January 27

What is evidence based practice in social work?

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Theory?

What theory?

I threw that out of the window after university!

My colleague started laughing.

I couldn’t see the humour in that.

During my first placement, I was very curious.

I asked many questions.

In fact, I asked so many questions that there was a dedicated time at the end of each day to answer my questions.

That afternoon, I asked my colleague what theories she used in her work with clients.

Her reply disappointed me.

Introduction

I will be the first to admit.

Sometimes, I don’t know what I’m doing with a client.

I don’t know what theory I’m using to inform or intervene my work, or even where I’m going with a client.

Maybe you feel the same.

You sit in the room with the client. Issues are raised.

You sit there, and wonder:

Where do I go with this?

How do I move forward?

It’s tempting to think that evidence-based practice is going to solve all your problems.

Give you answers to how to proceed with the clients you’re stuck with.

Today’s article isn’t meant to use evidence-based practice as another stick to whack you with.

Follow this! Or not…

Use more evidence! Or not…

Rather, it’s to see how your practice can be better informed with evidence, rather than with your gut.

What is evidence-based practice?

EBP is a process that requires practitioners to identify, evaluate, and apply evidence pertaining to a client’s problem to subsequent practice decisions

Jenson (2007)

Put simply, your social work practice should be based on evidence. What you do, and what you do moving forward, needs to be supported by evidence.

You don’t just use your gut.

It’s not like cooking. You don’t add sugar and salt ‘to taste’.

Similarly, you don’t add an intervention, or use another approach, based on what you feel.

It should be substantiated.

Or should it?

What is the distinction between evidence-based and evidence-informed?

There has been debate over whether evidence-based practice is the best way forward.

As Nevo and Slonim-Nevo (2011) argue, part of that has to do with how evidence-based practice seems to place academic evidence over the clinical expertise of the practitioner and the client’s wishes.

They also argue that evidence-based practice seems to imply that your social work practice interventions can be sufficiently justified with current ‘best evidence’ (2011:1179).

Instead, evidence-informed practice defends a holistic view of practice as being ‘informed by, but not adequately based on evidence’.

Whilst evidence supports your work, it does not become the basis by which you do your work.

There remains considerable flex in how you decide what you do.

Triangulating evidence for evidence-informed practice (RIPFA 2018)
Triangulating evidence for evidence-informed practice (RIPFA 2018)

So what now?

In the rest of this article, I share:

  • our common problems with EIP
  • how you can better use evidence-informed practice in your work

Our problems with EIP

As a practitioner, I’ve noticed that my colleagues (and myself!) tend to struggle with an evidence-informed approach to social work.

NO TIME!!!

Oh the perennial problem.

No time! I have no time!

How do you expect me to read more academic papers, reflect on the expertise of others, and to use evidence to further inform my practice?

You’re expecting too much, John!

Do you know how stressful being a social worker even is!?

Overwhelming casework, piles of case notes that are left untyped, overflowing inboxes… oh we all know the social worker’s life.

Expecting you to use more evidence to inform your practice seems a bad idea.

Or is it?

You post-rationalise

You may post-rationalise your actions. When someone asks you to share why you did what you did, you plonk in a fancy-sounding theory.

You don’t have to raise your hands if you’ve done that.

I’ve done that most of the time during supervision.

Post-rationalising can be helpful to reflect on what you did.

It might not help you to know how to move forward.

But using evidence to inform your practice also means using evidence before your practice.

For example, you are stuck with a client. You wonder how to move forward.

3 options.

  1. Ask your supervisor/colleagues for help.
  2. See if there’s research or academic books on the problem you’re facing with the client.
  3. Recall what has worked for previous clients of yours with similar problems.

Why do we need evidence-informed practice anyway?

If there’s one reason, it’s to help you progress.

Mind you, I’m not saying that it’s to help your client progress. But to help you.

You’re always going to have difficult clients, with difficult problems that struggle to be solved.

There are days where you fail.

This is inevitable.

But not learning from these failures, is foolish.

You let your failure go to waste.

Evidence-informed practice intervenes at the point of your failures in social work. You can then bounce from failure to success.

How do you apply evidence-informed practice?

So you have no time, no energy, and no idea how to better use evidence-informed practice?

By far the most important thing is to commit to getting better.

As Angela Duckworth wrote in her book ‘Grit’,

Some people get 20 years of experience.

Others get 1 year of experience, 20 times in a row.

Don’t get 1 year of experience.

Leverage that experience, through evidence-informed practice, to make your experiences count.

Make it a practice.

It’s a practice.

So practise it.

Making it a practice is about making it regular.

Commit to it.

Here’s what might help.

Adapted from Daryl Chow, Scott Miller and Mark Hubble, their ARPS framework seeks to embed deliberate practice within psychotherapy.

Whilst their work is for therapists, it is useful for social work too.

  1. Automated structure
  2. Reference Point
  3. Playful experimentation
  4. Support
evidence based practice in social work
The ARPS framework for deliberate practice

Automated Structure

Every Wednesday morning, from 1100-1200, I block out an hour for reviewing of a client session. I set this as a recurring appointment on my Outlook calendar. Colleagues know that I’m not to be disturbed during that time.

I block out Wednesday mornings because a mid-week date works better for me to know if there are things I should adjust for the rest of the week.

Every week, I record a client session. I make this the default option for the clients I see. In my own experience, I’ve come to see that the discomfort is more often my own than the client’s. Be clear with the client that it is for your own review, and nothing else.

If a client expresses discomfort, please do not push the issue.

Reference point

Be clear about what you’re working towards.

Have concrete goals that you are working towards.

Daryl Chow and Scott Miller’s Taxonomy of Deliberate Practice Activities (TDPA) offers a way for you to track your progress.

There are three steps to understanding your reference point.

  1. You need to first know where you are.
  2. Know where you want to go.
  3. Then understand how to get there.

At the end of each workweek, write a short 150 reflection to the question:

What is one thing that stands out, that I want to remember?

Playful experimentation

Review a 5-10 minute segment of your recording.

What would you have done differently in that moment? How might you do it differently in future?

Support

Find a supervisor who’s willing to sit and watch recordings with you.

Don’t just talk about the clients you manage. At some point, you will realise that there’s a limit to how much can be gleaned from discussing the client, without the client.

Expect more from your supervisor.

Read.

Okay, okay, you don’t have time to read.

And you’re probably sick of reading so much case notes, assessments, and emails.

Yet I’m asking you to read!

Yes.

But I don’t like reading!

You’re reading comments on Facebook?

Fancy captions on Instagram?

The long essays people send to you over WhatsApp?

Yup, you’re probably a reader.

More of a reader than you readily attest to.

You know the benefit of reading. I wouldn’t belabour the point.

But I would encourage a different way of reading.

Read books that are targeted towards a mainstream audience.

You might find your eyes squeezing shut whilst reading another academic paper.

Self-help and pop psychology have been all the rage over the past decade. People are looking for quick-fixes. You might think that they are shallow on content.

But books written by therapists and social workers for a more mainstream audience have their merits.

They offer useful thoughts you can explore during your client sessions.

You can learn more from them, and enjoy yourself at the same time!

Some books I recommend include:

  • Rising Strong (Brené Brown)
  • Daring Greatly (Brené Brown)
  • Maybe you should talk to someone (Lori Gottlieb)
  • The Art of Possibility (Ben and Roz Zander)

Conclusion

Evidence-informed practice seems like yet another to-do on the ever-growing list of things social workers have to do.

But better social work starts from better social workers.

EIP isn’t just to make clients better.

It’s to make you better.

At the end of the day, no one likes getting stuck in the plateau of pain.

Where you try this and that, but nothing moves.

Evidence-informed practice is about bringing progress, little by little, one day at a time, to a profession where we believe in better.

That whatever difficult situation someone finds themselves in, it can be better.

Maybe we can be better too.


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