Before making a major decision in life, we go through a decision-making process.
For example, when choosing a holiday destination or buying a car, we weigh up options and then arrive at a decision.
Weighing up include finding out the views of friends and family, reading around the subject area online, referring to previous experience and our own preferences.
This is to make sure that the decision we finally make is based on evidence.
Similarly, the components of evidence-based practice follow the same principles.
So what is evidence-based practice?
Evidence based practice is the combination of three key components; the values of a patient or individual being cared for, the expertise of the professional and the best research evidence available.
To provide effective interventions, social workers should understand the use of research evidence in practice.
- The Professional Capabilities Framework (PCF) highlights the need for social workers to “make use of research to inform practice”.
- The Knowledge and Skills Statement (KSS) for Social Workers in Adult Services says that social workers “should use practice evidence and research to inform the complex judgements and decisions needed to support, empower and protect their service users”.
- The Knowledge and Skills Statement (KSS) for Child and Family Practitioners also reminds us that social workers should use methods based on evidence and to triangulate them to ensure robustness.
Evidence-Based Practice (EBP) in Social Work
Does this all sound simple?
Well, evidence-based practice is more complicated than that.
This is because in evidence-based practice, you should also have the individual’s best interests in mind.
In addition, there are ethical dilemmas that may arise, advance decisions that may prevent certain actions from being taken, and individual decisions which may be deemed as unwise.
What is Evidence Based Practice in Social Work?
Evidence-based practice (EBP) originated within the medical field in relation to drug testing and similar interventions (Webber, 2015).
The process involves practitioners using current evidence cautiously combined with clinical expertise, ethics, client preferences and professional judgement to guide and inform the provision of treatments and services (Aveyard and Sharp, 2013).
It implies the use of relevant, thorough, transparent and good judgement in practice to inform social work interventions based on service user’s needs, values, and wishes.
This article will critically evaluate what makes up evidence in social work practice.
In addressing this topic, evidence-based practice (EBP) and how research and evidence inform practice will be analysed.
It will highlight the value of evidence in the growth of policy and social work practice.
Social theory, practice wisdom, and service user experience in EBP will be analysed.
Finally, what impedes EBP such as issues of policy, managerialism and diversity will be highlighted.
The Evidence in Evidence-Based Practice
We may define evidence as a structured inquiry presented to support an assertion (Mathews & Crawford, 2011).
It ensures that the place of social work within the interprofessional environment is enhanced if it can show the rationale for action or inaction (Webber, 2015).
Aveyard and Sharp (2013) share similar views by highlighting that social workers are accountable to the law and are increasingly being asked to argue their case in court settings with concrete evidence to justify a course of action, especially in child protection cases.
The proficiency in using evidence to inform practice is also a requirement of social workers as part of registration with Social Work England.
What is considered an Evidence-Based Practice?
The more familiar form of evidence that is referred to when discussing EBP is evidence emerging from research (Barker, 2010).
Social work research can be defined as the use of research techniques to solve problems that social workers confront within tasks and it is categorised into research (qualitative and quantitative) and non-research (practice knowledge) evidence (Aveyard & Sharp, 2013).
One major drawback is that bias is a huge obstacle for a researcher in achieving credibility and accuracy (Pack & Cargill, 2015).
BUT multiple research methods can be used alongside empirical materials enabling researchers to manage intrinsic bias that comes from specific research method (Bryman, 2015).
Also, where mixed methods are used, it could help provide the opportunity for triangulation, a method for validating information collected through various methods (Hussein, 2015; Bryman, 2015).
While studies by Gray and Webb (2012) suggest that a significant element of reliable evidence is that it is impartial, systematic and independent, Webber (2015) argues that evidence is rarely utterly reliable, and there are noteworthy cases where it has been found to be imperfect.
For instance, there has been a very significant emphasis on “seeing the child” in initial assessments (Munro, 2008). Despite this, some research into serious case reviews and public investigations have clearly evidenced practitioner shortcomings in this respect (Ayre, 1998; Calder, 2015; Smith, 2009).
This was further highlighted in the case of baby Peter Connelly, where parents used tactics to avert the practitioner from observing the child (NICE, 2016; Local Safeguarding Children Board Haringey, 2009; Munro, 2006a, 2008b).
What are the Different Forms of Evidence in EBP?
It is important to note that different forms of evidence may be used for various purposes.
For instance, if evidence is required about service user experience, then quantitative research such as randomised controlled trial (RCT) will not be suitable, rather, research conducted using a qualitative approach such as in-depth interviews will be more appropriate (Patton, 2002).
Payne, Seymour and Ingleton (2008) also share similar views by highlighting that while RCT could be appropriate for healthcare, it may not apply to social work practice.
This is because such research evidence is situational and this results in problematic relationships between the evidence gathered and social work practice (Aveyard & Sharp, 2013).
For example, following a methodological rigorous RCT study it was found that children looked after by relatives do better than children looked after by foster carers (Kerr, Nixon, Pinkerton & Houston, 1999).
While this seems to be a perfectly acceptable and unproblematic finding, it does not mean that placement of a particular child with their grandmother will be successful or even better than placement with another foster carer.
This was demonstrated in the case of Victoria Climbie, where she was a victim of abuse from close family relatives (Garret, 2006; Rustin, 2004).
Social Work as a Practical Moral Activity
EBP in social work is a contested ground, with some considering it as a rational–technical activity and others as a practical-moral activity.
Social work viewed as a practical-moral activity implies practitioners incorporating elements of art and craft in providing expert care and help combined with the application of disciplined reasoning and not the application of concepts and research knowledge (Rogowski, 2010).
However, viewing social work practice from this perspective suggests sharing different viewpoints when working with children and families in child protection. It also involves consideration of how best to intervene in situations where a child’s welfare is paramount (Soydan, 2014).
Thompson (2016) argues that this method identifies that social work practitioners and service users have their own morals and values that can affect approaches to children safeguarding work.
For example, a social worker might have strong views about cases where the allocation of resources are concerned leading to misrepresented approaches to evaluation, interventions and decision-making.
Despite such flaws, Park and Cargill (2015) contend that social work practice is a practical moral activity. An idea that suggests that social work EBP can result in positive outcomes when relationships are built with service users.
Practitioners seek to understand each service user as an individual by noting their concerns and encouraging participation.
Ruch, Turney and Ward (2010) share similar views by highlighting that participation initiatives result in a redistribution of power and equal relationships. However, Beresford and Carr (2012) are of the opinion that this gives a false impression of power transfer. A way of tackling this issue is to foster person-centred approaches.
Social work as a Rational Technical Activity
Social work EBP as a rational–technical activity focuses on EBP that draws mainly on processes, scientific studies, and theories/models to enhance decision-making (Thompson, 2016).
This notion suggests that social work practice ought to be grounded on dependable methods obtained from systematic studies.
The attachment theory by Bowlby (1988) for instance, may fall within this activity as it is used as a model that guides social workers in decision-making when working with children and families.
Bowlby’s (1988) attachment theory offers the foundation and context for social workers in child wellbeing assessments, as it classifies different behavioural patterns and relationships (Maclean & Harrison, 2015).
Why is Attachment Theory Useful to Social Work Practice?
Those who work with children mostly depend on attachment theory to make some decisions as it helps them to understand the importance of developing close relationships.
Similarly, Cassidy and Shaver (1999) agree that attachment theory has brought significant changes in child care, adoption and fostering where it has helped social workers to remove abused children from their caregivers.
Research in this area is limited however, it has identified that children subject to abuse and neglect fall within a category where the threshold for developing insecure attachments with their caregiver is high resulting in an augmented risk of developing attachment irregularities (Howe, 2009).
Notwithstanding the strengths of attachment theory, some writers have pointed out some limitations.
Goldberg (2013) suggests that early attachment helps in the development of a child but does not determine later development. Hart (2011) shares similar views by stating that the attachment theory under-emphasises the degree to which humans can self-repair as it ignores individual capacity to stabilise themselves and their striving for independence.
However, Shemmings and Shemmings (2011) argue that along with other influences, early attachment contributes significantly in later years. Hence, social workers may use this information as a guide when deciding and planning interventions for children and families with an emphasis on enabling secure attachments.
Following the adoption of the United Nations Convention on the Rights of the Child in UK law, the Children Act 1989 came into effect to bring together various pieces of legislation (Tassoni, 2007).
As a consequence of the death of Victoria Climbie in 2000, recommendations made in the Laming report were taken up in the government green paper ‘Every Child Matters’.
The Green Paper also emphasised that the government’s intention was to protect children and maximise their potential by putting children at the heart of its policies (Hoyle, 2016). Subsequently, the Children Act 2004 was passed to implement this programme in England.
In social work, our unconscious values and beliefs impact on our decision-making. Thus, in decision-making, we may be more sympathetic towards a child with hearing impairment because they cannot be blamed for their circumstances than we may be towards a child who has been expelled from school because of their behaviour.
However, with schedules such as the Common Assessment Framework (CAF) priorities and progress can be measured, thus improving outcomes for children (Yardley, 2014).
CAF is often used in early identification, assessment of needs and intervention, often in child protection (Social Care Online, 2016). It makes use of personalised services which identifies the child’s strengths and weakness with the wellbeing of the child at its core (Asmussen, 2011).
A study by Thorpe, Regan, Mason and May-Chahal (2007) concluded that the CAF potentially offers a way forward and makes every child matter because it begins with relationship building. In this context relationships are seen as resources which facilitate conversations about how things could be different or otherwise for children and families.
For instance, Dale’s (2004) qualitative study of 18 families showed the importance of relationship-based working. It identified that a trusting relationship with the child and family members was conceived as a positive intervention.
Through this, support could be targeted in the most efficient way and may include strength-based interventions.
What May Come in the Way of Evidence Based Practice (EBP)?
Policies and guidelines in organisations may also come in the way of EBP, and this is because the focus is on processes rather than outcomes creating a negative culture of research-based practice (Aveyard & Sharp, 2013).
The importance of fidelity to these policies and guidelines limits opportunities for innovation. Besides, Rubin and Babbie (2010) argue that on an individual level, rigid adherence to EBP approaches can inhibit professional experience and expertise in relationship building.
However, EBP involves the integration of professional expertise and as ethics and values underpin social work approaches, it means we need to find out issues involved from the service user’s perspective and in ways that they can understand and take part (Banks, 2012).
Thus, as social work seeks to challenge the obstacles of discrimination and prejudices that prevail in society, it is essential for EBP to strive to capture the needs and attributes of the service users in order to promote an efficient use of limited resources, reducing costs for local authorities and society (Littlechild & Payne, 1999).
Social work EBP seeks to explore individual, or group diversity needs to ensure that everybody’s needs, problems, wishes, and requirements are understood and responded to in the best possible way (Webber, 2015).
However, issues of diversity such as prejudice may come in the way of EBP. The categorisation of individuals or families, for instance, can be oppressive and destructive as research into domestic violence and child abuse has illustrated (Coulshed & Orme, 2012).
Hence, it is vital not to generalise about families based on diversity but to try to understand how that particular family works for effective outcomes.
Before you go
Research evidence forms a cornerstone of social work practitioner’s knowledge base, with reflective practice as an essential aspect.
It is meaningless to depict evidence in this way unless we have research that is consistent and up-to-date. Theories and models support practice, and practice wisdom is enhanced when there is carefully planned reflection and observation.
To combat some limitations of EBP, a set of evaluative tools can be applied to a piece of research to determine its robustness and the effectiveness of outcomes and interventions in practice.
Supervision may also be used for reflection and emotional support. Web sites such as community care can be used to keep knowledge up to date.
PIN FOR LATER!
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