A Model for Implementing an Evidence-Based Practice in Student Fieldwork Placements: Barriers and Facilitators to the Use of “SBIRT”

ABSTRACT

This article reports on focus group data analysis that was used to understand initial, largely positive outcomes from a university-based initiative to disseminate and implement an evidence-based practice (EBP)—Screening, Brief Intervention, and Referral to Treatment for Substance Use (SBIRT)—into student fieldwork placements, which are usual care social work settings. Focus groups were conducted with three groups of stakeholders involved in the ongoing project: social work department faculty (n = 10), bachelor- and master-level social work students (n = 8), and social work fieldwork instructors (n = 6). Dimensional analysis of the focus group data yielded results indicating that dissemination and implementation of SBIRT was influenced by agency- and school-level factors and perceived fit between the EBP and individual professional identity, intrapersonal characteristics, and timing. The resulting model, developed through the focus group analysis, is offered and shows how these factors interacted and affected training, supervision, and use of the EBP. The model provides social work educational programs and agencies a working tool for diagnosing and proactively addressing barriers and breakdowns in the EBP implementation process. Future research that tests the model as a diagnostic tool and generates knowledge about its influence in developing competent evidence-based practitioners is indicated. Future focus groups in relation to this initiative are needed to better understand these barriers and facilitators in the EBP implementation process and their critical roles in the process of translating SBIRT into standard social work practice.     

Critical Components in Implementing Evidence‐based Practice: A Multiple Case Study of Individual Placement and Support for People with Psychiatric Disabilities

When developing Community Mental Health Services to support people with psychiatric disabilities, European countries are advocating evidence ‐based practice (EBP ). Individual Placement and Support (IPS ) is an evidence ‐based model designed to support people in acquiring and maintaining competitive employment. Implementation science is a growing research field, with a focus on components that impact the process of implementing EBP programmes. In this multiple case study, we have followed three IPS demonstration sites for two years, in order to describe and analyze barriers and facilitators for implementation, according to constructs described in the Consolidated Framework for Implementation Research (Damschroder et al. 2009 ). The results highlight the importance of strategic networking, as well as the need for planning and preparations carried out before the start of an EBP programme, since deficiencies related to these constructs are difficult to compensate for.      

Developing the NICE/SCIE Guidelines for Dementia Care: The Challenges of Enhancing the Evidence Base for Social and Health Care

Internationally, interest is developing in the challenges ofdeveloping evidence-based guidelines for social work practice.The paper reports on the process of establishing the UK’sfirst joint health and social care evidence-based practice guideline,which is in dementia care. The paper addresses the methodologicaland procedural challenges of reviewing, meta-analysing and synthesizingknowledge for health and social care given the contrasting historiesof the two sectors in relation to the emergence of evidence-basedpractice. Dementia care is a complex domain within which socialand clinical perspectives intersect, reinforcing the desirabilityof producing ‘joined up’ health and social carepractice guidelines that are relevant to integrated services.It is suggested that the exemplar of producing a joint healthand social care guideline for dementia may be a model for futuredevelopment of practice guidelines. Some of the main recommendationsare presented to illustrate the character of the joint guideline,lessons are drawn for future guideline development, and implicationsfor policy and practice implementation are considered.     

Applying Evidence-Based Practice in Group Work at an Alternative High School

Social workers often are reluctant to use evidence-based practice in group work. Part of this reluctance is because of the perceived rigidity of the process and its emphasis on research. However, social workers can rely on the four cornerstones of evidence-based practice—research, clinical experience, personal views, and client’s perspective—to provide an evidence-based group intervention. In this article, the authors illustrate how social workers used the four cornerstones at one alternative high school to provide an evidence-based group intervention. These cornerstones were used from the beginning of the process, which started with choosing the type of intervention, through the end of the process, which concluded with assessing the intervention. In this article, the authors show that it is possible for social workers to provide an evidence-based group intervention, while remaining flexible, thereby contributing to social workers’ knowledge of how to use evidence-based practice with groups.     

In their Own Right: Translating the Policy of Carer Assessment into Practice

Successive legislation has underscored the importance of assessmentsthat are sensitive to the needs of carers and take into accounttheir ability and willingness to continue caring. This papersynthesizes qualitative and quantitative findings from a continuingprogramme of carer-related research that began in 1993 and hascontinued in parallel with legislative changes. It considersthe process and characteristics of carer assessment from theperspectives of carers for individuals with a range of healthand social care needs, and practitioners. This paper exploresthe assessment of carer need over time and highlights the considerableand enduring gap between policy and practice. It considers practitioners’reluctance to offer separate carer assessments, identifies confusionrelating to the interpretation of eligibility criteria and documentsthe limited contribution of health service staff. The need foran evidence-based framework for good practice, that distinguishesbetween carer needs, service provision and carer outcomes, ishighlighted. The paper concludes by identifying key changesthat are necessary to promote future good practice, such asstaff training and information strategies and the need for practitionersto engage with carers as partners in the care process.     

Researching Vulnerable Groups: Ethical Issues and the Effective Conduct of Research in Local Authorities

The Data Protection Act 1998 and Research Governance Frameworkfor Health and Social Care (Department of Health, 2003a) havebrought consideration of ethical issues in the conduct of researchinto sharper focus. This paper, based primarily on the authors’experiences of conducting research on children in need and outcomesfor vulnerable children, examines the impact these changes havehad on the research process. The difficulties experienced byresearchers in gaining access to research participants in orderto develop evidence-based policy and practice are explored.Finally, the paper outlines some practical steps that can betaken to facilitate the effective conduct of research.     

Whatever Happened to Teamwork? Reflections on CMHTs

Correspondence to Morag McGrath, Centre for Social Policy Research and Development, Bryn Afon, University College of North Wales, Bangor, Gwynedd LL57 2DG. Summary This paper is based on a survey of Community Mental HandicapTeams (CMHTs) in Wales undertaken in 1987. After briefly describingthe range of community teams, individual planning is examined.It is argued that although other models for service co-ordinationat a case level are possible, teamwork has the advantage ofalso providing a framework for service planning and development.Teams' progress in planning and their perceptions of barriersto effective planning are outlined. Despite deficiencies indifferent areas of team functioning, teams can be seen to havemade much progress in terms of service development. Apart fromresource limitation, a central theme in discussing constraintsto more effective team working was the appropriate level ofdelegated responsibility. It is suggested that this is a crucialfactor when considering three important concepts in the All-WalesStrategy for the development of mental handicap services—needs-ledservices, local community-based services and consumer participation.These three concepts are explored within a continuum of teamdevelopment from ‘traditional’ through ‘transitional’to a ‘needs-led’ service model. The necessary managementsupport to achieve a needs-led model is summarized. Althoughfurther research is required to evaluate the different modelsof multi-disciplinary teams and the new arrangements advocatedin the White Paper of separating service assessment and purchasingfrom service delivery, the experience of the CMHTs in Walespoints to the potential of multi-disciplinary teamwork.     

Outline of a Critical Best Practice Perspective on Social Work and Social Care

Correspondence to Harry Ferguson, Faculty of Health and Social Care, University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD. E-mail: harry.ferguson{at}uwe.ac.uk Summary This article seeks to lay the foundations for a new, more positiveperspective on critical practice, research and learning in socialwork and social care. A ‘critical best practice perspective’seeks to move the literature beyond a ‘deficit approach’where the focus is on what does not get done (well), to createa perspective where learning occurs in terms of best practicewhich is set out as a model for developing systems and practicecompetencies. This requires a focus on the actual critical practicesthat are ‘best’ demonstrating the very practicethrough which positive outcomes were achieved. A detailed case-studyis offered drawn from a large scale research study which typifieshow a critical best practice perspective can provide for learningin key areas such as how to engage service users, advocate ontheir behalf, promote protection, establish empowering relationshipsand conduct longer-term therapeutic work in an antioppressivemanner. The research method uses critical theory as an interpretativeframework for reaching an operational definition of 'excellence’and what is ‘best’, which is drawn from the perspectivesof the range of stakeholders who construct practice. This requiresa broadening of the concept of evidence-based practice to includequalitative research methods and the experience of professionals,service users and the production of ‘practice-based evidence’.     

Practitioner Research: Evidence or Critique?

In this paper, I revisit some of the origins and more recentdirections in practitioner research in social work, seeing itas a phenomenon that—rather than being special or narrowlyassociated with social work—manifests a pervasive clusterof concerns about good professional practice in contemporarysociety. Drawing on some general conclusions of a recent studyof practitioner inquiry, I indicate ways in which the widersystems of which it is a part frequently hamstring the potentialof such research to operate as more than a fringe operation—a‘street market’ version of mainstream research.I outline four ways in which social workers, service users,agency managers, academics, government departments and universitiesshould work to a transformative agenda for practitioner research—transformativefor both practice and research. This will involve refashioningthe interface between the methodology and methods of practiceand research; generating practitioner research capacity; recognizingthe subtlety and critical potential of a genuinely ‘practical’agenda in practitioner research; and rescuing practitioner researchfrom a simply technical information-providing function, thatby-passes the challenge to promoting critical practice.     

Resistance and anxiety as factors in the discontinuance of child guidance treatment 1

In this article, the authors provide background on evidence-based practice and then summarize the evidence base for short-term and long-term psychodynamic psychotherapies. The research included conforms to the hierarchy of evidence promoted by the evidence-based practice movement. Experimental research on psychodynamic psychotherapy reveals these therapies have generally moderate to large effect sizes for depressive disorders, anxiety disorders, personality disorders, eating disorders, somatic disorders, some substance abuse disorders, and some mixed disorders. There is a clear evidence base supporting psychodynamic psychotherapy as effective in treating several mental health disorders. Additional outcome research on psychodynamic psychotherapies, using varied outcome measures, should be funded and completed.     

Preventing Suicide: A Neglected Social Work Research Agenda

Social workers encounter suicidal clients; however, little isknown about social work’s empirical knowledge base forsuicide assessment and treatment. In the first comprehensivestudy of social work’s contribution to the suicide literature,the authors conducted systematic electronic and manual searchesfor suicide research published in peer-reviewed journals bysocial work investigators for the period 1980–2006, withthe purpose of ascertaining the state of clinical knowledgerelated to suicide risk factors and effective treatments. Thesefindings reveal that despite recent increases to the study ofsuicide by social work researchers, they have contributed limitedevidenced-based knowledge in the last twenty-six years on thetreatment or prevention of suicide or suicide-related behaviours.The article outlines the risk factors for suicide and discussesthe implications for clinical social work practice and research.     

Treatment‐as‐usual in effectiveness studies: What is it and does it matter?

Andrée Löfholm C, Brännström L, Olsson M, Hansson K. Treatment‐as‐usual in effectiveness studies: What is it and does it matter? A hallmark of an evidence‐based practice (EBP) is the systematic appraisal of research related to the effectiveness of interventions. This study addressed the issue of interpreting results from effectiveness studies that use treatment‐as‐usual (TAU) as a comparator. Using randomised controlled studies that evaluate the effectiveness of multisystemic therapy as an illustrative example, we show that TAU includes a wide variety of treatment alternatives. Estimated treatment effects on recidivism suggest that TAU seems to contain a greater variation in underlying risk than experimental conditions, supporting the hypothesis that the content of TAU could affect outcomes. Implications for the realisation of an EBP are discussed.     

Practice Frameworks: Conceptual Maps to Guide Interventions in Child Welfare

This paper discusses the development of a practice frameworkfor child welfare in New Zealand. A practice framework is definedas a conceptual map that brings together, in an accessible design,an agency’s approach to social work practice with childrenand families. Designed as a tool for practitioners, the NewZealand practice framework integrates three perspectives: child-centred;family-led and culturally responsive; and strengths and evidence-based.The practice framework establishes a vision for New Zealandchild welfare work that is grounded in the realities of practice,supported by research and embedded in a set of principles andvalues that are essential to the work. As a concept, it providesa clear understanding of what underpins the work, and how thisinforms our interventions with children and families. As a toolfor practitioners, it provides a theoretically informed interventionlogic and a set of triggers to support best practice.     

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.     

What are the minimal requirements of rational choice? Arguments from the sequential-decision setting

There are at least two plausible generalisations of subjective expected utility (SEU) theory: cumulative prospect theory (which relaxes the independence axiom) and Levi’s decision theory (which relaxes at least ordering). These theories call for a re-assessment of the minimal requirements of rational choice. Here, I consider how an analysis of sequential decision making contributes to this assessment. I criticise Hammond’s (Economica 44(176):337–350, 1977; Econ Philos 4:292–297, 1988a; Risk, decision and rationality, 1988b; Theory Decis 25:25–78, 1988c) ‘consequentialist’ argument for the SEU preference axioms, but go on to formulate a related diachronic-Dutch-book-style’ argument that better achieves Hammond’s aims. Some deny the importance of Dutch-book sure losses, however, in which case, Seidenfeld’s (Econ Philos 4:267–290, 1988a) argument that distinguishes between theories that relax independence and those that relax ordering is relevant. I unravel Seidenfeld’s argument in light of the various criticisms of it and show that the crux of the argument is somewhat different and much more persuasive than what others have taken it to be; the critical issue is the modelling of future choices between ‘indifferent’ decision-tree branches in the sequential setting. Finally, I consider how Seidenfeld’s conclusions might nonetheless be resisted.     

Evaluating Children's Services: Recent Conceptual and Methodological Developments

This article considers recent innovations and challenges withrespect to the evaluation of children’s services interventions.It sets out a method for designing and evaluating services thatis based on research evidence gathered on individual cases andthat permits revision of those services in the light of emergingresults. It starts by describing briefly different ways of identifyinga discrete group of children with similar needs. It then outlinesapproaches to ensuring that an intervention for those childrenis underpinned by theory and research evidence–includingthe idea of ‘logic modelling’–before discussingthe importance of capturing accurately how well the interventionis implemented. Experimental and non-experimental methods ofassessing an intervention’s effectiveness are considered,with particular emphasis on techniques for enhancing the causalinference that can be drawn from studies and the importanceof matching method and purpose. The article also demonstrateshow the principles and methods used in relation to evaluatingservices for groups can be applied in clinical work with individualcases, and identifies the benefits of this general approachto evaluation over and above the information that it provideson what works.     

Child Sexual Abuse Allegations in the Context of Divorce: Issues for Mothers

Correspondence to Catherine Humphreys, Department of Applied Social Studies, University of Warwick, Coventry, CV4 7AL Summary The investigation and assessment of allegations of child sexualabuse constitute a difficult and contentious area for practitionersinvolved in this process. When these allegations emerge in thecontext of divorce, the problems of assessment appear to becompounded. This paper argues that when mothers raise concernsabout child sexual abuse during divorce proceedings these areoften construed as vindictive or misguided. Such constructionsof mothers have significant implications for the protection,or lack of protection of children in these circumstances. Theway in which this ‘knowledge’ about mothers hasdeveloped is explored and held up against the results of empiricalstudies which show that there is little basis for this constructionof mothers. Possible explanations for this incongruity are suggestedwith a view to progressing child protection in this area. As the court cases go on I can see the hopelessness of the wholething. It's getting stronger in me to want to take the law intomy own hands. I wouldn't say it's revenge, it's not ... I meana mother protects its young. You wouldn't see a lioness lettingsomething attack its young. (A mother expressing her desperation that the Family Court ofAustralia has ordered her to send her child on visits to herex-husband who she believes sexually abused their child.)     

Development and Application of a Standards-Based Inventory of Foundation Competencies in Social Work with Groups

The International Association for Social Work with Groups Standards for the Practice of Social Work with Groups is an essential document for advancing practice and teaching about social work with groups. However, surveys have reported that many group workers know little about the Standards or about how to teach or apply group work knowledge and skills. This article summarizes the research on the development of a reliable and valid inventory based on the Standards and an effective teaching strategy to improve learning about the Standards. The inventory and teaching method provide tools for advancing evidence-based practice and teaching.