Clinical S ocial W ork Research

1. Clinical Social Work Research Patience Matute-Ewelisane Eugene Shabash Jayne Griffin

2. History of Clinical Social Work: • Prior to the 1960s, casework, informed by Freudian theory and ego psychology, was the central focus of the social work profession • In the 1960s, social work began to focus on community organizations, social program, policy design and social action • Social workers who engaged in individual treatment were accused of being agents of social control, of blaming the victim instead of the effects of oppression, poverty and trauma and of pathologizing the behaviours of marginalized groups (Goldstein, 1996, p. 90)

3. History of Clinical Social Work: • Social Workers supporting individual treatment felt clients issues were being oversimplifiedand that clients needs were not being met • Social workers in direct practice felt alienated from the profession and worried about their acceptance as clinicians along side psychologists and psychiatrists • In 1971, the Federation of Societies for Clinical Social Work formed with the aims of establishing standards of practice and meeting the needs of direct practitioners • In 1972, The Clinical Social Work Journal was created (Goldstein, 1990, pp. 90-91)

4. Definition of Clinical Social Work • Clinical social work: shares with all social work practice the goal of enhancement and maintenance of psychosocial functioning of individuals, families, and small groups. Clinical social work practice is the professional application of social work theory and methods to the treatment and prevention of psychosocial dysfunction, disability, or impairment, including emotional and mental disorders. It is based on knowledge of one or more theories of human development within a psychosocial context. The perspective of person-in-situation is central to clinical social work practice. (http://www.socialworkers.org/practice/standards/clinical_sw.asp#definitions )

5. Definition of Evidence Based Practice: • Includes selecting, implementing and then evaluating interventions related to the client’s specified problems and goals, based upon the best available information or evidence of effectiveness….EBP requires the social worker to find reliable sources of information and then judge the quality of the information in order to inform selection of interventions. (Vonk, E.M. & Tripodi, T. & Epstein, I., 2007, p. 91)

6. Clinical Social Work: • Assessment • Intervention • Evaluation • Integrating research into Clinical Social Work Practice: • We are going to explore how research can be implemented into each part of the clinical social work process

7. ASSESSMENT • Diagnostic assessment: the clinical social worker is supposed to accomplish 4 major tasks and then make a decision. • Gather information • Determines client’s eligibility • Prioritize client’s needs • Set intervention goals (Vonk, E.M. & Tripodi, T. & Epstein, I., 2007)

8. RESEARCH INTERVIEW Structure Content Interview schedule Environment Pretesting USING AVAILABLE INSTRUMENTS When What Who How (Vonk, E.M. & Tripodi, T. & Epstein, I., 2007)

9. SYSTEMATIC OBSERVATION Assess frequency of behaviours in various settings Can validate information provided by less structured means To see how well clients follow treatment plans To access the clinical process To evaluate treatment SPECIFICATION AND RATING OF PROBLEMS AND GOALS Listen Observe Operationalization (Vonk, E.M. & Tripodi, T. & Epstein, I., 2007)

10. INTERVENTION Clinical Social Workers can choose interventions with clients based on: • Previous training and practice experience • Treatment traditions and protocols of the agency where they are working • Research – Evidence based practice (Vonk, E.M. & Tripodi, T. & Epstein, I., 2007)

11. Steps to Evidence Based Intervention Selection: Specify the problem: Severity Duration/Frequency Under what conditions is the problem likely to occur Characteristics of the client involved Client’s goals Treatments that have been tried in the past, levels of success 2. Locate relevant research literature: Systematic reviews (literature reviews) Practice guidelines (treatment protocols or manuals) Expert Consensus Guidelines Independent search of available literature (Vonk, E.M. & Tripodi, T. & Epstein, I., 2007, p. 92-94)

12. 3. Assessing the level of Evidence: Randomized controlled trials (RCT)- hypothesis tested with a large group of people Quasi-experimental/non-experimental- describes statistical relationships between outcomes and interventions Case studies/pilot studies – describes intervention techniques, clients, agencies Practice based opinions and untested hypothesis 4. Assessing Measurement Accuracy, Reliability and Validity: Measure Accuracy: the degree to which the process of determining the treatment’s effectiveness was free from error. Reliability of measurement: the consistency that an instrument measures something Validity of measurement: is the instrument measuring what it says it will measure? (Vonk, E.M. & Tripodi, T. & Epstein, I., 2007, p. 92-96)

13. 5. Assessing the Empirical Relationship Between Invention and Outcome: Determining the strength and predictability of the relationship between the intervention used and the results. 6. Assessing the External Validity: Degree to which the results can be generalized 7. Assessing Internal Validity: To connect the intervention to the desired outcome 8. Applying Appropriate Criteria: Will the results be considered strong evidence or a hypothesis to undergo further testing? (Vonk, E.M. & Tripodi, T. & Epstein, I., 2007, p. 97-100)

14. 9. Assessing the Utility of Intervention and Implementation Issues: Is the intervention appropriate for this client, social worker (training), situation, agency? 10. Issues Related to the Intervention: Is it specific? Does it match the values and ethics of social work? 11. Issues related to the client: Based on the client’s worldview, beliefs and values is the intervention a good fit for him/her? 12. Issues related to the Social Worker and Practice setting: Does the social worker have the proper training to perform this intervention? Is the intervention suitable for the practice setting? Cost? (Vonk, E.M. & Tripodi, T. & Epstein, I., 2007, p. 101-102)

15. EVALUATION Evaluation is the last phase of clinical social work practice and informs about: • the degree treatment’s goals were achieved. • cost-benefit of treatment • further strategies: continue, modify or stop treatment • efficacy of particular treatment approach

16. Focus of Evaluation • Treatment evaluation: effectiveness and efficiency of social worker with the client • Program evaluation: practice setting effectiveness and efficiency of the whole program • Evaluation • Formative • Summative

17. Client Sensitive Evaluation • Objectives • Design • Confidentiality • Inform consent • Ethical dilemmas

18. Single Case Design Single case design: working with a single client’s unit (person, family or group) • Use of single case design by itself • Use of single cases for aggregation

19. References Goldstein, E. (1996). What is Clinical Social Work? Looking Back to Move Ahead. Clinical Social Work Journal, 24 (1), 89-104. doi: 10.1007/BF02189944. Goldstein, E. (2007). Social Work Education and Clinical Learnings: Yesterday, Today and Tomorrow. Clinical Social Work Journal, 35, pp. 15-23. Doi: 10.1007/s10615-006-0067-z Vonk, E.M. & Tripodi, T. & Epstein, I. (2007). Research Techniques for Clinical Social Workers. New York: Columbia University Press.