Evidence-based Social Work Practice Research Articles

The mismatch between the map and the terrain—evidence-based social work in Sweden

In this article we will give an account of the introduction of evidence-based practice (EBP) in Swedish social work. The Swedish development may serve as an example of what happens when the process is driven by bureaucracy with a strong public funding/back-up rather than by the academy. This is not to say that the Swedish case is unique, but rather that problems and controversies that are well established on the international arena are in Sweden framed in a very particular context. The most far reaching efforts to implement EBP in Swedish social work have been carried out by central bureaucracy. The introduction of EBP may be depicted as a top-down guideline project, with randomized controlled trials as the gold standard. Shortage of evidence paired with political pressure to implement EBP has to a certain extent also brought about dissolution of the basic concept. The article concludes with an elaborated assessment of how current conceptions of EBP relates to professional and contextual conditions of Swedish social work practice. We also address the issue of how to establish what adequate and valid evidence is by suggesting an approach that deviates from predominant evidence hierarchies and polarized extremes.

Outcome Studies of Social, Behavioral, and Educational Interventions

This collection of articles elaborates on various aspects of outcome studies. Outcome studies feed and nurture the field of social work and other human services professions with evidence on what works. Outcome studies are designed to measure and understand the effectiveness of social, behavioral, and educational interventions. The ultimate purpose of social work action is change; that is, intended betterment of living conditions of a client, a family, or a community. Intended outcomes are often carefully considered and targeted when designing an intervention to cause betterment. However, social work interventions take place in real-life situations in which many other factors than the intervention itself are present and interfere to different degrees under different circumstances. In social work and other human services, unintended outcomes are very common and frequently complicate the processes of designing outcome studies and measuring outcomes. Thus, the main challenge of any outcome study is to determine what would have happened in the absence of a professional intervention in order to estimate the outcomes of the intervention program. As noted by Fraser and colleagues in this collection, intervention studies and outcome studies are akin but still different. Outcome studies belong to the general sphere of program evaluation. Intervention research includes phases of designing and developing an intervention program to be explicitly tested within the framework of the intervention research. Conceptualization of data-driven program theory, efficacy testing under strictly controlled conditions, and effectiveness testing in real-life situations, and on a larger scale compose the main steps of intervention research. Outcome studies and intervention research form the backbone of evidence-based practices in social, behavioral, and educational professions. In other words, outcome studies are designed to substantially contribute to the evidence base of social work and other human services. The collection of the articles offered in this special issue is the proceedings of the Stockholm Conference on Outcome Studies of Social, Behavioral, and Educational Interventions sponsored by the National Board of Health and Welfare, the Swedish Council for Working Life and Social Research, the Swedish National Board for Institutional Care, and the Swedish National Institute for Public Health in collaboration with the Hamovitch Center for Science in the Human Services at the School of Social Work, University of Southern California, held on February 7 to 8, 2011. The collection of articles begins with an introductory presentation by Mark W. Fraser and his colleagues and can be read parallel to a handy book, Intervention Research: Developing Social Programs (Fraser, Richman, Galinsky, & Day, 2009). This article describes the core features of outcome research and discusses challenges to designing and conducting robust and compelling outcome studies. As much as outcome studies are essential to evidence-based social work practice, it is equally difficult to conduct successful outcome studies—a problem often revealed during study quality appraisal processes performed by systematic review teams with the Campbell and Cochrane collaborations. Some of the issues raised by Fraser and colleagues are also addressed by Kelly and Moore, who examine the process of building an evidence base for better and more effective public health and mental health services from a British perspective. Kelly, the director of the Centre for Public Health Excellence, located in London, England, offers a special insight into national perspectives on policies of making public health interventions effective and cost-effective. Preoccupation with scientific and technical aspects of outcomes studies may at times blind researchers, decision makers, and professionals when assessing the meaning and ethics of outcome studies. In her contribution, Eileen Gambrill critically assesses ethical aspects of outcome studies, arguing that no research area is more political than the evaluation of outcome studies, and fundamentally challenges outcome researchers to serve social work clients on sound ethical grounds.

The Meaningful Involvement of Service Users and Carers in Advanced-Level Post-Qualifying Social Work Education: A Qualitative Study

Martin Webber, BA (Hons), MSc, DipSW, Ph.D., is a Lecturer in Social Work, a registered social worker and programme leader of the MSc in Mental Health Social Work with Children & Adults at the Institute of Psychiatry, King’s College London. His research interests are in social inclusion, social capital and mental health social work, with a particular interest in the development and evaluation of interventions that improve social, as well as health, outcomes. He is co-editor of Reflective Practice in Mental Health: Advanced Psychosocial Practice with Children, Adolescents and Adults (Jessica Kingsley, 2010, with Jack Nathan) and author of Evidence-Based Policy and Practice in Mental Health Social Work (2nd edn, Learning Matters, 2011), both aimed at supporting the professional development of advanced social work practitioners. Karen Robinson worked for nearly a decade in adult education. She had obsessive compulsive disorder (OCD) for over thirty years, but delayed twenty-four years before seeking help from the mental health service. She subsequently trained, and has worked, as a service user researcher. She has also worked to support the involvement of service users and carers in a social work programme. Drawing on her personal experience of OCD and cognitive behavioural therapy, she contributes to the training of mental health professionals. She is currently working on a three-year research project: ‘Seeking help and receiving appropriate treatment for obsessive compulsive disorder’.

The Complexity of Evidence-Based Practice: A Case Study

In this article, the author addresses areas of complexity within evidence-based social work practice that she has encountered in her work with clients. The author offers an in-depth case study from her practice that involves the assessment and treatment of a client with a complicated diagnostic presentation. Clinical choices are discussed using a biopsychosocial framework that highlights the importance of attending to the client's specific needs as the author select interventions based on the best available research.

Bayesian Analysis for Evidence-based Practice in Social Work

As evidence-based practice (EBP) continues gaining prominence in the professional literature, at least two overlapping challenges make it difficult for mainstream social workers to accept EBP as the primary mode for practice. Social workers need a robust pool of intervention research on which to base practice decisions. The research must remain current; be well formulated, for instance, conforming to the Consolidated Standards of ReportingTrials guidelines (the gold standard for reporting clear, transparent, and sufficiently detailed conference abstracts and journal articles); and be focused on ascertaining the most appropriate interventions that attain the desired outcomes for specific clients with specific problems (Hopewell et al., 2008; Thyer, 2001). Social workers also need research that values knowledge derived from clinical expertise or practice wisdom. Any apprehension social workers have with adopting the kind of transparent EBP put forward by Gambrill (2007) may be attributed in part to the lack of appreciation for practice wisdom that is hard to observe and quantify as a valid source of evidence. Over the past few years, other professions have found Bayesian analysis useful across many disciplines where data collection is difficult or expensive, most notably medicine and pharmacology. The application of Bayesian analysis to adaptive designs in clinical trials has allowed trials to stop sooner, thus getting patients on an effective medicine or off of a harmful medicine much faster than in the past (see, for instance, Giles et al., 2003, and Krams, Lees, Hacke, & Grieve, 2003). This article introduces Bayesian analysis as a statistical paradigm conducive to addressing the challenges of EBP in social work research and practice. In contrast to classical statistical methods, Bayesian analysis allows researchers to translate practice wisdom into evidence and incorporate data from past and present studies. The article begins with a brief introduction to Bayes's theorem, followed by a discussion and comparison of classical and Bayesian approaches. Finally, we provide a practical example of Bayesian analysis to assess the clinical improvement of youths receiving children's psychosocial rehabilitation (CPSR) from a mental health clinic that specializes in the treatment of youths with severe emotional disturbance (SED). STATISTICAL APPROACHES Classical Statistical Analysis Most statistical analysis done in social work has tended to be in the classical (also called the frequentist) paradigm. In the frequentist approach to statistics, parameters are assumed to be fixed, unknown quantities. A sample is taken from the population, and inference is generally accomplished through either hypothesis testing or confidence intervals. There are actually several difficulties with frequentist inference, but one problem in particular is that it relies on what is termed the repeated paradigm, which makes interpretation of results difficult and quite nonintuitive. For instance, suppose interest lies in the proportion of clients therapeutically discharged from a state-supported intensive outpatient treatment program for mental health and substance abuse disorders. We denote this unknown proportion p. The frequentist confidence interval (CI) found in most introductory textbooks is of the form [??] [+ or -] [z.sub.[alpha]/2 [square root of ([??](1 - [??]/n)], where [??] is the estimated proportion of positive responses, found by taking the number of positive responses divided by the sample size n, and [z.sub.[alpha]/2] is the value of the standard normal distribution that leaves (1 - [alpha]/2) * 100 in the upper tail of the distribution. The common value for [alpha] is .05 which leads to a value [z.sub.[alpha]/2] = 1.96. The interpretation of this interval is not the desired one of the probability that p in the interval is 95%. Instead, we have to imagine repeating the experiment essentially an infinite number of times and interpreting the interval by saying that 95% of these repeated sampling intervals would contain the true parameter p. …

Teaching EBP in social work: Retrospective and prospective

• Summary: This article examines the precursors and advent of the evidence-based practice (EBP) movement, identifies feasibility obstacles to increasing the emphasis on teaching EBP in social work, offers some suggestions for alleviating those obstacles, and discusses arguments for and against the proposition that EBP is being oversold by advocates for increasing its emphasis in social work practice and education. • Findings and Applications: It suggests that that if we increase the emphasis on EBP in the curriculum, we must so in an appropriate manner that gives adequate attention to the various kinds of EBP questions and their respective research hierarchies, to the significant degree of practitioner flexibility encouraged by the EBP process, and to the important role of theory and relationship factors in that process.

Social Work Practitioners and Practice Evaluation: How Are We Doing?

Practice evaluation is an important component of evidence-based social work practice. Previous research in this area has concluded that even though social workers receive evaluation training, it remains under-utilized in practice. This study discusses the results of a survey of 134 social workers across different social work settings, positions, and level of preparation, examining incidence and type of evaluation activity, training received, and barriers related to implementing practice evaluation in the practice setting. Results report that the majority of social workers are not involved in evaluation activities beyond collecting basic statistics.

Evidence-Based Clinical Practice: The Effectiveness of Music-Based Intervention for Women Experiencing Forgiveness/Grief Issues

This study evaluates the effectiveness of individual grief counselling using music-based intervention for women who had unresolved forgiveness/grief issues due to the loss of a loved one. Each individual (N = 21) completed the 12 bi-weekly grief counselling sessions, in which the pretest and posttest data were collected. The results suggest that music-based intervention made a positive impact on the individuals who had current unresolved forgiveness/grief issues and depression symptoms. A strong positive correlation was observed between their perception of unresolved forgiveness/grief issues and their depression levels. Implications for evidence-based social work practice are discussed.

Talking Knowledge — Practising Knowledge: A Critical Best Practice Approach to How Social Workers Understand and Use Knowledge in Practice

There is strong government support in the UK for the development and implementation of evidence-based or knowledge-informed practice in social work. At the same time, despite many national and local initiatives to support evidence use, there is still uncertainty and disagreement about how best to enable organisations and practitioners to achieve this goal. This paper argues that policy and practice initiatives to promote the effective use of evidence and knowledge for practice must be based on an understanding of how social workers understand and use knowledge in their day to day practice. It reports on a small-scale research study in Scotland which uses a ‘critical best practice’ approach to take an in-depth look at how six social workers make use of research, inquiry and other forms of knowledge evidence in relation to an example of their practice. The research found that the social workers drew on a wide range of knowledge in active, critical and reflective ways that were embedded within the particular context of their practices and their own experiences and beliefs. The findings highlight a range of personal and organisational capabilities which may support best practice in using knowledge to inform social work practice.

Realist Evaluation in Wraparound: A New Approach in Social Work Evidence-Based Practice

Objectives: The purpose of this study was to develop a realist evaluation paradigm in social work evidence-based practice. Method: Wraparound (at Gateway-Longview Inc., New York) used a reliable outcome measure and an electronic database to systematically collect and analyze data on the interventions, the client demographics and circumstances, and the outcomes. Results: Research designs (e.g., single-system and group) can fall into place naturally and patterns in the data can be investigated using data analysis approaches such as binary logistic regression. Conclusions: Realist evaluation can be performed at regular intervals when an outcome measure is repeated, with the purpose of investigating what interventions work and in what circumstances.

Author Guidelines for Reporting Scale Development and Validation Results in the Journal of the Society for Social Work and Research

Peter Cabrera-Nguyen Washington University in St. Louis Reliable and valid measurement is critical for advancing social work research and evidence-based social work practice. However, the quality of available evidence is largely determined by the study designs used in intervention research. A well-designed intervention study includes optimal sampling techniques, data analysis using appropriate statistical methods, steps to enhance internal and external validity, and psychometrically sound assessment instruments. Ensuring intervention studies include assessment instruments with strong psychometric properties may, ultimately, enable practitioners to assess client target problems with greater precision. Further, increasing the availability of instruments with demonstrated reliability and validity may also help practitioners select evidence-based interventions that best match the needs of their clients. Therefore, it is important for social work researchers engaged in scale development and validation to conduct their research and report their findings in a reliable manner that allows other researchers to replicate those findings. The guidelines presented in this article are intended to assist

Guided or independent? Social workers, central bureaucracy and evidence-based practice

Since the start of the 1990s, a number of professional fields in the Western world have been confronted with increasingly explicit demands for scientific assurance regarding the effects of the work they do. The debate on the relationship between research and practice in social work has often been carried out under the heading of evidence-based social work or evidence-based practice (EBP). This article is based on a survey distributed to a representative sample of social workers and middle managers within the Swedish municipal social services. The results indicate a generally positive attitude among Swedish social workers towards EBP; at the same time they show a low level of active contact with the research literature of relevance for EBP. The results are contextualized and discussed against the background of some major methodological issues in EBP, such as, for example, the so called Dodo bird verdict in psychotherapy outcome research.

From Opinion-Based to Evidence-Based Social Work: The Swedish Case

This article presents an account of Sweden’s Institute for Evidence-Based Social Work Practice (IMS), located in Stockholm, Sweden. The article places IMS in the context of making Swedish social care services less opinion-based and more evidence-based. The institute is an example of how policy-driven processes promote the use of evidence-based practices in this European nation. The article includes presentations of history, organization, and products of IMS, and concludes with comments on future opportunities and challenges.

Longitudinal Invariance of the Satisfaction With Life Scale for Individuals With Schizophrenia

Objectives: This study examined the longitudinal structural stability of a subjective quality of life measure in an ethnically diverse sample of 331 adults with schizophrenia. Methods: Participants completed the Satisfaction With Life (SWL) scale at entry to community-based mental health services and again at 6 and 12 months. Five types of measurement invariance were tested using a series of multiple-group confirmatory factor analyses. Results: All five types of longitudinal invariance were supported. Conclusions: These findings offer strong support for the validity of the SWL scale as a tool for research or for clinical purposes to assess the effectiveness of interventions over time. Implications for use of the SWL scale in evidence-based social work practice are discussed.

Teenage childbirth among female international adoptees: a national cohort study

1.Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden 2.Centre for Health Equity Studies (CHESS), Karolinska Institute, Stockholm, Sweden 3.Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden 4.Department of Neuroscience, Child and Adolescent Psychiatry, University Hospital of Uppsala, Uppsala, Sweden 5.Stress Research Institute, Stockholm University, Sockholm, Sweden 6.Institute for Evidence-based Social Work Practice, National Board of Health and Welfare, Stockholm, Sweden

Producing and consuming knowledge in social work practice: research and development activities in a Swedish context

This article presents various forms of activities performed by locally based social welfare research and development (R&D) units in Sweden. The authors argue that these units are vital actors in the field of encouraging and strengthening evidence-based social work practice. They are close to social services organisations and have the ability to use flexible methods in order to bridge the gap between research and practice in a local context. The theoretical framework for the article is the organisational excellence model – an archetype for how research can be used in practice.

Reflexive Professionalism as a Second Generation of Evidence-Based Practice

This article refers sympathetically to the thoughtful debates and positions in the Research on Social Work Practice ( RSWP; Special Issue, July, 2008 issue) on “What Works? Modernizing the Knowledge-Base of Social Work.” It highlights the need for empirical efficacy and effectiveness research in social work and appreciates empirical rigor demanded by leading proponents of an evidence-based social work practice. Yet it argues that these high standards of evolution are based on a methodological conceptualization of impact, which might be less than appropriate for social work. We propose a refashioning of efficacy and effectiveness research in social work that focuses on explaining and understanding of causal mechanism. We suggest a second generation of evidence-based practice, which is substantiated in the concept of reflexive professionalism.

A Reflection on Reasons, Preconditions, and Effects of Implementing Evidence-Based Practice in Social Work

Over past decade, there has been an increasing recognition that social work should be evidence based. The potential contribution of evidence-based practice (EBP) to effectiveness, efficiency, and accountability of social work education and practice has been emphasized (Gambrill, 1999, 2007; Gellis & Reid, 2004; Gilgun 2005; Thyer, 2004). This article reflects on reasons, preconditions, and effects of adopting EBP in social work. These issues are important but are rarely examined. We find that proponents of EBP in social work are conservative toward problem that research evidence is not used by practitioners. They neglect preconditions for implementing EBP and are not sensitive to negative effects of adopting EBP in social work. MEANING AND PERFORMANCE OF EBP IN SOCIAL WORK In terms of meaning of EBP, many scholars in social work (for example, Gambrill, 1999; Gibbs & Gambrill, 2002; Gilgun, 2005; Thyer, 2004) follow definition of evidence-based medicine, such as the integration of best research evidence with clinical expertise and patient values (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000, p. 1). Regarding performance of EBR five steps of evidence-based medicine formulated by Sackett et al. (2000) are also followed by social work scholars (for example, Gibbs & Gambrill, 2002; Thyer, 2004). The five steps are as follows: first, to covert one's need for information into an answerable question; second, to search best evidence to answer that question; third, to critically evaluate that evidence; fourth, to integrate critical evaluation of research evidence with one's clinical expertise and with patient's unique biology, values, and circumstances; and fifth, to evaluate one's own effectiveness and efficiency in undertaking previous steps and to strive for self-improvement. REASONS TO ADVOCATE EBP IN SOCIAL WORK A review of literature on EBP in social work reveals two fundamental reasons for academics to advocate EBP in social work. According to Gibbs and Gambrill (2002), Rosen (2003), and Crisp (2004), one obvious reasons to advocate EBP in social work is that social workers in service agencies have seldom applied research evidence to their practice. These academics all based their arguments on studies by Kirk and Rosenblatt (1981), Rosen (1994), and Rosen, Proctor, Morrow-Howell, and Staudt (1995), in which findings revealed that social workers rarely use and value research evidence in their decision making for interventions and other practices. Another reason is that EBP is believed to be able to promote utilization of research findings in social work education and practice. For example, to advocate EBP in social work education, Howard, McMillen, and Pollio (2003) highlighted importance of empirical research to effective social work practice; they argued that scientific findings should guide selection and application of social work practice and that social workers should remain current with a growing scientific database. DISCUSSION AND SUGGESTIONS EBP has potential benefits to social work. First, social work has been obsessed with professional status (O'Neill, 1999). The emphasis of research evidence in EBP social work can enhance credibility of social work profession. Second, it has been found that social workers seldom use research evidence in practice (Rosen, 1994; Rosen et al., 1995; Sheldon & Chilvers, 2000). The emphasis of research evidence in EBP social work can promote integration of research evidence into social work practice. However, realization of benefits of adopting EBP in social work is subject to many factors, such as relevance of evidence to social work practice. A reflection on reasons, preconditions, and effects of adopting EBP in social work indicates that present implementation of EBP may result in much harm. Reflection on Reasons to Advocate EBP A reflection on two fundamental reasons to advocate EBP in social work will reveal beguiling rationale when we make a simple comparison of it with consumers' neglect of industrial products or business services. …

Knowing or Un-knowing? That is the Question

• Summary: A present trend in social work is the focus on evidence-based knowledge. This kind of knowledge does fill a purpose, but is not sufficient on its own. The article argues that social workers need a complement to knowing, and this approach could be conceptualized as un-knowing. In this article, a theory of un-knowing for social work practice is outlined. This implies a theoretical scrutiny of knowing and un-knowing and a discussion of how it can be used in practice. Moreover, the article presents findings from an empirical study of social work students who describe their usage of different forms of knowledge reflexively. • Findings: The article presents the results of a study in which social work students' usage of different forms of knowledge in their field studies was examined. The results demonstrate that social work students use different forms of knowledge in practice, and un-knowing is one of the actively used forms. Women tend to use un-knowing somewhat more than men. • Applications : The article is a contribution to the ongoing debate on evidence-based practice in social work. It is argued that it is important to teach social work students to understand un-knowing in theory and to use it in practice, and in combination with other forms of knowledge in social work.

Ethical Considerations of Evidence-Based Practice

During past decade evidence-based practice has become increasingly influential in social work practice and education (Gilgun, 2005). The increasing influence is evidenced by proliferation of articles and books about subject (Chwalisz, 2003). Evidence-based practice has largely been accepted as a positive advancement in profession (Fook, 2004; Gilgun, 2005). Its proponents contend that basing social work practice on research evidence is an important ethical mandate (Gibbs & Grambrill, 2002). Indeed, incorporating state-of-the-art knowledge and research has long been considered essential to good social work practice (Goldstein, 1990; NASW, 2000). It is perhaps because of this recognition that potential ethical consequences of evidence-based practice movement have too infrequently been explored. Science, and, by extension, evidence-based practice, hold elevated and privileged positions within modern societies and are commonly viewed as value free and accepted on face value. Yet, within any epistemology lies implicit values that silently guide those who adopt its approaches and methods. This is also true for social work movements, theories and perspectives; values are embedded deeply within each and have implications for what problems profession pays attention to and how it responds to them. Embedded within structure and core elements of evidence-based practice are implied organizing principles that can lead to privileging of certain sets of values, knowledge, and actions over others. Webb (2001) has asserted that the emerging panacea of evidence-based practice in social work has thus far developed without critical (p.15). The purpose of this commentary is to briefly illuminate these tendencies as a means of stimulating dialogue and debate within profession. The aim of this article is not to disparage evidence-based practice movement but to highlight some of dilemmas that call for more careful exploration. PRIVILEGING KNOWLEDGE OVER VALUES Although evidence-based practice movement does not ignore professional values, importance of validated scientific evidence is central aspect of approach and may overshadow social work values. Although science has provided many valuable insights for social work, there is a risk of overreliance on knowledge. Gordon (1965) articulated this concern over 40 years ago when she asserted following: knowledge is called on when a value is needed as a guide to action, resulting action may be unpurposeful (p. 365) That is, social workers may achieve their stated aims, but their stated aims may not be most important and necessary to achieve. Social work practice may indeed lose its depth or conscience. At its core, social work is a profession predicated on ideology and values (Perlman, 1986). For instance, one of ways in which elevation of knowledge over values can affect social work is through privileging of efficiency over autonomy. If outcome research becomes most important factor guiding social work services provision, a focus on client empowerment and autonomy may become at risk. For instance, research may show a specific medication or treatment approach to be most effective, yet clients may wish to handle these problems in a manner that is more consonant with their personal values or strengths. For example, a Puerto Rican client living in Philadelphia may wish to seek services of a healer before considering an evidence-based cognitive behavioral or pharmacological intervention for depression. Although evidence-based practice does not call for practitioners to ignore wishes of clients, it is feared that focus on outcomes research would lead practitioners to overzealously pushing certain approaches. How this may affect work with vulnerable and oppressed populations over time is still unknown. Evidence-based studies have not ascertained degree to which use of its practices affects client empowerment, freedom, or emancipation, longitudinally (Fook, Ryan, & Hawkins, 1997). …