Transcript crafting an Evidence base for social work practice

Jim Chaousis, MMHSc, AASW, ISPS
Principal Social Worker
Perth, WA 28th March , 2012
INTRODUCTION
A conversation about the
theme of the mental health
symposium
“Haven’t social workers been
operating in the public mental
health system since the early
sixties – the theme seems to
suggest that your profession
is still trying to figure out what
the evidence base for practice
should be-surely it’s some kind of
joke Jim?”
INTRODUCTION
A short story about Mario – the visual artist
WHAT I WILL PRESENT
A. Describe the education of social workers in mental health as a
clue to the broad knowledge base (and evidence) underpinning
practice
B. Explore what factors enable or stifle the uptake and learning's
around crafting an evidence base, including what constitutes
evidence.
C. Draw some conclusions and make some recommendations
SOME QUOTES
Practice not informed by evidence is a recipe for
bamboozlement. (Gambrill, 2001)
The dominant orthodoxy of regarding the results
of experimental research as evidence, and all
other knowledge as something other than
evidence does not reflect the understanding of
practice held by many healthcare
providers.(Pearson, Wiechula, Court & Lockwood,2007)
INTRODUCTION- WORD ANALYSIS
CRAFTING
• To make or construct
in a manner
suggesting great care
and ingenuity
• Craftsmanship is
quality driven
INTRODUCTION-WORD ANALYSIS
EVIDENCE
Evidence (noun)
• knowledge on which
to base a belief
• facts for making a
conclusion, or in
support of a belief
• related words:
authenticate, attest ,
cogent evident
INTRODUCTION-THREE ELEMENTS OF CRAFTING
SKILL
COMMITMENT
JUDGEMENT
CRAFTING
INTRODUCTION-THE APPRENTICESHIP
ART
KNOWLEDGE
ETHICS
Social
Work
Practice
ACQUISITION, APPLICATION & DEVELOPMENT
Moving from the generic social work training to being contextually relevant
CONTEXTUAL FRAMES OF KNOWLEDGE
PSYCHIATRIC PARADIGM (McHugh,2001)
•Disease perspectives
•The logic of
categories/what the
person has
•Psychosis, depression
etc.
•Dimensional
perspective: The logic
of individual
differences/what the
person is
•Potential, response
•Behaviour
perspective:
•The logic of goal
directed behaviour
•What the person
• does
• Choices, desires
PATHOLOGY
PERPETUATING
FACTORS
PREDISPOSING
FACTORS
PRECIPITATING
FACTORS
• Life story
perspective:
•The logic of the
narrative/what the
person encounters
•Setting, outcome,
CONTEXTUAL FRAMES OF KNOWLEDGE
INTERWEAVING OF TYPICAL BIOPSYCHOSOCIAL FACTORS (BLOCH & SINGH, 1999)
TIMING
BIOLOGICAL
PSYCHOLOGICAL
SOCIAL
PREDISPOSING
GENES
UPBRINGING
POVERTY
MOTHER’S
ALCOHOLISM
PERSONALITY
TRAITS
MIGRATION
TRAUMA
BEREAVEMENT
BEING
MUGGED
ILLICIT DRUGS
BEING JILTED
RETRENCHED
DRUG
ADDICTION
RELATIONSHIP
PROBLEMS
STRESS AT
WORK
POOR
NUTRITION
CONFLICT WITH
NEIGHBOURS
FINANCIAL
DEBTS
PRECIPITATING
PERPETUATING
CONTEXTUAL FRAMES OF KNOWLEDGE
Sources of knowledge that is grounded in the consumer and the family’s experience
Person
•Practical knowledge
•Attributions and Worldview
Family/ Carers
•Practical knowledge
•Attributions and Worldview
Neighbourhood
Network
•Practical knowledge
•Attributions and Worldview
BUILDING AN EVIDENCE BASE-CONSTELLATION
Specialist knowledge around specific challenging and complex predicaments
Substance
misuse
Victims of
violence
Homelessness
Forensic issues
Migration &
refugees
Unemployed
Trauma
BUILDING AN EVIDENCE BASE-CONSTELLATION
Quality of Life Niches
Affordable
housing
Income
security
Meaningful
work
Physical health
Learning
opportunities
Friendships
Recreational
activities
CONTEXTUAL FRAMES OF KNOWLEDGE
RECOVERY MATRIX (Slade,2009)
•One that makes the
experience
comprehensible &
allows for a positive
future
•Gives the possibility of
a personally valued
future
•Transition from being
clinically managed to
taking personal
responsibility through
self management
FRAMING THE
ILLNESS
SELFMANAGING
THE MENTAL
ILLNESS
DEVELOPING
A POSITIVE
IDENTITY
DEVELOPING
VALUED
SOCIAL
ROLES
•Involves the
acquisition of
previous, modified
or new valued social
roles
CONTEXTUAL FRAMES OF KNOWLEDGE
The domain of social work in mental health (AASW), 2008)
Social context
Social
consequences
Social justice
SOCIAL WORK SUPPORT STRUCTURES
Activities to consolidate and extend on the job learning
Reflective
Practice in
supervision
Journal Club
Sponsored by the
CAHE
Accessing PD
Funds from the
Allied Health
Allocation
Educational
Scholarships for
Post-Graduate
Degree Courses
Performance
Review &
Development
Plans
CORE SKILLS FOR THE 5 MAIN DISCIPLINES
Scope of clinical practice – Part A : Core skills shared by the five disciplines
Care-coordination
Psychosocial
assessments
Mental health
assessments
Valuing interdisciplinary
teamwork
Upholding respect,
ethical & professional
practice
Maintaining
professional group
behaviour
Specialists' service for
CALD consumers
Understanding
psychiatric medications
and the medico-legal
framework
Mental Health Care
Plans
Evidence-based
therapeutic
interventions
Individual/group therapy
Crisis Intervention
Psycho-education
Management of
comorbidities
DELINEATING THE SCOPE OF PRACTICE
Part B: Some of the distinctive• social work focus areas
INDIVIDUAL
FAMILY
COMMUNITY
• Individual and relational counselling e.g. grief,
loss, violence and abuse issues
• Resource to teams on community services
• Protection of rights and interventions within
the legal system
• Health promotion
• Family assessments and interventions
• Psycho-education
• Service/community development to address
identify gaps
• Promoting environmental interventions to
enhance consumers adaptability./enhance
social functioning
FOUR PROVISIONAL EVIDENCE LOCALES
Personal/ Clinical
Knowledge
Research Derived
Knowledge
Organisational
Based
Knowledge
Knowledge
from
Consumer/
Carer
ASSETS OF SOCIAL WORK PRACTICE
Exceptionally
high skilled
activity
Person
centred
Contextual
specialists
Demands
considerable
intellectual
abilities
Prizes
practical
knowledge
Family
oriented
The
integration of
an extensive
knowledge
base
ON BEING A RESEARCH-AWARE PRACTITIONER
Time
Constraints
Don’t
understand
the EBP
Paradigm
Being
mocked by
colleagues
Some major
impediments
Explicit
knowledge
not valued
Unsure
about the
benefits
Inadequate
knowledge
& skill set
DEMORALISED / FATIGUED PRACTITIONERS
Not
capitalising
on reflective
practice
Low uptake
of
Educational
Scholarships
Marginal
participation
in Journal
Club
Some key
indicators
Performance
Review &
Developmenta burden
Continuing
Professional
Development
not a priority
Sense of
being
overwhelmed
by workloads
BUILDING ON SOCIAL WORKERS’ STRENGTHS
Engagement
Understanding
Listening,
CONCLUSIONS & RECOMMENDATIONS
A culture of
lifelong
learning
A dynamic
tradition
In the service
of human
flourishing
CONCLUSIONS & RECOMMENDATIONS
Training
•Training initiatives via the
College of Social Work
Discussion
Forums
•College of Social Work
•AASW EBP Special
Interest Group Forum
Research
Surveys
•EBP Research Project
partnerships MA/PhD
•Practice-based research.
QUESTIONS FOR GROUP DISCUSSION
1. WHAT ARE YOU CURRENTLY DOING THAT REFLECTS EVIDENCE BASED
PRACTICE.? WHAT NEEDS TO HAPPEN TO FURTHER EMBED AN EVIDENCEBASED APPROACH INTO YOUR PRACTICE?
2 . WHAT ARE SOME OF THE SUPPORT SYSTEMS (E.G. PROFESSIONAL
SUPERVISION) THAT SOCIAL WORKERS MIGHT TAP INTO TO BEGIN /CONTINUE
THE CONVERSATION AROUND EVIDENCE-BASED PRACTICE?
3. WHAT DO YOU CONSIDER TO BE SOME OF THE CHALLENGES IN EMBRACING THE
EVIDENCE-BASED PARADIGM.?