Social work practice research: The question of questions

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Social work practice research The question of
questions

• Enola Proctor
• George Warren Brown School of Social Work
• Washington University in St. Louis
• September 17, 2005
• San Antonio, Texas
• Prepared for the National Association of Deans
  and Directors (NADD)

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Looming crisis in professional stature

• Quality and sufficiency of applications to
  schools of social work
• Areas of practice defaulted to other professions
• Growing demands for accountability and evidence

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Significance of social work practice research

• Evidence root of societal sanction for
  professional activity
• Profession has responsibility for knowledge base

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Social work research and the professions
knowledge needs

• The question of questions
• What research questions should we be asking?

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Strides in social work knowledge development

• Growth in externally funded research
• Increase in thematic research centers
• Hartford initiative in gerontology
• NIDA NIMH funded research centers
• School-initiated centers
• Specialization of profession
• NASW member sections
• Practice research conferences
• Recent publication of research agendas
• Aging, quality of care, practice guideline
  development

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Key questions in social work practice research

• What are the practices in social work practice?
• How does social work practice vary?
• What is the value of social work practice?
• What practices should we use?
• How do we improve social work practice?

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Caveats

• Working definition of practice
• Interventions
• Outcomes
• Practice comprises professional action at all
  levels
• individual, group, team, community, societal

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Q 1 What are the practices in social
work practice?

• What do we do?
• How much do we know about what we do?

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Percentages of Social Work Articles by Type
Replicablity of Intervention (Total Articles
n1849)
Research Intervention Articles, Interventions not
Replicable 7
Research Articles with Replicable Interventions 3
Rosen, Proctor, Staudt, 1999
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Research on interventions

• Can we name our interventions?
• Issues of
• Nomenclature
• Common language
• Procedure codes
• Is there a taxonomy of social work interventions?
• Rosen, Proctor, Staudt, RSWP 2003
• Staudt, Cherry, Watson, SWR in press

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Associated questions

• About intervention knowledge
• Are interventions standardized (manuals
  protocols)?
• Do SW practice researchers direct their attention
  to priority interventions?
• Interventions corresponding to priority outcomes
• About practice itself
• What interventions do social workers employ most
  frequently?
• Are interventions used with fidelity?

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Q 2 How does social work practice vary?

• Interventions are not universally appropriate

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How does social work practice vary?

• What factors are associated with variability in
  use of interventions?
• Do interventions vary by
• Problem (severity, duration, comorbidity?)
• Clients?
• Providers?
• Training?
• Payment source and structure?

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Practice variation research

• Examples of practice variation questions
• Detection of problems
• depression, substance abuse, domestic violence,
  child abuse
• How does social workers recognition of these
  problems vary?
• Examples of practice variation researchers
• Bentley medication practices
• Proctor Morrow-Howell 24 of client
  depression noted by social workers in agency
  record

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Research to identify sources of variability in
interventions used

• What variability is observed?
• Is the observed variability rational?
• What variability is OK?
• What variability is desired?
• juxtapose observed patterns with
• theory, best practices, assumptions about who
  should get what kind of care.
• Health Services research
• Andersen model variability from factors other
  than need and preference inequitable care

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Research on practice variation

• Extends social works historic social justice
  perspective to disparities research
• McMillen racial variations in mental health care
  for children in child welfare
• Foundation for quality of care research

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Q 3 What is the value of social work
practice?
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Metrics for social works value

• Cost of service as market issue
• Social work has long been recognized as among
  the cheapest profession
• Value
• How can we become the high value profession?
• What is our professions value added?
• With social work, what?
• Without social work, what is missing?

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Research to capture social work value taxonomy
of outcomes

• Research on the most salient outcomes in social
  work practice (Proctor, Rosen, Rhee, 2002)
• Documentation
• Frequency
• Variability across practice settings, sectors of
  care
• Factors associated with variation
• Classification Taxonomies
• Descriptive, typology categories
• Conceptualization of impact, value
• Do SW practice researchers focus on outcomes most
  important to profession?
• Potential to enhance relevance of intervention
  research

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Differential Focus on Outcome Domains in Practice
and Research
Proctor, Rosen Rhee (2001)
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Research to capture the value of social work
practice

• Measurement of the increment attributable to
  social work intervention
• Quantification of value
• Cost to deliver
• Cost-benefit
• Cost of care studies
• Comparative costs of interventions.
• Studies of value, or cost-effectiveness,
  cost-benefit

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Q4 What practices should we use?

• Fundamental building block research
  effectiveness of interventions for outcome
  attainment

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Research questions to inform, What practices we
should use

• What interventions are effective?
• What interventions are effective for a priority
  outcome?
• Which interventions are most effective for a
  given outcome?
• What interventions correspond to client
  preferences?
• Which interventions are most effective for the
  client group at hand?
• What interventions are most cost-effective?

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Challenge for social work research community

• Identify practices with strong evidentiary base
• Review, synthesize, consolidate
• Construct practice guidelines useful to social
  workers
• Built from social work research

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Q5 How do we improve social work practice?

• Assessing and improving quality of care may
  become this decades most pressing challenge for
  social work
• Proctor, 2003
• McMillen, Proctor, et al. (SWR, in press)

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Research to improve social work practice

• Identify and develop quality indicators
• Target quality improvement
• Focus professional training around best practices
• Develop improvement strategies
• Advance quality improvement research
• Partner with field to roll-out and test quality
  improvements

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Q5 How do we improve social work
practice?

• Needed research designs methods
• Decision support research
• Dissemination research
• Models of agency partnership
• What methods are effective?
• Implementation research
• Distinct outcomes
• Acceptability
• Feasibility
• Sustainability
• Fidelity

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Challenges

• Breadth of field
• Limits of research training
• Too few doctoral graduates
• Too little post-doctoral training
• Limited scope of research expertise
• Weaknesses in research infrastructures
• Research is investigator driven
• Most research is small in scale
• Multiple funding agencies
• Poor fit of professional priorities to funding
  agencies

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What to do about the question of questions in
practice research?

• Rationalize our research endeavors
• Pursue research purposively around priorities
• Social work research/ academy becomes knowledge
  resource to practice
• Organize practice research around agendas
• Social work research is too often piecemeal
• Agendas need to be
• comprehensive,
• substantively differentiated
• long-range research
• Establish centers of excellence around research
  agendas

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Research agendas enable

• Stock-taking
• What do we know?
• Basis of confidence in professional practice
• Foundation for advocacy on behalf of profession
• What do we NOT know?
• knowledge gaps
• Cautionary notes
• Establishing research priorities
• Shape research around professions needs