Evidence-Based Social Work Practice: Challenges and Promise

1. Evidence-Based Social Work Practice: Challenges and Promise Aaron Rosen George Warren Brown School of Social Work Washington University Outline of an invited address at the Society for Social Work and Research, San Diego, California January 2002

2. Basic premises: Professional social work practice is: • Committed to client’s best welfare • Values guided • Goal directed, hence pragmatic • Accountable: Must demonstrate effectiveness and efficiency • Committed to science-based criteria for evidence and knowledge Rosen (2002) Slide 2/15

3. Therefore, practice must be: • Responsive to client needs and concerns • Outcome oriented • Systematic • Explicit and subject to scrutiny • Guided by scientifically tested knowledge on effectiveness • Evaluated and corrected Rosen (2002) Slide 3/15

4. But studies indicate that most practice is: Not systematic Not guided by tested knowledge Not empirically evaluated Rosen (2002) Slide 4/15

5. A complex set of contributing factors--three practitioner-related factors are addressed here: • Similarity of social work professional concerns to lay experiences and problems • Post-modern and other orientations to knowledge • The dilemma of idiographic application of normative generalizations Rosen (2002) Slide 5/15

6. Similarity of SW professional concerns to lay experiences—hence little awareness of differences between lay and professional helping process • Uncritical transfer of problem-solving strategies • Use of implicit knowledge for decision making • Use of authority and self as source for practice hypotheses • Values and intent sufficient for action (intervention) • Discomfort with uncertainty of research findings and probabilistic knowledge Rosen (2002) Slide 6/15

7. Post-modern and other orientations to knowledge • Rejection of “deterministic” model inherent in science-based practice • Preoccupation with subjective vs. “objective” reality • Rejection of scientific paradigm as applicable to practice knowledge and research • Extolling the covert—intuitive and ad-hoc in practice Rosen (2002) Slide 7/15

8. 3. The idiographic application of empirical generalizations: A basic dilemma • Research findings and empirical generalizations are based on samples of individuals, behaviors, and situations—unlikely to fully correspond to characteristics of an individual client, whereas: • Responsible clinical practice requires addressing needs of a particular client in a given situation • Empirical generalizations are probabilistic and tentative, and usually account for only a portion of the variance of concern, whereas: • Clinical practice is categorical—you either act (e.g., implement an intervention) or withhold action—irrespective of the inherent uncertainty Rosen (2002) Slide 8/15

9. Challenge: How to reconcile and cope with this dilemma? Integration of three complementary and interrelated concepts: • Systematic planned practice • Single case evaluation • Practice guidelines for intervention Rosen (2002) Slide 9/15

10. Systematic planned practice • Practice as a planned process of explicitly interrelated, organized, and rationalized series of decisions and steps referring to specific treatment components • Primary treatment components for which decisions are made and explicitly justified: 1 Problems—assessed, formulated, prioritized 2 Outcomes—distinguished by role, ordered, specified 3 Interventions—specified, ordered, enacted 4 Evaluation—outcome measurement 4 W’s (whose, what, when, where) Rosen (2002) Slide 10/15

11. Single case evaluation • Criteria and techniques of measurement • Assessment of outcome attainment (design) • Clinical and statistical significance Rosen (2002) Slide 11/15

12. Practice guidelines for intervention—function • Assembly and organization of empirically tested knowledge to inform effective practice • Facilitate practitioners’ access to, use, and proper application of that knowledge to the individual case • Maintain communication between practitioners and researchers regarding knowledge needs • Enhance practice-relevant research and capitalize on practice-generated clinical hypotheses and innovations Rosen (2002) Slide 12/15

13. Structure of practice guidelines for intervention: Four primary components • 1. A taxonomy of outcome-based targets of intervention to organize access to and retrieval of knowledge • 2. Target-related arrays of empirically tested alternative interventions and interventive programs • 3. Specification of moderating conditions (outcome, client, and setting) as criteria for choice among alternatives, and for altering of interventions components and doses • 4. Limitations, and a guiding algorithm for practitioner implementation, improvisation, evaluation, and conclusions (centrally cumulating via PRN) Rosen (2002) Slide 13/15

14. 4th component—practitioner-centered and most demanding. Research needs to: • Develop algorithms for case-focused implementation, improvisation, and evaluation • Develop means for practitioner decision making under conditions of uncertainty, including satisficing heuristics • Develop practitioner-friendly PRN’s for communicating, integrating, and testing practitioner derived clinical hypotheses Rosen (2002) Slide 14/15

15. Implications for professional curriculum—explicate and emphasize: • Distinction between professional role and responsibilities and lay role • Distinctions between values as guide to setting of service goals, and knowledge as guide to action—pragmatic and ethical • Distinction between description, explanation, and control oriented knowledge, their saliency for different practice tasks (passive and active predictions) • Complexity of the treatment process, primary decision junctures and tasks, and procedures for decision-making under uncertainty Rosen (2002) Slide 15/15