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Reconsidering critical appraisal in social work: Choice, care and organization in real-time treatment decisions
Stockholm University, Faculty of Social Sciences, Department of Social Work.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This paper seeks to provide an empirically grounded discussion of the critical appraisal model of EBP in social work practice. Studying decisions in practice, the paper looks ethnographically at an attempt to implement critical appraisal in social work practice, and problematizes some of the assumptions underlying this idea. Whereas critical appraisal tends to view treatment decisions as clear-cut events that are made by autonomous social workers, participant observation shows that decisions emerge over time and that they are ‘organizational’ rather than emanating from individual social workers. Drawing on Mol’s (2008) notion of the ‘logic of care’ and findings from studies of organizational decision making, a more practice oriented understanding of treatment decision-making is outlined.

Keyword [en]
Evidence-based practice, decision making, critical appraisal, ethnography, logic of care, organizational decision-making
National Category
Social Work
Research subject
Social Work
Identifiers
URN: urn:nbn:se:su:diva-126505OAI: oai:DiVA.org:su-126505DiVA: diva2:900627
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2016-02-04 Created: 2016-02-04 Last updated: 2016-02-08Bibliographically approved
In thesis
1. Evidence-based practice behind the scenes: How evidence in social work is used and produced
Open this publication in new window or tab >>Evidence-based practice behind the scenes: How evidence in social work is used and produced
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this dissertation is to examine empirically what Evidence-based practice (EBP) and its standardized procedures become when put into practice in social work. EBP builds on the idea that professional practice should be based on systematic and reliable knowledge of the interventions and instruments used in this work. This implies a standardization of both research and practice that has been highly contested. Inspired by works within science and technology studies (STS), this dissertation analyses the actual content of the standardized procedures and their uses in social work practice.

The dissertation examines a ‘critical case’, a substance abuse social services agency that has worked extensively for several years at implementing EBP, and consists of four papers focusing on three standardized procedures used by the agency in order to enact EBP: 1) the Addiction severity index (ASI) assessment instrument; 2) the psychosocial intervention Motivational interviewing, and 3) the decision-making model Critical appraisal (CA). Ethnographic methods were employed to study the agency’s concrete uses of the standardized procedures in daily practice. MI was also followed in the research literature as it became established as an ‘evidence-based’ intervention.

Fundamentally, the development of the standards of EBP can be a messy and paradoxical process. In the stabilization of MI, its differences and ‘fluidity’ have eventually been made to disappear and left a stable ‘evidence-based’ object.

Findings from the ethnographic studies show that EBP, as enacted in the agency’s daily practice, is a bureaucratic project where the agency’s managers have decided on and control the use of a set of standards. Thus, what constitutes relevant evidence is based not on professional discussion within the agency but is ultimately determined by the managers.

In practice, the standards introduce new logics that cause tensions within the agency, tensions which the social workers are left to handle. Main conflicts concern how the client work is ordered and contradictory organizational rationales. The three standards are used to varying extent, which can be understood by examining what they seek to standardize and how they are put to work. CA was not used at all, mainly due to its design. Disregarding organizational rationales that are unavoidable within the social services, it could not be adapted to the agency’s work. With ASI and MI the situation was different, mostly because of their organizational adaptability. ASI could be implemented in several phases of the agency’s work flow resulting in adjustments of both the instrument and the work flow. As a ‘fluid intervention’, MI was constrained by, but also adjustable to the organization. It was thus possible for both ASI and MI to transform and be transformed by pre-existing practices, in effect creating new practices.

A major conclusion is that EBP and its standardized procedures is a more dynamic and multifaceted process than previously acknowledged in social work. Rather than a deterministic one-way path, there are different kinds, degrees, and mutual transformations of standardization processes, which must be appreciated in research and in practical efforts to implement EBP. Given the importance of the organization in professional social work, there is a need to move away from individualistic conceptions of EBP and to consider what evidence use might mean from an organizational perspective.

Place, publisher, year, edition, pages
Stockholm: Stockholm University, 2016. 81 p.
Series
Stockholm studies in social work, ISSN 0281-2851 ; 32
Keyword
Evidence-based practice, Evidence-based medicine, Addiction severity index, Motivational interviewing, critical appraisal, ethnography, social work, substance abuse, science and technology studies, standardization
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-126503 (URN)978-91-7649-345-8 (ISBN)
Public defence
2016-03-18, Aula Svea, Sveavägen 160, Stockholm, 10:00
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Note

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Manuscript.

Available from: 2016-02-24 Created: 2016-02-04 Last updated: 2016-02-15Bibliographically approved

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