Putting evidence into practice in primary care social work IASW Social Work in Primary Care Conference
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1 Putting evidence into practice in primary care social work IASW Social Work in Primary Care Conference Dr. Helen Buckley Assoc Professor, School of Social Work and Social Policy, TCD 2 nd October 2015
2 Aims of presentation Aim of presentation two fold Look at the business of implementing evidence based practice See how effectiveness in primary care social work can be evidenced
3 What is evidence based practice? Typically, EBP involves the steps of formulating problems or questions, sourcing the best evidence to answer the question, critically appraising the evidence for validity, integrating the evidence with practice experience and specific contextual factors, taking action and then evaluating effectiveness
4 Does EBP fit with social work? The requirement to audit has clearly presented problems for a profession like social work, which is not only context bound and based on a somewhat contested knowledge base, but traditionally practised in the private realm of the worker-client interface. A lot of social work is making sense in the face of contested meanings and conflicting paradigms
5 Is EBP in social care a realistic concept? The assumption that research can be readily translated into practice has been challenged, for example by Brady and Dolan (2007), who consider that its vulnerability to a range of flaws means that it should not be totally relied upon, to the exclusion of other demonstrations of good practice such as show-casing In medicine, cause and effect may be anticipated, whereas in social work, service users come with their own histories and understanding embedded in social relationships and far from being passive recipients of an intervention, are constantly engaging and disengaging. The nature of research in social care is more about increasing background understanding, giving insights into the nature of problems, changing attitudes and beliefs and generating ideas rather than prescribing action (Research in Practice, 2006). Nonetheless, EBP has become firmly embedded in health care and social work has some catching up to do Nutley et al. (2007) argue that the term evidence-informed practice is intended to denote the role played by evidence, whilst acknowledging that that other factors continue to exert some influence.
6 Challenges to performance measurement in primary care social work Quantity vs. Quality Certain results can be ambiguous, e.g service users maintained in their homes, economies in service delivery can mean success but can also mean inadequate service provision Some measures only tell half the story, e.g attendance at meetings, interdisciplinary work; evidence ignores quality Statistical data tends to be full of inconsistencies, yet, it would be valid to claim that the data illustrated in social work statistics is typical, and demonstrates the different perspectives, value systems, organisational cultures and local factors that contribute to identifying and defining social problems
7 Why have performance measurement? Primary care, like family support or early intervention, can be warm and fuzzy with little substance Certain concepts such as support can be quite meaningless Not always clear if needs and services are well matched Neither quantity nor quality of interventions measured at all at times This can mean that interventions can be service rather than service user led
8 What does research say about social workers use of evidence? Decision making is influenced by a number of issues, such as the legal context, practice tools, client needs, experience, intuition, willingness of families to engage, access to resources Some believe that it overlooks the sensitivities and complexities of social work, particularly the importance of relationship
9 Overall findings Barriers: Individual practitioner Lack of access Lack of time for luxury of research Resistance to change Reluctance to prioritise reading research over other tasks Lack of trust in research Lack of critical appraisal skills Lack of awareness of sources Reluctance to formally cite literature
10 Individual barriers: some quotes If I were to sit at my desk reading relevant books you would feel like you were not doing your job The last thing you want to do is read something that creates [more pressure] and then have to try and implement something Why do we keep doing what doesn t work? We keep doing the same behaviours, maybe it s like fear and not knowing any other way
11 Organisational barriers Lack of research culture: action rather than reflection, lack of value attributed to research Competing agendas Lack of resources to promote research implementation Reliance on oral exchanges of information
12 Organisational Barriers: Some quotes You don t want to be considered an upstart! [research] is the last thing to be looked at and used for policy and decision-making.
13 Barriers related to the nature of research evidence Lack of specificity and over simplicity Volume Gaps and lack of relevance Perceived lack of Irish material Conflicting interests of researchers and service providers Complicated presentations including statistics Methods of dissemination: lack of interaction between research producers and research users
14 Barriers related to research material: Some quotes Its very clinical it s not representative of the actual experiences it s not personal it s very much based on science and I m not a great lover of that method You cannot use research to prove anything but use it as a guide. You have to combine it with your own experience the reality is so complex and there are too many variables involved if I am bombarded with a loads of statistics I just tune off might as well be looking into a field of thistles
15 Facilitators: Individual Motivation of individuals Ability to frame well crafted questions Critical appraisal skills Informal sharing in the work place around the photocopier, feedback from seminars, students on placement
16 Facilitators: organisations Time, opportunity and a culture of support Employment of researchers and commissioning research Partnerships with research organisations Informing protocols with research Providing training in critical reasoning Setting expectations and providing incentives Focusing on self evaluation
17 Can service user experience be measured? Service users rate social work intervention very much in terms of the quality of relationship, the level of respect they are accorded as well as reliability, accessibility, empathy and tolerance. Also highly rated are depth of knowledge, evidence of ability to work well with other disciplines as well as access to resources
18 Deconstructing practice into steps which add transparency to the process and make it easier to measure Responding Considering urgency Devising an approach Gathering information Reflecting and analysing Planning Evaluating
19 Initial response Rationale Why now? What is known? What evidence is being presented? What are the strengths in the situation? Does the individual and/or family know about referral?
20 Considering urgency How serious is the concern that is being reported? What are the protective factors? Is there a worrying history? Are there extra complications?
21 Devising your approach What is the purpose of your involvement? What is the time frame? What information is needed from whom? From what other sources should it be got? How do I involve other professionals? How will the individual or family participate in any intervention? What is the priority?
22 Gathering information What are the needs of this person or family? Which needs are general and which specific to their condition or circumstances? How can that need be met within their family, within their extended family, within their informal and formal community? What is needed at each of these levels? Identify different factors impacting on the capacity of carers or community to meet their needs this is a crucial point which can lead you to appropriate interventions
23 Reflecting and analysing What facts, observations and opinions do you have to support the information gathered? What does this mean in relation to the wellbeing of this individual or family? How do practice experience, research findings and literature inform this part of your assessment? Should an intervention be made now? If so what? Has this individual or family the capacity and the motivation to make any necessary changes?
24 Planning and evaluation What are the long term goals here? What are the process (intervention)goals? What resources do you need? How will you know if the intervention is effective? When will you know? What will you do if it is not?
25 Ensuring quality All the above steps need to be based on guidance that enables you to: Be aware of the quality of engagement Reminds you to be participative Keeps your focus on the broad picture Allows you to challenge your view Keeps you gender and culturally sensitive
26 Promoting a more evidence informed way of working Practice manuals Use of evidence in supervision Use of resources, SCIE, Campbell-Cochrane websites and systematic reviews Doing research Research to practice programmes
27 Thank You
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