A Commentary on David Drucker's “Ask a Silly Question,Get a Silly Answer

ABSTRACT

This commentary views Drucker's paper as an example of practitioner research aimed both at developing a stronger evidence base for the profession, and promoting a form of thinking useful to Western social work practice. Links are also drawn between the ideas expressed in “Ask a Silly Question” and participatory social work in several non-Western parts of the world.     

社会工作研究的人文精神——对以实证主义为导向的美国社会工作研究的批判

长期以来,国际社会工作研究常常倾向于以实证主义和经验主义为基础的研究导向,特别是在美国,基于证据的研究方法在社会工作领域十分流行。随着全球化的推进和人们生活方式的现代化,社会工作研究所面临的问题更为复杂,其解决方法单纯依靠各种技术处理的手段来展开是远远不够的,我们在讨论这些问题时,要强化其价值导向。这要求我们在讨论社会工作研究的问题上,把我们的关注点从证据、技术手段和职业标准扩展到价值观、人文精神和对全球化问题的关注等方面,以此来推进国际社会工作的发展。     

Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes

This study describes the implementation of three evidence-based treatments addressing traumatic stress symptoms within a wraparound foster care program in Illinois. Child–Parent Psychotherapy (CPP), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) were implemented with a racially diverse sample of youth ages 3–18 at six agencies. Culturally sensitive adaptations were made to treatment approaches to improve client retention and outcomes. Data analyses revealed no racial differences in retention in the program and no differences in outcomes between minority youth exposed to the intervention and other participants. All three evidence-based treatments were effective in reducing symptoms and improving functioning among minority youth. Implementation issues, including challenges and culturally competent accommodations, are discussed.     

The fusion of culture and science: Challenges and controversies of cultural competency and evidence-based practice with an African American family advocacy network

This paper identifies interrelationships between evidence-based practice (EBP), radical structuralism, and culture, arguing that culturally-specific beliefs and norms should be integrated into evidence-based, cross-cultural partnerships within child and family service systems. A single case study of family advocate training in evidence-based practice is provided as an illustration of, and impetus for, the development of a format for use with community-based and ethnically-diverse parent/family advocates. The lessons learned from teaching evidence-based practice to a parent advocate in a particular child welfare service system are highlighted. The use of enhanced roles for social workers and indigenous social capital and resources, such as family advocates as allies, is recommended to help achieve a greater degree of accountability, cooperation, and core understanding in the use of EBP. By training racially-diverse foster parents as mental health advocates to work collaboratively with policymakers, community groups, and family participants, proponents of EBP will reach and benefit more diverse populations.     

Building cultural competence: A systematic evaluation of the effectiveness of culturally sensitive interventions with ethnic minority youth

Growing diversity within the US population accentuates the need for the development and implementation of culturally competent services in the field of child welfare. Despite this, few studies exist that examine the effectiveness of culturally sensitive interventions (CSIs) with ethnic minority populations, who are considerably more at risk of developing psychosocial problems including substance and alcohol abuse, delinquency, low academic achievement, and poor self-esteem. With the demand for evidence-based practice it is imperative that we examine the effectiveness of CSIs designed to prevent and treat youth problems. The main goal of this review was to systematically analyze the methodology of recent CSI research with populations of ethnic minority youth in order to evaluate each intervention's ability to adhere to existing standards of evidence-based practice. The fifteen CSI studies examined in this review illustrate progress in their attempt to adhere to the methodological rigor required of evidence-based practice. This review encourages the field of child welfare to position itself analogously with and embrace the movement toward building cultural competence by further investigating the effectiveness of culturally-sensitive interventions with ethnic minority youth.     

Issues in Portability of Evidence-based Treatment for Adolescent Depression

Depression is one of the most commonly diagnosed psychiatric disorders among school-aged youth, with high prevalence and far-reaching consequences. However, even though there are two evidence-based practices for treating adolescent depression (Cognitive-Behavioral Therapy and Interpersonal Therapy), most adolescents referred for treatment are unlikely to receive either. In part, this is due to the difficulty of transporting an evidence-based practice from laboratory to real-world setting, and determining how to transport an empirically validated treatment has thus become a focus of concern for social work researchers and practitioners. A host of client, clinician, setting, and treatment delivery variables can influence portability. Taking all these factors into consideration is a daunting task—but less daunting if done at the onset, during the initial process of efficacy research, rather than afterward as a separate stage. The thesis of this paper is that the only solution to the problem of portability is a combined, rather than sequential, approach to treatment development in which effectiveness and application concerns are included in the original research design. A review of suggested approaches, as well as discussion of factors that contribute to variance in outcome, is followed by recommendations for future research.     

Evidence-based practice: from medicine to social work

The last 10 years have witnessed an increasing interest in evidence-based practice in the field of medicine. The product of a time characterised by the explosion of information technology, a heightened sense of risk, and the enshrining of the principles of economy, effectiveness, transparency and consumerism, evidence-based practice has rapidly expanded from medicine to other fields, including social work. The new paradigm has generated not only great enthusiasm in many areas of the social work profession but also an intense debate about the transferability of the principles of evidence-based practice from medicine to a discipline that operates amidst particularly complex and multifaceted societal factors. Similarly, the concept of evidence upon which social work practice should be based has been the object of considerable discussion, though initial emphasis on results from randomised controlled trials seems to be gradually shifting towards broader approaches to defining evidence. Although organisational constraints and job pressures are likely to favour the use, among practitioners, of ‘preappraised’ resources, this should not prevent social workers from acquiring the skills and knowledge necessary to make independent and critical appraisal of evidence.     

An overview of evidence-based program registers (EBPRs) for behavioral health

Evaluations of behavioral health interventions have identified many that are potentially effective. However, clinicians and other decision makers typically lack the time and ability to effectively search and synthesize the relevant research literature. In response to this opportunity, and to increasing policy and funding pressures for the use of evidence-based practices, a number of “what works” websites have emerged to assist decision makers in selecting interventions with the highest probability of benefit. However, these registers as a whole are not well understood. This article, which represents phase one of a concurrent mixed methods study, presents a review of the scopes, structures, dissemination strategies, uses, and challenges faced by evidence-based registers in the behavioral health disciplines. The major findings of this study show that in general, registers of evidence-based practices are able, to a degree, to identify the most effective practices meet this need to a degree. However, much needs to be done to improve the ability of the registers to fully realize their purpose.     

Early assessment of implementing evidence-based brief therapy interventions among secondary service psychiatric therapists

This implementation study was part of the Ostrobothnia Depression Study, in Finland, which covered implementation of motivational interviewing (MI) and behavioral activation (BA) within regional public psychiatric secondary care. It aimed to evaluate the mid-term progress of implementation and related factors. Altogether, 80 therapists had been educated through the implementation program by the point of the mid-term evaluation. Eligible information for evaluation was gathered using two questionnaires (q1, q2) with a one-year interval.A total of 45 of the 80 therapists completed q1, 30 completed q2, and 24 completed both questionnaires. Professional education was the only background factor associated with adopting the interventions (q1: p = 0.059, q2: p = 0.023), with higher education indicating greater activity. On the basis of trends such as changes in overall usefulness score from q1 to q2, the most involved therapists were slightly more likely to adopt MI/BA. Our experience so far suggests that encouraging staff to begin using new interventions during education is very important. The Consolidated Framework for Implementation Research was found to be a useful tool for constructing the evaluation.     

Do Family Meetings Improve Measurable Outcomes for Patients,Carers, or Health Systems? A Systematic Review

Abstract

Family meetings are a common intervention in acute and subacute inpatient care settings. The aim of this systematic review was to investigate the quantitative research exploring the impact of inpatient family meetings on patient, carer, or service outcomes. A search of electronic databases (Medline, Cinahl, Embase, PubMed, and Psychinfo) was conducted from the earliest available time until July 2012. Inclusion and exclusion criteria were applied, and quality assessment of included articles was conducted. Eight studies were included in the final selection. Results indicate that there is some low-to-moderate quality evidence that inpatient family meetings reduce psychological distress of family carers and assist in meeting their information and support needs. There is weak evidence that inpatient family meetings may help to reduce readmission rates and facilitate entry to continuing care programs.