Theorising Social Work Research
Social Work: Who owns the research process? 20th September 1999, Belfast Towards Evidence Based Services for Children and Families Celia Atherton Research in Practice Why do research - what is the purpose of research? To know more about the world, our place in it and our functioning within it? What is the purpose of work? To earn money, to pursue our interests? For many, also to contribute to improving our world and the experience of living things within it - human beings included. So, why research? There are those who believe in the pursuit of knowledge for its own sake. While laudable, and necessary, that cannot be so for research that is concerned with need and service - a category of utmost importance to 'social work research'. The purpose must also include helping those concerned with need - those in need, those who have the power to determine need, those who are charged with helping to ameliorate need, those who live close to need, those who feel a citizen's concern about need. The purpose should, in measurable part, be about understanding need, its causes and its resolution in ways which are not only effective but are also ethical and empowering. All of this points to an unmistakable requirement to engage with everyone concerned with need - especially those in need and those who try to ameliorate need - the worlds of users and practitioners.
The worlds of research and practice are linked by a desire to help improve the lives of vulnerable people and a belief that knowledge - held by service users and professionals alike - of what research (evidence) has to offer can assist in this endeavour. It is the securing and cementing of this connection that lies at the heart of Research in Practice's work.
Research in Practice is an ADSS initiative which started in 1996, first based Dartington and now at Sheffield also. It is the largest child care research and practice project in the country working with 56 member agencies (54 local authority social services departments and two large voluntary child care organisations). It aims to encourage the use of child care research in planning and practice and to develop a research ethos - what might be called 'research-mindedness' - within the personal social services for children and families.
Research in Practice now works with over one third of all local authorities in England so creating real opportunities for replicable development of evidence based services alongside increased authority to speak on behalf of a representative sample of agencies about their needs, aspirations and achievements. The resulting work is pursued through an active and close partnership with its member agencies, based on common objectives and delivered through a range of specific services and programs.
Distinctive Features and Objectives
In an era when so much of what statutory agencies do is determined by others this initiative is notable for its voluntary nature. Member agencies join because they want to be key players in this exciting development which brings together research, practice and policy. The speed with which the initiative has progressed is just one measure of their willing enthusiasm. This increased interest, demonstrated here and elsewhere - such as in the work of Making Research Count - in evidence based working might suggest confidence that we all mean the same thing. This is unlikely. We still have no agreed definition and any roomful of people asked for a definition would give widely varying, if any, answers. Research in Practice uses this definition to bring together the various aspects of a professional's developing expertise:
Evidence based social care is the practice of a range of professionals grounded in sound knowledge about the needs of children and families informed by:
- the best available evidence on what is effective
- the practice expertise of professionals
- the experiences and preferences of service users.
Without knowledge of the evidence any policy maker or practitioner risks being out of date. Not taking account of practice expertise risks practice and policy being evidence tyrannised. However apposite our proffered intervention, denying the importance of the user's experience and preference is liable to see our offers ignored. While refuge may be taken in labeling the user 'uncooperative' the reality is that dictatorial practice of this kind is no longer ethical - and is certainly ineffective.
The very idea of evidence based practice is young. Its older sister, in medicine, still counts in years not decades. Yet it is increasingly hard to remember how willingly our profession has worked with scant if any knowledge of the relevant evidence base. We now know that there is not always an evidence base to use - that some decisions have to be made without benefit of evidence. But for decades we have been prepared to practice without even knowing whether evidence existed to support or challenge our practice. And we did not worry overly - for we were more concerned with the value of our experience on the job, the power of our values, the requirements of our agency's procedures and the services we believed to be available. All vital - but not sufficient.
Few feel able to justify the perpetuation of this state of affairs and yet a torrent of questions falls like boulders on a path. Where is the evidence? Can it be accessed? Can it be relied on? Does it answer the questions in the practitioner's mind? Are its implications for policy and practice clear? There is a gulf between research and practice but responsibility is too easily laid at the door of social work alone. Explanations are found also within the research world - both those that do, and those that fund, research, and those who support research use. The annual NHS spend on dedicated library and knowledge systems is approximately £70m a year (soon to be £90m). The annual NHS spend on research and development activity in just one of 8 UK regions is approximately £8m a year. Social care invests a tiny fraction by comparison. A poor relation indeed.
The work of the Research in Practice initiative is planned around three distinct themes:
Getting research to decision makers in practice and policy and to service users
Encouraging research use within practice and policy
Developing research for practice and policy - practitioners, policy makers and children and families
The planned work is based on three principles, derived from research studies, which shape the Research in Practice approach.
1. Working in partnership
The work of Research in Practice acknowledges that although an important starting point, simply disseminating good evidence is not enough to support evidence based practice1,2 &3. Strategies must be developed to encourage further steps of adoption; implementation; and impact 1. Influencing factors are the work environment and the organisational culture. Research suggests that organisations need to be flexible, experimental, and imaginative if practitioners are to adopt and implement research in their practice 4,5,6&7. Many authors highlight the need to be sensitive to, and work with and within, practitioner cultures 8,9. Appropriate leadership styles 6,8, systems and structures also help to facilitate evidence-based practice 3,8,10, describe the need for organisations to meet the "corporate challenge" (where evidence based practice is seen to be a priority at the highest level).
The working environment therefore is crucial to making evidence based practice happen. Bullock et al (1998) 2 describe the workplace as the soil that enables the seeds of good research to grow into evidence based practice. It is essential therefore that member agencies are active partners in the implementation and the evaluation process. Research in Practice aims to develop indicators to reflect the nature of the work environment, and how this may change over time, in response to developing evidence based practice in member agencies. It works closely with member agencies in their organisational development to support evidence based practice and to using a diversity of methods to learn with them over time.
2. Research should influence decision making at every level within an organisation
This principle includes decision making between individual practitioners and their clients, decision making within teams, and decision making at policy level5. The dissemination of evidence to individual practitioners and team leaders through the Research in Practice workshop programme is intended to help develop both individual and team practice. Working within teams in this and other ways to support evidence based practice appears to be effective in other settings too5, 11. The principle of developing teamwork based on a needs assessment of the population using the service is also important12. The seminar programme aimed at policy makers, managers, and elected members, intends to influence decision making at higher levels within each member agency.
3. Learning from one another
The Research in Practice initiative represents the convergence of the two worlds of practice and research and, as such, could be viewed as a case study of organisational change and development. Both Research in Practice and its member agencies learn from each another through systematic reflection and sharing knowledge, experience and ideas. Specifically, the programme aims to adopt the principles of a learning organisation13 which include
- learning from success and failure
- cycles of re-examination, feed back, and reflection
- recognition that we should learn from the application of evidence into practice, which is grounded and legitimated through service experience
- sharing information
- bench-marking - that is checking how well each member is doing compared to each other; themselves over time; and against set standards.
Member agencies maximise the value of their investment in Research in Practice by:
- seeing membership as an opportunity rather than a solution
- using the services of Research in Practice as means to an end rather than an end in themselves
- ensuring that membership of Research in Practice and the desire to develop evidence based services are embedded within the key structures of their agency.
Research in Practice's way of working is
- voluntary - agencies join because they want to, not because they have to
- collaborative - services are not imposed but are negotiated with the total membership.
- pro-active and responsive - enabling agencies to get the support they believe they need and to be introduced to new concepts and methods
- out-going - seeking to share the best of what member agencies are doing, and to introduce them to the best of what others are doing and can provide for them
- committed to service user participation - by working alongside member agencies to identify and implement effective ways to share and gain knowledge together.
All the services are designed to be at the forefront of current knowledge about effective dissemination, adoption and implementation of research within the child care practice world. The intention continues to be to tailor services to the needs of the different agencies by providing the many constituencies within each with a range of services in varying proportions. The hope is that this individualised approach supports each agency in its particular journey to promote and strengthen evidence based practice.
Over the last year Research in Practice has:
- delivered two audiotapes (an introduction to evidence based practice and one reviewing the key research on family placement for looked after children) which help practitioners and policy makers keep up to date with the research most relevant to their own performance targets. These are provided free to member agencies and are available for sale to others
- published the EvidenceBank on the web (www.rip.co.uk), so enabling all member agency staff to gain access to evaluated, relevant research at the touch of a finger. While access to the necessary IT equipment varies across agencies the advent of the Quality Protects initiative will see this provision increase markedly over the next two years
- brought the best researchers to elected members to help make the best use of research in their pivotal role in tackling youth offending and anti-social behaviour
- worked with front-line children and families teams in a range of member agencies to help them identify practices which promote evidence based practice - an action pack for use by others will be developed by this project group. It is this work which will be discussed by Mel Davies in her presentation to the seminar on Monday 20 September
- linked the work of member agencies to develop evidence based services with other relevant organisations and individuals including major research funders
- provided over 1,000 research focussed workshop places on 40 workshops covering 16 themes in eight venues across England
- run a series of national seminars for senior planners and policy makers, including consideration of the commissioning and management of external research - likely to become a more central activity in light of Quality Protects
- enabled directors of member agencies to hear about methods used by the social exclusion unit which might have salience for their own work, consider the shape of services in the next decade if they were to be truly needs-led, and to have first sight of DH thinking about the research they should commission to support Quality Protects
- maintained a pro-active engagement with member agency Link Officers, both in person and through regular letters, Newsposters and other briefings and consultations
- provided a service to the wider ADSS membership through workshops at the Social Services Conference, the ADSS Spring Seminar and the provision of Quarterly Briefings to all ADSS members
During the current year Research in Practice will:
- increase our workshop provision to 42 workshops covering 17 themes
- increase and develop both the content and design of the EvidenceBank website - and establish an Advisory Group, including children and families, to guide this work
- publish key messages about the commissioning and management of external research, and of a research overview (prepared by Audrey Mullender and Cathy Humphries) on the messages from recent UK research on the impact of domestic violence on children
- provide up-to-date research findings to elected members and to directors
- start our evaluation of the value of Research in Practice to its member agencies of their progress in developing evidence based practice
- run a number of regional events to allow member agencies to learn from each other and to support capacity building in a number of ways
- promote the implementation of agency-wide evidence based practice strategies through a number of national events
- produce three more audiotapes, on residential care, preparation for citizenship, and youth offending - and develop further their uses for groups of staff, elected members and children and families
Challenges for researchers and funders
Whilst there is much for service agencies to do, real change will only come about when all parties to the research process change. The challenges to researchers and those who fund research are immense. The research must speak to the concerns of those who seek to help vulnerable members of our community, and to those children and families themselves. It must address their concerns and deliver the results in a manner that is both understandable and cognisant of the way in which the findings might be used most effectively. For too long the majority of national research has been driven by a central government agenda or by the particular interests of the researchers themselves. Frequently there is a happy co-incidence between those interests and the requirements of local agencies and their practitioners. But not often enough. We do not even know what research is most needed by practitioners.
Funders do little to identify and respond to these needs. A pilot study (Any Questions?) conducted recently for Research in Practice demonstrates how much will have to be done if the beginnings of researcher and funder interest in opening the door to research users is to bear fruit. The study sought to enable teams within member agencies to identify their needs for national research. Initial results suggest that since most teams are unfamiliar with the world of research they find it almost impossible to take part. This should not be mistaken for a lack of interest in taking part but could, alternatively, be seen as a requirement on others to make the platform for consultation more responsive to the needs and circumstances of research users. Those teams which did feel more confidence nevertheless found it difficult to be clear about the presence of needed research if it had not been brought together through overviews or reviews of a number of studies.
Furthermore, if the research world is to respond positively to the demand from practitioners for help in understanding the importance and application of research more will need to be communicated about the relative strengths and weaknesses both of individual studies and collections of studies. It has been suggested14 that in future the reliability of research could be identified according to three criteria:
- tentative -where the user would pause, take stock and ask questions
- indicative - where the findings are not of highest quality, and the user is urged to proceed with caution
- conclusive - where findings have a high level of scientific rigour and reliability.
Currently, few studies in social care meet the highest levels of reliability. Herein lies the true meaning of using 'the best available' evidence. However, when findings are replicated across a number of studies they do merit a greater degree of reliability. Roy Parker's finding, first published in 196615, of a clear association between placement breakdown and the presence of the foster carers' own children in the home has since been reinforced by a range of other studies. Sadly this highly reliable finding also provides an unwelcome example of how our service agencies continue at times to ignore the evidence and so do more harm than good.
Those who provide services, and those who hope to benefit from them, increasingly see the need to base their judgement on sound evidence. This need is turning into a demand. One which should sing sweetly to all. Users of research recognise the need for a range of research, answering different but equally important questions. All recognise that what we have at present does not cover the whole range in equal measure. Most especially there is a need for more, and more robust, effectiveness research. Research which, as an example, will allow a social worker to face confidently this form provided for service users:
I have been referred to the (name of agency and intervention which will be used)
Outcomes hoped for:
A. Related External Research
1. Research shows that this intervention helps people like me.
2. This intervention has never been rigourously tested to see if it helps people like me.
4. Research shows that other interventions help people like me.
3. Research shows that this intervention is likely to have harmful effects (eg - decreased positive parenting skills).
B. Agency's Background regarding use of this method
1. The agency to which I have been referred has a track record of success in using this intervention with people like me.
2. The staff member who will work with me has a track record of success in using this intervention with people like me.
If we are to make progress here - as a community of researchers, funders, practitioners and service users we must all be involved in the dialogue from the beginning.
- NHS Centre for Reviews & Dissemination (1999). Getting evidence into practice. Effective Health Care Bulletin. Vol. 5 No.1
- Bullock, R; Gooch, D; Little, M; Mount, K. (1998) Research in Practice. Experiments in development and information design. Aldershot. Ashgate.
- Walshe, K & Ham, C. (1997) Acting on the evidence. Birmingham. The NHS Confederation.
- Batesone, G & Edwards, M. (1996) Achieving clinical effectiveness: just another initiative or real change in working practice? Journal in Clinical Effectiveness. Vol. 1 No. 1 pp19-21
- Muir Gray, J. (1997) Evidence Based Health Care. How to make health policy and management decisions. New York. Churchill Livingstone.
- Eve, R; Golton, I; Hodgkin, P; Munro, J; Musson, G. (1997) Learning from FACTS. Occasional Paper no.97/3. Sheffield. ScHARR publication.
- Pinkerton, J (1998) The impact of research on policy and practice: a systematic perspective in Iwaniec, D & Pinkerton, J. [Eds] Making Research work. Promoting Child Care Policy and Practice. Chichester. Wiley.
- Kitson, A; Harvey, G; McCormack, B (1998) Enabling the implementation of evidence based practice: a conceptual framework. Quality in Health Care. Vol. 7 pp 149-158.
- Mulhall, A; Alexander, C & Le May, A. (1998) Appraising the Evidence for Practice: What do nurses need? Journal of Clinical Effectiveness. Vol. 3 No.2 pp54-58
- Newman, M; Papadopoulos, I & Sigsworth, J. (1998) Barriers to Evidence-Based Practice. Clinical Effectiveness in Nursing. Vol. 2 pp11-20
- Morrell, C; Harvey, G; Kitson, A. (1997) Practitioner based quality improvement: a review of the Royal College of Nursing dynamic standard setting system. Quality in Health Care. Vol. 6 pp29-34
- Ovretveit, J. (1997) Planning and Managing Teams. Health and Social Care in the Community. Vol. 5 No.4 pp269-283
- Mintzberg, H; Ahlstrand, B; Lampel, J. (1998) The Strategy Safari. New York. Free Press.
- Roy Parker, in a paper to DSRU child care seminar October 1998
- Parker, R. (1966) Decision in Child Care Allen and Unwin