluid support?

Abstract

Background:Although increasingly accepted in some corners of social work, critics have claimed that evidence-based practice (EBP) methodologies run contrary to local care practices and result in an EBP straitjacket and epistemic injustice. These are serious concerns, especially in relation to already marginalised clients. Aims and objectives:Against the backdrop of criticism against EBP, this study explores the ramifications of the Swedish state-governed knowledge infrastructure, ‘management-by-knowledge’, for social care practices at two care units for persons with intellectual disabilities. Methods:Data generated from ethnographic observations and interviews were analysed by applying a conceptual framework of epistemic injustice; also analysed were national, regional and local knowledge products within management-by-knowledge related to two daily activity (DA) units at a social care provider in Sweden. Findings:In this particular case of disability care, no obvious risks of epistemic injustice were discovered in key knowledge practices of management-by-knowledge. Central methodologies of national agencies did include perspectives from social workers and clients, as did regional infrastructures. Locally, there were structures in place that focused on creating a dynamic interplay between knowledge coming from various forms of evidence, including social workers’ and clients’ own knowledge and experience. Discussion and conclusions:Far from being a straitjacket, in the case studied management-by-knowledge may be understood as offering fluid support. Efforts which aim at improving care for people with disabilities might benefit from organisational support structures that enable dynamic interactions between external knowledge and local practices.