Eileen D. Gambrill

Educational Policy and Accreditation Standards: Do They Work for Clients?

2. On what criteria should standards and policy be based? For example, should they be based on authority (consensus) or on evidence that pedagogical theories and practices contribute to preparing social workers who provide effective, efficient, ethical services to clients (i.e., contribute to solving problems)? Should standards be consistent with research findings regarding the evidentiary base of educational theories and practices used in relation to promoting client well-being and justice?

An assertion inventory for use in assessment and research

The Assertion Inventory is a 40 item self-report inventory which permits respondents to note for each item their degree of discomfort, their probability of engaging in the behavior, and situations they would like to handle more assertively. Normative data from a college population as well as data from women taking part in assertion training groups are included. Comparative distributions of these populations over four combinations of response probability and discomfort scores are presented as well as reliability and validity data. The value of the Inventory both in clinical settings and in research is discussed.

Evidence-Based Practice: An Alternative to Authority-Based Practice

There is no agreement on “one way of knowing” in social work, and it is certainly not scientific reasoning that is accepted, as can be seen by examining the literature in social work on “different ways of knowing.”

Evidence-Based Practice: Counterarguments to Objections

Evidence-based practice (EBP) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of clients. The authors describe and offer counterarguments to objections to EBP. These objections could result in premature dismissal of this new form of practice and education that offers potential benefits to social work and its clients. Objections to EBP fall into six categories: (a) arguments from ignorance about the nature of EBP, (b) misinterpreted professional standards, (c) arguments appealing to tradition, (d) ad hominem arguments, (e) arguments on ethical grounds, and (f) philosophical arguments. Reviewing objections to EBP may help us to increase our understanding of barriers to use of practice-related research findings in the helping professions and honoring related requirements described in our code of ethics.

Evidence-Based Practice and Policy: Choices Ahead

Choices about how to view evidence-based practice (EBP) are being made by educators, practitioners, agency administrators, and staff in a variety of organizations designed to promote integration of research and practice such as clearinghouses on EBP. Choices range from narrow views of EBP such as use of empirically based guidelines and treatment manuals to the broad philosophy and evolving process of EBP, envisioned by its originators, that addresses evidentiary, ethical, and application issues in a transparent context. Current views of EBP and policy are reviewed, and choices that reflect the adopted vision and related indicators are described. Examples include who will select the questions on which research efforts are focused, what outcomes will be focused on, who will select them and on what basis, how transparent to be regarding the evidentiary status of services, how clients will be involved, and whether to implement needed organizational changes. A key choice is whether to place ethical issues front and center.

Risk assessment in context

Abstract This article provides an overview of the context in which decisions about risk are made in child welfare including personal, task, and environmental factors that may contribute to uncertainty and less-than-optimal decision making, as well as some of the methodological challenges posed by the use of current risk assessment instruments. Actuarial, consensus-based, and clinical instruments are discussed and the more successful track record of actuarial decision-making in child welfare and related fields is highlighted. Methodological challenges to assessing risk are also presented including lack of reliability and validity of measures, definitional dilemmas, temporal issues such as changes in risk over time, absence of base rate data, predicting for individuals and sensitivity and specificity of measures. Implications for the design and implementation of risk assessment tools are considered in light of contextual influences and methodological limitations. Lastly, an overview of the contents of Part One of this special issue on risk assessment is provided.

Social Work: An Authority-Based Profession

Although social work is flourishing by many outward signs, such as the increased number of schools of social work, it is argued that this growth has not honored obligations in our code of ethics, for example to inform clients, to empower them, and to offer competent services. A great disconnect continues between what we say we do and value and what we actually do. Change in this pattern will be encouraged by increased client access to information over the Internet and the evidence-based practice movement, which encourages transparency of what is done and to what effect, and involvement of clients as informed participants in decisions that affect their lives.

From the Editor: Evidence-Based Practice: Sea Change or the Emperor’s New Clothes?

There are many lenses through which to explore the history of a profession.· One is in relation to reactions to new developments originating either outside or within the profession . What will be the reactions of the social work community to evolving developments in evidence-based health care as described in original sources such as Sackett, , Richardson, Rosenberg, and Haynes (1997) and Gray (1997)? Evidence-based practice originated in health care as an alternative to authority-based practice (for example basing decisions on uninformed opinions) . Origins suggested by Gray (2001) include: (1) the study of variations in service decisions and clinical practice, (2) gaps between practicerelated research findings and what was done, (3) economic pressures, (4) the knowledge revolution including the evolution of the systematic review and description of flaws in traditional modes of dissemination such as

The need for comprehensive risk management systems in child welfare

Abstract Risk assessment studies in child welfare have largely focused on identifying individual or family risk factors associated with future harm or on the value of various assessment tools constructed of such factors, paying scant attention to the risk posed by the system and its larger context. These risks include services provided to children and families that have little or no evidence of effectiveness, lack of proper assessment of service needs, inadequate linkage of available services to desired outcomes, and an agency culture that is reactive rather than proactive in its pursuit of risk reduction. Drawing on related literature, this article introduces guidelines for the development and implementation of a comprehensive risk management system in child welfare.

Evidence-based practice and the ethics of discretion

• Summary: The purported purpose of literature in the helping professions is to contribute to helping clients. Most authors who prepare articles are employed in universities and colleges which claim to value the pursuit of truth. Yet the professional literature is rife with inflated claims of what ‘we know’ and ‘do not know’ as well as distortions of ideas and issues. Nowhere is this more obvious than in the steady misrepresentation of the process and philosophy of evidence-based practice (EBP). Authors have exercised their discretion to misinform rather than to inform readers about this new idea that is so compatible with social work values and obligations described in professional codes of ethics (for example, to involve clients as informed participants and to be competent) and so sensitive to practitioners’ need for tools that enable them to meet ethical obligations in a context of uncertainty and lack of resources when making life-affecting decisions. • Findings: Evidence-based practice was developed to help practitioners to deal with the inherent uncertainty of practice in an informed, accountable way, paying attention to the need to develop tools to enable this process, such as the Cochrane and Campbell data bases of systematic reviews related to specific clinical and policy questions as well as constraints such as dysfunctional organizational practices and lack of resources. The importance of considering the unique circumstances and characteristics of each client, including their values and expectations, as well as the limitations of published research (e.g. inflated claims of effectiveness and hiding of disliked alternative views) is highlighted. Decision-making is viewed as a complex process requiring individual tailoring of decisions on the part of practitioners as well as skeptical appraisal of claims in published research. This process and philosophy shares core values promoted by social work. The process and philosophy of evidence-based practice as described in original sources is not presented in the majority of publications in social work. This makes it impossible for readers to understand the original vision as well as recent developments in its application. Indeed, the five-step process involved in EBP described in original sources is typically not described, even in entire books on the subject. Given that new ideas may benefit clients, for example by enabling the honoring of ethical obligations and encouraging the development of tools that practitioners need to make informed (rather than misinformed or uninformed) decisions, this is a concerning lapse. Many authors have used their discretion to hide rather than to reveal this new idea and related developments, such as new ways to involve clients as informed participants. Reasons why are suggested, including the play of propaganda in the helping professions, the failure to read original sources, and a detachment from the needs of direct line staff and clients. • Applications: This article suggests ethical obligations in exercising discretion when choosing how to describe new ideas (e.g. accurately or in a distorted form). The importance of reading original (rather than secondary) sources is emphasized.