Post Submitted by Chelsey O’Hare:
I was just reading about Evidenced Based Practice and I can see why it’s controversial in social work practice. From my understanding it seems too stringent and bureaucratic. It’s as if we have to conform to a practice/research style in order to be micro-managed by the bureaucracy that is providing us funding. I also think that it does not leave much room for us to be innovated in social work practice at all; it does not promote our creativity. Studies supporting the effectiveness of interventions typically do not find that the tested interventions are guaranteed to work with every client or situation (Rubin & Babbie, 2013), that statement leads me to believe that social work is trying too hard to prove itself as a science. I also think that there should be a more balanced approach to this while including the dodo bird verdict and including our capacity to be creative and innovative. It seems obvious to me that as a professional we will base our practice on proven to an extent methods.
Learning about EBP has caused me to become more and more disenchanted with social work. I feel like it undermines the ideals and ethics of the social work profession as a profession of change. If we see a problem we are suppose to work for change, and I do not understand how we are supposed to do that if our practice depends on following a practice that occasionally worked for someone else. And it goes back to the complaint I have had for awhile now, which is the focus on clinical work. If we aren’t working towards large social change through advocacy efforts than we are not fulfilling the social work standards of ethics, EBP does not apply to advocacy efforts. The bureaucratic aspect of Evidence Based Practice seems  to be for the sake of capitalism. This leads me to conclude that when put so much emphasis on EBP rather than innovation and creativity, social work just becomes another business.
Posters email: chelsey_ohare@yahoo.com
There are valid concerns here, this is in important topic that each social worker should consider. Is an obsession with EBP taking the emphasis away on from macro social work? Many thanks to Chelsey for this submission.
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There are valid concerns, and in social work as in other professions people tweak figures to make it appear that measures and objectives are met. And yes, the great push is from a capitalistic and bureaucraticperspective, however, having a sound evidence base will help our profession gain the support, understanding, and respect it deserves. The difference is we need to define the evidence and not have it defined for us. We need documented outcomes reporting success in measurable ways in clincial practice as well as macro practice. It’s hard to design a reaseach project around and the collection of data could be unwieldy, espeically in terms of macro, but ultimatly this is very advantageous to our profession. Having a documented knowledge base, and growing with it, can only help us as professional social workers as well as those we serve.
Chelsey, I’m so glad to wrote this. I hope you post more for us.
I agree with you Michelle that we need sound proof but I think the scales have been tipped to heavily towards EBP. Also for community practitioners it has created a problem because when it comes to advocacy, public policy and community organizing there is no solid way to demonstrate outcomes. this has resulted in foundations being hesitant to fund these types of programs. Steven Teles & Mark Schmitt did an excellent report on this which can be found here http://www.ssireview.org/articles/entry/the_elusive_craft_of_evaluating_advocacy
Melinda K. Lewis also blogs often about her quest for a evaluation tool that will accurately measure advocacy outcomes.
On the surface perhaps, but it depends on our goals, we can measure if children eat, if poor capture wealth…
EBP is vital to proving we are a worthwhile profession. If we never attempted to measure our practice or determine outcomes, we would still be following Freud. There is an absolute need for qualitative work, and as we understand the social sciences more and more, this might become easier to measure as well. Don’t let anyone stifle your creativity, just become creative in the packaging of it.
Adman with all things there needsto be balance between the rational and intuitive.
Yes, balance. That’s the thing, it is so out of whack. I remember one of my professors complaining about this because he felt the students where too obsessed with EBP and completely discounting intuition. And who is to say that intuition won’t lead to something that can eventually be measured for validity? Innovation requires not only intelligence but also imagination.
I agree with what was written in that EBP places emphasis on bureaucracy over practice. I also think that EBP is about evaluating practices through a scientific method which also has a Eurocentric bias too. Thoughts?
Scientific method works, period. Associating cause and effect accurately works for every culture. For social work to be taken seriously as a profession, our actions need to be evaluated for effect. I’ve run into far too many therapists the believed using psycho-jargon and sing-song voices to clients equaled treatment; complaints by foster parents that taking kids to therapy was a waste of time is often all too valid. MSW programs only scratch the surface of clinical training- techniques and methods need to be evaulated- it is a serious ethical issue. Billing or getting paid for a service under the guise of resolving a problem, but failing to help due to lack of proper skill, is unethical for every profession. Social work is no exception.
Einsteins leaps came.not from the scientific method but from imagination. We must be careful that the rational does not obscure the fantastic
Imagnation is important, but it also must be controlled to negate poor (or even harmful) outcomes. Trials, particularly controlled trials, reduce risk and test potential methodologies for effectiveness. Post follow-ups further document outcomes to verify usefullness. I don’t want my hands tied having to stick solely to what has been deemed evidence-based, but I do want to know the tools I use are known to be helpful. I also want to build on already existing evidence base, and as social scientists –which is where social works foundations rest, we are perfectly justified, if not encouraged toward those ends. We had to take research and stats for a reason, though many of us would rather not have done so.
I think the main point is that even evidence does not.make a theory true in any real sense. There is a tendancy to put.on those blinders
If someone says black others say white. No.one is arguing the need for forms. Forms.helps us understand the complicated world. Forms are the world delineated, but that real.world.can never be delineated absolutely. Forms help us understand the formless world. Black contains white and white black. The world.could not be otherwise. If we trade our hearts for statistics we are lost, if we clings to.our hearts and.ignore statistics we are lost. We must be.more skilled and sensible to think that the defense of one commits to the abandonment of the other
Einstein NEVER abandoned ther scientific method!! He had imganitive leaps from previously proven scientific data– then he had to PROVE his theory via scientific method with peer scrutinity. Otherwise, he’s be viewed as a nut job, not a valuable scientist. Science does not squelch innovation- it is the process used to evaluate ideas to see if they are accurate interpeations of the world. Use your heart to guide you– use science to evaluate if following your heart is truly acheiving your goals. Self-delusion and false inferences are common thinking errors- scienctific method weans us from those. We owe our clients no less than our best.
I did not use the word abandoned at all, in any sense. I said his greatest leaps came about using his imagination…….but let’s see what Einstein says on the issue..
“All religions, arts and sciences are branches of the same tree. ”
“We cannot solve our problems with the same thinking we used when we created them. ”
“No problem can be solved from the same level of consciousness that created it. ”
“Imagination is more important than knowledge. ”
“Education is what remains after one has forgotten what one has learned in school. “
My greater concern is not in pursuing building evidence based practice models as a norm, it is more on the possiblity of paper achievements, of tweaking figures to make it appear that newly instituited measures and objectives are met while not actually changing anything; of business as usual, while ignoring the huge possibility in front of us which could transform the poorly performing status quo. I am sure many have witnessed this across agencies.
Corruption of data to suppport and sell techniques is a major ethical concern. I think this occurs frequently, as issues can be so complex- and politically sensitive- that people that want to sell their services avoid real issues, and use data incorrectly to further their program for monetary gain.
Nowhere in Einstein’s quotes does he say “Do not evaluate your ideas.” Scientific method is exactly that- evaluation of ideas to ensure they are effective. I wouldn’t pay a plumber, an electrician, a surgeon, or a dentist to use their “Imagination” alone to address my problem- why should anyone expect social workers to do the same? Creativity it important- but it must be based on proven methods, otherwise one is conducting an unethical experiment on human lives.
EBP is interesting and I think something to be aware of in practice and I do mean that. But, so are a number of theories and approaches to counseling or acupuncture or tea leaves hung around the neck to reduce anxiety (assuming one isn’t allergic), or an evening with the family in the sweat lodge. In my early days of stumbling along trying to feel like I knew what I was doing I met a psychologist who was in the field many years. He often worked with native americans. I respected him quite a bit and he was one of several mentors along the way for me. Try to imagine, coming from the east coast, that I am reading Masterson’s theories of treating borderline and narcissistic personality disorders and here is this psychologist telling me how he would teach the native american family he was working with some ritual for them to do to bring them peace and comfort. I would look at him like “What did you say?”. It was confusing for me and at times I felt it was unfair as well because that didn’t fit with my concept of what a therapist does. Feeling pretty green and wanting to hold onto some sense of competence, I wanted reassurance about how the world goes round and for it to fit in some comfortable way. He helped a number of people even though I sometimes thought this just west coast crazy thinking ( too comfort myself I assure you).
Too try and pigeon hole what we do so rigidly is such an over simplification of the process as to be naive and at times foolish. Does anyone remember years ago when they studied the “great masters” in psychotherapy and documented every word, nuance, phrases that the “great ones” uttered, or mumbled in some cases. The thinking was if we just copy what they do then it can be duplicated and provide the same results. Wouldn’t that be brilliant? Well, they learned it’s not that simple. That the 26 year old graduate student behaving like Albert Ellis somehow didn’t cut the mustard. There are too many intangibles to the science and art of therapy. And don’t think that there isn’t other agenda’s associated with creating a lock step, cookbook approach to treatment. The bill payers would love to make this part of health care more simple to assess. The idea of making some chart they can look at and say “well that 300.40 should be better in 7.75 sessions” and “why aren’t you reading affirmations in each session as the model says………….” Insurance companies hate things that aren’t black and white. Now before you get yourself in a tizzy, and you know who you are……. I respect that if EMDR is obviously proving more helpful to trauma victims of all types, then that’s where I’m recommending they go. If a client has a substance abuse problem and want to do marital counseling and ignore that issue, most of us would or hope they would, have the good sense to realize that’s not likely to be very successful. Now, I guess you could go down that road while incorporating motivational therapy with it. But, there I go being creative or perhaps not following the cook book. Anyway, enough! I think I made my point. Oh, another thing, If you think EBP is going to protect the public anymore than presently I strongly disagree. You will still have professionals making poor judgements, unethical choices, or just plain poor therapists even if they have a cook book. After all does a cook book make a great chef? Also, and I promise to stop after this, what is this idea that we have to prove ourselves?? I’ve been hearing that for over 30 years. I certainly don’t see myself standing up with pride and a deep sense of achievement for the profession if some time in the future the front page of NASW says ” 95% of all social workers base their practice on EBP.”
Thank you for the detailed thoughts and honest words, the issues you have raised are number 1 on my problems with social work in general, trying to memorize techniques instead of learning to trust ourselves is not honest practice!
Matthew,
Well it comes with over 30 years of being in the profession and the perspective that provides.
It’s very welcome so stick around!