Professor Donald Forrester, in a new book, argues that the evidence-based model should be integral to all social work practice approaches
One of the most worrying aspects of the Baby P case was the failure of social work to be able to defend itself in the face of a firestorm of media criticism. In other professions individuals were held to account, but the entire profession of social work was judged and reformed.
This seems to be related to a more profound problem, namely whether we – the social work profession – can articulate and defend a convincing vision of what we do and the contribution that it makes. It seems that at present the answer to this question is sadly “no”.
The academic critiques of the current system – while they correctly identify bureaucracy and managerialism as huge problems – do not offer a vision of social work that appeals to politicians and policymakers.
The solution lies in three actions. First, investment in developing an evidence base to tell us what works for social work. Second, a commitment to using evidence-based ways of working (which may mean workers being expected to use specific approaches). Third, a focus on professional excellence in developing and delivering evidence-based approaches that recognises the time and skill required (as opposed to a belief that such approaches can be delivered as a cheap or simple option).
The idea that interventions should be based on evidence in social care has to be tempered by the fact that each individual and family is unique and it is difficult to specify approaches. But, in fact, this is true of many interventions – from prescribing medicines to teaching children to read. We would nonetheless expect professionals providing interventions to use those with the best evidence, rather than the one they like or “common sense”. It is difficult to see why social work should be different, and impossible to justify the failure of social work researchers to study what works or the failure of social work systems to use approaches based on evidence.
I would argue for interventions based on evidence from studies which compare one intervention with other ways of working (including normal service).
There have been many criticisms of this vision of evidence-based practice. One is that it can fail to be critical of social and political factors involved. For instance, cognitive behavioural therapy is an evidence-based way of helping people with depression but does not address the fact that depression is often created by social factors.
A pragmatic criticism is that EBP can too easily be used as a tool of central control.
Another consideration when using evidence-based approaches is the time and attention that needs to be spent controlling the quality of the intervention and the upskilling of practitioners to deliver it. All too often pilot projects fail to replicate their findings when rolled out to other settings. This is a key issue relating to the importance of excellence in the delivery of service.
I would argue, however, that a focus on delivering evidence-based approaches would provide the structure that social workers need to deliver excellent services. If we do not wrestle with these issues and develop our own form of EBP – one that can avoid simplistic and individualistic approaches and take seriously the complexities of delivering excellent practice – we will increasingly find an unsatisfactory and managerial form of EBP imposed upon us.
This is because – despite EBP being largely rejected by the social work community – policymakers, politicians and the public readily see the logic of a profession basing the work it does on evidence of effectiveness. They see that EBP adds a level of transparency and accountability.
Most importantly, EBP provides a fresh way forward for those interested in developing excellence in practice. For in contrast to the dominant, managerial approach – which focuses on bureaucratic collection of data on processes – EBP focuses on what happens when a practitioner meets a client and what the outcome is.
For this reason EBP is compatible with “reflective” and “relationship-based” approaches that are popular among social work academics. Indeed, almost all evidence-based ways of working rely on relationships and use reflection – and it is difficult to see why the public should fund relationship-based or reflective ways of working if we cannot show they make a difference. EBP needs to be integral to these approaches rather than seen as different to them.
Donald Forrester is director of the Tilda Goldberg Centre at the University of Bedfordshire
More details of Children’s Services at the Crossroads from the Russell House website
This article is published in the 24 June 2010 edition of Community Care magazine under the headline Invest in What we Can Prove Works