Evidence-Based Practice in Social Work: Challenges and Opportunities for Clinicians and Organizations

Evidence-based practice (EBP) is increasingly emphasized in social work, yet effective approaches for translating research evidence into social work practice remain elusive. Despite a growing body of evidence describing effective interventions with a variety of populations, social workers continue to encounter substantial challenges with incorporating knowledge gained from these intervention studies into their routine practice with clients. This paper presents the current research outlining the known barriers and promoters to using EBP in social work clinical practice. Because social workers practice within the context of organizations, we consider the barriers that exist at both the individual and organizational levels that affect clinical social work practice. In addition to addressing the various challenges to incorporating research evidence into practice, we will also discuss a variety of emergent opportunities accompanying the move toward EBP that can be leveraged by clinicians in their social work practice with clients.     

When Is Research Good Evidence? Issues in Reading Research

Although using published research is only one part of the evidence-based practice process, clinical social workers more often doubt their abilities in this area than in client assessment or in the individualizing of treatment approaches to fit client preferences, values and resources. This article reviews the nature of research and the reason it is often a preferred source of information; common flaws to watch for in published research; types of research studies and how different kinds of studies are viewed by those interested in treatment outcome research; and the elements of a published research report that must be considered when deciding on its usefulness for decision-making about practice. It will also include discussion of the controversies that surround these topics, which are significant. While readers will have been introduced to these topics in their professional education, when knowledge is not used it is often not well-remembered. Few clinicians find that reading, assessing, or conducting research is part of their daily work, which is one reason why the discussion of evidence-based practice and other approaches to the use of research in clinical practice can be anxiety-provoking. This “refresher” emphasizes that critical thinking skills, which clinicians often have in abundance, are the single most important element in using research to inform practice.     

Collaborative Data-Mining in an Adolescent Mental Health Service

Summary

As full participants in a collaborative clinical data-mining project intended to promote staff reflection and to improve services, clinicians discovered just how valuable their practice expertise was in maintaining project relevance. In this paper, they describe challenges they faced as non-experienced researchers and writers and how their practice skills enabled them to overcome these challenges. Benefits derived include: enhanced skills (in both practice and research), sensitization to previously overlooked areas of practice, and an increased sense of professionalism.     

Research and Practice:

In this multiply-authored account, five academicians discuss the connections between their work as clinicians and their clinical qualitative research. Each saw connections between practice and research, and each in her or his own domain of interest has found that practice informs research and research informs practice. This article also introduces three major types of qualitative clinical family research: conversational analysis, recursive frame analysis, and hermeneutic phenomenology.     

Teaching Note—Asserting Social Work’s Role in Developing an Interprofessional Education Project

ABSTRACT

Interprofessional (IP) education is an essential component of today’s health care education. IP education has been recognized and supported for its potential to educate workforce-ready health care clinicians with the knowledge and skills, necessary to collaboratively deliver high-quality, client-centered care. While social work’s reflective, patient-centered, and holistic approach to care is invaluable in addressing healthcare challenges at all levels, social work’s lack of involvement in IP health care team practice is evident in the development of IP education curriculum with other health care disciplines. This article describes how one School of Social Work at a regional public university became part of a longitudinal IP education project in collaboration with a large R-1 research university, creating an IP opportunity for Master’s in Social Work (MSW) students. It also discusses the process taken for social work inclusion in the IP project, an experiential elective course designed to supplement the project, as well as Transformative Learning Theory, the conceptual framework used.     

A Working Model of Cross-Cultural Clinical Practice (CCCP)

A long-standing gap between clinical and cultural practice can lead clinicians to feel overwhelmed by the task of integrating clinical practice with a culturally sensitive approach, while working toward changes in clients’ lives. This article attempts to assist clinicians in their efforts to achieve this task. Using a Task-Analysis approach in the alliance research (Safran et al. 1994), this article discusses the development of Cross-Cultural Clinical Practice and proposes a detailed working model for its possible application. A case example is presented to highlight key components of the model. Limitations and implications of the model in clinical social work practice are also described.     

The Social Model of Disability as a Threshold Concept: Troublesome Knowledge and Liminal Spaces in Social Work Education

This paper draws on the notion of threshold concepts to consider the way in which disability studies has the capacity to transform social work students' understandings of disability and therefore influence their practice. Most students enter social work programmes with the professed aim of ‘helping’ and so to be confronted by an approach (the social model of disability) and a body of research and theorising (disability studies) that challenges their taken-for-granted assumption that social work practice is ‘helpful’ is unsettling and can lead to resistance. The purpose of this article is to interrogate practice on a social work programme where a commitment to social model practice is explicated and embedded with the purpose of identifying what it is we want students to ‘get’, whether they find this troubling and how they can be effectively supported as they move through liminal spaces in social work education.     

Engaging with Parents in Child and Adolescent Mental Health Services

This paper asks the question: How can child and adolescent mental health clinicians constructively engage parents as a resource in the young person's treatment? It draws from qualitative research data that explore parents' experience of their involvement in their adolescent's mental health treatment program. The paper especially focuses on challenges for clinicians in engaging with parents as part of the treatment program for young people. Clinicians' input about their perceptions of interacting with parents is utilised alongside parents' experiences of their involvement in clinical processes. The clinician data revealed key challenges were managing their reactions to parent defensiveness; broadening the focus from just alleviating symptoms in the young person; not taking sides with the young person; and resisting becoming an expert instructor. The paper discusses Murray Bowen's original family research about engaging parents in treatment with the symptom bearer and addresses how clinicians can build a positive alliance with parents that avoids blame while constructively opening exploration of the family relationship process as part of a collaborative approach.     

No Easy Answers: Ethical Challenges Working with Sex Offenders

Therapeutic practice with sex offenders and similarly ostracized populations presents unique personal, clinical, and professional challenges for clinicians. This article examines four areas of difficulty—treatment efficacy, clinical competence, boundary maintenance, and stigmatizing policies—and reviews ethical and clinical standards for addressing these challenges. Specific recommendations for competent practice, supervision, research, and advocacy are given.     

Split or Synthesis: The Odd Relationship Between Clinical Practice and Research in Social Work and in Social Work Education

The relationship of practice and research in social work has often been characterized as a ‘split’ in interests and in professional purposes. The same split also appears in social work education. This article examines several issues related to better integrating clinical practice and research in social work and in social work education. The article opens with a historical exploration of the origins of the social work profession as based in differences between practitioners and researchers. Second, differences in the purposes, professional cultures and professional organizations of clinical social workers and social work researchers are examined. Third, the processes and methods of clinical practice and research are systematically compared and contrasted. A chart outlining their similarities and differences is offered. The article closes with several recommendations to improve social work education in both areas that can lead to better integration of clinical practice and research in social work.     

Forensic Patients and Forensic Mental Health in Victoria: Legal Context,Clinical Pathways,and Practice Challenges

Forensic mental health services in Australia have evolved and developed considerably over the past two decades. To clinicians unfamiliar with them, the contemporary practice environments in which professionals deliver specialised forensic mental health services and the legislation governing offenders with a mental illness can appear extremely complex. This article outlines the legislation applying to individuals found not guilty of a serious offence on the grounds of mental impairment in the State of Victoria, describes the characteristics of the forensic patient population, and delineates the clinical pathway forensic patients typically take, using an illustrative case example. The competencies and attributes required by forensic practitioners are highlighted, along with the clinical challenges they face, including the inherent need to address risk in a service that has become recovery-focused in orientation. A central theme of the discussion is how social workers adapt their practice within these highly regulated settings to effectively meet forensic patients' needs.     

Supervising Mental Health Clinicians in The Context of Complex Organisational Dynamics

This article discusses the complex dynamics and challenges of providing supervision to mental health clinicians working within an organisational context when the supervisor is not part of the organisation and has no formal managerial or accountability responsibility. It considers two models of supervision and their application to three supervisory relationships in an organisational context. It concludes that for supervision to be effective there needs to be a consideration of the social defences in operation within the organisation and how they are met by the anxieties and defences of the supervisor and supervisee. This requires a mixed approach by the supervisor of the technical with the inter-subjective as a reliance on one model of supervision risks limiting the effectiveness of the intervention. The role of the supervisor can enable the supervisee to establish a clinical framework and the necessary environment essentials for their practice.     

Clinical Practice with Older LGBT Clients: Overcoming Lifelong Stigma Through Strength and Resilience

This article provides an overview of the unique challenges and strengths of the older lesbian, gay, bisexual, and transgender (LGBT) population and the theories and evidence-based interventions that can be used to work with them in a clinical setting. Two case studies will be used to highlight potential issues in clinical social work and provide guidance for intervention with LGBT older adults. The article concludes with a summary and implications for clinical social work practice.     

The coping model: what is it and what might be its implications for social work practice?

This article examines whether a coping model developed as a framework for analysis of research interviews is useful in social work practice. The coping model emerged from a study involving qualitative interviews with social service clients in Norway, designed to explore how they coped with challenges in everyday lives, both on an individual level and in interacting with their environment. The model emerged from preliminary analysis and was then used in further analysis of the interview data. The study showed that the informants experienced two major challenges: (1) Unemployment and (2) living with a shortage of money over time, even though their life situations were heterogeneous. Some informants experienced potent coping strategies in finding employment and became independent of social services. Other informants experienced shortages in their capacities for work and continued to be dependent on allowances. They used their coping resources to achieve more meaningful life situations without employment. The coping model represents how coping is understood theoretically in the study and the present paper considers the model's relevance and implications for social work practice itself.     

From the Editor—In This Issue

This article critically analyzes challenges that may influence whether evidence-based practice (EBP) enjoys more success than previous efforts to improve the integration of practice and research in social work education. Key challenges include: (1) alleviating disparities in how EBP is being defined by social work educators; (2) maximizing the feasibility of implementing the EBP process appropriately after graduation, while at the same time preparing students not to over-rely on authoritative publications that designate certain interventions as evidence-based; and (3) preventing evidentiary standards from getting softened to the point that EBP becomes a meaningless term, as any study, regardless of its methodological rigor, can be cited to justify deeming an intervention to be evidence based.     

Affirmative Practice and Alternative Sexual Orientations: Helping Clients Navigate the Coming Out Process

Those who differ from the dominant heterosexual ideal of exclusively other-sex attraction and intimacy encounter unique challenges, such as the coming out process, during which individuals with alternative sexual orientations must explore, define, and disclose their orientations in a way straight individuals need not. This article focuses on how clinicians can aid clients throughout the coming out process in a way that affirms the full range of sexual orientations. Following an overview of alternative sexual orientations and models of the coming out process, a case example is used to illustrate how clinicians can help clients address three challenges of coming out: overcoming internalized biases; clarifying their sexual orientation and identity; and making decisions about disclosure.     

Working with fathers of at-risk children: Insights from a qualitative process evaluation of an intensive group-based intervention

This article is based on qualitative research with fathers who attended Mellow Dads, an intensive ‘dads only’ group-based intervention underpinned by attachment theory for fathers of at-risk children. Specifically the article draws on data from a process evaluation of the programme in order to explore the challenges of engaging men in effective family work. The methods used to undertake the process evaluation included participant observation of one complete Mellow Dads course, interviews with fathers and facilitators, interviews with the intervention author and a study of programme documentation. The article focuses on the theoretical underpinning of the programme, its acceptability to the fathers and the challenges faced by facilitators in delivering the programme as intended. The fathers appreciated the efforts of facilitators to make the group work, valued the advice on play and parenting style as well as the opportunity to meet other fathers in similar circumstances. However, there were obstacles that impacted on the effectiveness of the programme. These included the considerable time required to get the men to attend in the first place and then to keep them coming, the lack of practice of parenting skills when fathers were not living with their children, and the difficulties of sharing personal information. The challenges identified raise questions about how much change can be expected from vulnerable fathers and whether programmes designed for mothers can be applied to fathers with little adaptation. The article aims to contribute to ongoing dialogue about the best way to successfully engage fathers in children's well-being, and raises the question as to whether working with fathers requires different skill-sets and approaches from the more familiar social work territory of working with mothers.     

Theory,practice, and perspectives: Disability Studies and parenting children with disabilities

Abstract

In this process-oriented article, the authors weave short personal narratives with theoretical reflections to examine the relationship between Disability Studies scholarship and parenting children with disabilities. The authors present three findings: first, their position as parent-teacher-scholars informs their work in Disability Studies. Second, the work of Disability Studies scholars has the potential to positively influence parents’ understandings of disability; consequently, Disability Studies-informed parenting can influence parent advocacy for their children. Third, parent-scholars have the potential to create research that can positively impact parents, practitioners, and the field of Disability Studies. The authors conclude by arguing that there is a need for Disability Studies scholarship for and by parents. This work is significant because it challenges divisions between theory and practice, and articulates a need and responsibility for parents to grapple with alternative understandings of disability and alternative (collective) ways to create better social conditions for their children.     

A BLUEPRINT FOR INCREASING THE RELEVANCE OF FAMILY THERAPY RESEARCH

Family therapy research and psychotherapy research in general have been criticized for their lack of relevance to clinical practice. This paper presents a fivestage model that family therapy researchers can follow to increase the relevance of their work for clinicians and other consumers of family therapy research. Using lessons derived from private industry, the research model is based on a marketing and developmental perspective.     

What White Mental Health Professionals Need to Understand About Whiteness: A Delphi Study

This Delphi study surveyed an interdisciplinary panel of diversity expert trainers (N=20) about what white mental health professionals need to understand about whiteness. The panel endorsed 162 items that included what white mental health professionals need to understand about historical and contemporary whiteness within the mental health fields and larger social systems, self of the therapist work for white therapists, as well as challenges to understanding whiteness in clinical training and practice. More specifically, the panel provided guidance on the cognitive and emotional transformations necessary for white mental health professionals to address whiteness, as well as the challenges to those transformations. The researchers provide clinical training implications for marriage and family therapists (MFTs) and other clinicians based on the results.