Theorising Social Work Research
What works as evidence for practice? The methodological repertoire in an applied discipline 27th April 2000 Cardiff
Research agenda and social care in Wales Graham Williams Chief Inspector Social Services Inspectorate for Wales
We are at an important time in the development of Social Services in Wales and we welcome the opportunity to consider the contribution of research to these developments. They include:-
- The establishment of the National Assembly.
- The Social Services White Paper for Wales - Building for the Future.
- The Modernising Agenda for Local Government.
- The Agenda for "social inclusion".
I could continue to list many initiatives including, for example, those to establish partnership working with health. The important point is that these developments provide the opportunity for social work and social services to establish its distinctive contribution alongside a range of partners in securing improved outcomes for vulnerable and often disadvantaged people.
What I propose to set out in this paper is:
- our present agenda for research in social care;
- thoughts on how this might be developed.
The present Research and Development Strategy for Social Care was published by the Welsh Office of Research and Development (WORD) in January 1998 following the work of a Planning Group and wide consultation. It was considered that at a time of significant reported pressures on the budgets for social care there is a need to identify which features of social care delivery are effective and cost effective. More generally there is an impression that social care has suffered from not having a cumulative body of evidence to support policy and practice. It is also apparent that there is a more general move within social care to directly involve practitioners and policy makers in the development and implementation of the findings of research. As discussed in a Department of Health (1994) report on research in the field of social care, there is concern that the results of research are not influencing practice and that practitioners are not involved in the research process. The following diagram adapted from the report illustrates the problem. The strategy outlined in this paper is designed to start addressing this problem and the difficulties it creates in social care.
Diagram 1. Research, Policy and Practice
The above diagram has been adapted from the Department of Health Report 1994 entitled 'A Wider Strategy for Research and Development relating to Personal Social Services.' It emphasises the weak link between research and practice that is currently evident.
The Aim of the Research & Development Strategy (R&D) is to develop the evidence base for social care policies and practice and to promote an evaluative culture among practitioners and policy makers
The objectives of the R&D strategy are to seek to create a framework to achieve this aim through:
- The development of a cumulative body of knowledge on the effectiveness of social care policies and interventions;
- The development of working practices which support the use of evidence in service planning and practice;
- Improved research and development awareness among practitioners and policy makers;
- Increased practitioner and policy maker involvement in the research and development process;
- Increased collaboration between researchers in higher and further education institutions, practitioners and policy makers;
- The provision of opportunities for R&D at the interface between social care and health and other relevant service sectors and,
- The attraction of increased resources to support research and development in Wales.
At present the evidence base for social care policies and interventions used by practitioners is extremely limited. In addition, there is uncertainty whether the research being commissioned at present is merely addressing topical issues rather than adding to a cumulative body of knowledge which can be referred to in policy making and practice. This situation is by no means unique to social care but at times of severe resource pressures and increased demands, the development of an evidence base to support policies and practice is particularly necessary. The development of the evidence base requires:
- a thorough review and dissemination of existing knowledge;
- recognition that new research must contribute to a cumulative body of knowledge;
- evaluation of new developments to assess their effectiveness.
The Use of Evidence in Service Planning and Practice
It cannot be assumed that the development of an increasing body of knowledge on effectiveness will be used in practice and policy development. It is necessary to assist policy makers and practitioners in determining how evidence can be used in their day to day work. Mechanisms need to be developed whereby evidence is automatically used in the planning of service developments. In addition practitioners and policy makers need to determine how evidence is used in situations where political or resource pressures exist.
Increased Practitioner Involvement in R&D
Currently, in Wales, the majority of social care research is undertaken by academic researchers based in academic institutions. While improved dissemination can improve the access of practitioners to research evidence, there is little evidence that practitioners will make use of such results. This appears to be partly an issue of ownership. While practitioners and policy makers do not have a sense of ownership of research there is a danger that the results will be unknown, ignored or not seen as relevant. The primary means by which this can be addressed is by increased involvement of practitioners and policy makers in the research process. This issue will only be addressed by reducing or removing the gap between research and practice.
Increased Collaboration Between Researchers and Practitioners
In developing the evidence base for social care there will be a need to ensure that Wales retains a capacity for high quality research of international repute. As indicated above however, there is a need for such research to involve practitioners. Such involvement will be required from the point of identification of research priorities through to commissioning research, undertaking research and making use of the results.
R&D at the Interface Between Social Care and Health
WORD is strategically positioned to support projects at the interface between social care and health. It is apparent that many of the key issues facing service provision lie at the interface between the provision of social care and health care. The R&D strategy provides an opportunity to examine such issues and involve professionals and researchers in both sectors to work jointly on such projects. In having budgets to support both social care and health R&D WORD is in a position to provide joint funding for projects which lie at the interface. In addition to social care and health the strategy will also encourage collaboration with a wide range of other sectors e.g. education, housing and the police in seeking means of addressing the needs of community members.
The benefits of an evidence based approach are seen as:
- More Effective Social Care Interventions
- Improved Resource Efficiency
- Improved Analytical Practice
- Raising the Status of Social Care Professionals
- Improved Public Confidence in Social Care
Defining Social Care Research & Development
Before defining the terms research and development it is necessary to provide an indication of the areas encompassed by the term social care. In broad terms social care may be defined as the provision of support to promote the safety and well-being of vulnerable individuals and enable them to have the opportunities to participate as full members of society. Some areas of provision may be excluded from the R&D strategy due to the availability of funding from other sources e.g projects purely focused on financial support through the benefits system.
One of the identifiable features of current attempts to address social problems faced by individuals and groups is an analysis of the current organisational boundaries and responsibilities. Currently there is a broader definition of the problems faced by individuals and the consequent need for the involvement of a wide range of professional groups and agencies in addressing those problems. While the work of the personal social services will remain central to the social care R&D strategy it will also involve health agencies, housing, education, employment and environmental health where they are seen to contribute to resolving problems being faced by individuals. Increasingly users, carers and members of the communities in which they live will also need to be involved in the research process. Due to the fact that the Wales Office of Research and Development combines R&D in social care and health issues, the interface of such bodies will be of particular interest.
Research & Development
The above definition provides a broad statement of the areas encompassed by the term research and development. The range of activities include early stage research designed to identify changes in the needs of populations or new approaches to interventions with individuals requiring support. Also included are activities relating to the implementation of evidence based practice within services. Crucially activities relating to the use of the products of research can also be encompassed in the term research and development.
Types of R&D Required
In examining the types of research and development activities required in Wales it is necessary to recognise that there are a range of other approaches that may be adopted to address problems faced by social care agencies. While there can be wider benefits to participation in research and development exercises (e.g. improved inter agency working, greater clarity of service objectives), it should be recognised that more appropriate responses may be required. Such responses to problems include monitoring, inspection and regulation, management, and training and education. The resources available to R&D are extremely limited and consequently the use of those resources must be carefully targeted.
Table 1. Types of R&D Required
Table 1 illustrates examples of the potential range of areas in which social care R&D may be applied. If an evidence based culture is to be developed the range of R&D outlined above should be viewed as standard practice in relation to new developments. In addition service monitoring through audit or quality assurance should enable regular checks of service standards, quality and appropriateness to be made.
A key task in the development of an evidence base will be reviews of existing research to develop an understanding of its relevance and usefulness in guiding present day policy and practice. The WORD has commissioned reviews of existing literature on specific themes and such reviews may precede decisions to commission new research projects. Where evidence is identified it will be necessary to ensure that it is made known to practitioners and policy makers.
Diagram 2 illustrates the range of methods which may be employed within social care R&D and highlights the fact that a range of methods can be considered appropriate to particular situations or stage of policy or practice development. A key objective for the R&D strategy will be to develop the skills and expertise required to undertake the range of possible studies within a wide range of potential client groups to a sufficiently high scientific standard. As Cheetham (1994) states "Practice and policy are rapidly evolving and changing, pressed by legislative changes, political priorities and resource constraints. Evaluative research which meets the tenets of social scientific enquiry is not high on the agenda of social work agencies." The challenge facing any R&D strategy must therefore be to achieve a balance of increasing the awareness of agencies of evidence for their practice and policies and flexibility on the part of researchers to work in rapidly evolving situations. In the case of researchers this will require flexibility in approaches rather than adherence to fixed methodologies.
Areas of Research
The two primary pieces of legislation of The Children Act and the NHS and Community Care Act are currently the focus of the work of the social care R&D strategy. However other legislation clearly impact on this area including, for example, the new flexibilities under the Health Act 1999. In addition the range of agencies and individuals who are likely to have an impact on the implementation of the two Acts will also be within the scope of social care R&D. It is important to note that a key role for research is also the development of policy.
Initially the Social Care Planning Group will determine what it considers as potential priority areas for Wales. Such a decision will need to identify:
- issues which are a priority for Wales;
- areas in which Wales should take a lead on an UK and international basis.
Such priorities may change over time, however it will be important to identify themes to which resources may devoted on a longer term basis or through the commissioning of a series of projects. Given the limited budget it is necessary to identify a clear focus rather than attempting to address all issues in a partial and unsatisfactory way. Among the factors to be considered in determining the R&D commissioned are:
- geography and culture of Wales;
- demographic trends;
- existing structures and responsibilities;
- the interface between social care and health;
- current and future potential issues specific to Wales;
- skills available to undertake work;
- work being undertaken elsewhere.
Developing an R&D Network within Local Authorities
In order to facilitate the approach to R&D outlined earlier in this document, a network of contacts within local authorities and other social care agencies has been established. These contacts are responsible for the co-ordination and promotion of social care R&D within their organisation, the circulation of disseminated information relating to the funding schemes made available through the social care R&D strategy, dissemination of research findings to other practitioners and continuing dialogue with the Office of R&D.
Developing Effective Practice
In a report by Whitaker and Archer (1989) it is argued that undertaking research has a direct benefit to the practice of social workers and much of the strategy outlined above is based on that premise. However, not all practitioners would wish to be involved in research but will need to be aware of research results. Therefore, making available the results of R&D activities to practitioners and policy makers will be key component of the strategy. The National Institute for Clinical Effectiveness in the NHS is separately funded and directly aimed at relating practice and research and consideration is being given to the establishment of a similar approach in social care. In addition, WORD is working in collaboration with bodies such as Central Council for Training in Social Work (CCETSW) and educational establishments to develop the link between research and practice.
Dissemination of research results is a key element of the R&D strategy although as has been argued the dissemination of material will not compensate for the ownership of research results by practitioners and policy makers. Dissemination can be achieved in two ways:
development of an R&D information source (reactive);
distribution of R&D information (proactive).
The Funding of Social Care R&D
At present the primary source of funding for social care R&D in Wales is the social care research budget administered by the Office of R&D. Additional support monies are available through the National Assembly in response to specific policy initiatives. As has been indicated local authorities also commission R&D projects and social care agencies undertake projects responsive to their own needs. Social care agencies and academic institutions also apply for funding from other central government bodies and charitable trusts. Increasingly European funds are also being used for development projects although the extent of research and evaluative projects funded through Europe remains limited.
Funding through the Wales Office of R&D
There are four funding streams through which the social care budget is channelled:
- Commissioned Programme;
- Responsive Research and Development Programme;
- Supporting and Developing the Research Skill Base in Wales: secondments;
- Small Grants.
The priority areas for the responsive, secondment and small grant scheme broadly encompasses research within the NHS and Community Care Act 1990 and the Children Act 1989 under the following specific priorities:
- identifying models of effective social care interventions;
- identifying effective structures for the provision of social care;
- identifying effective models of inter-agency working;
- identifying the needs of carers and effective responses to address those needs.
Priorities for the commissioned scheme were agreed by the planning group in September 1998 as follows:
- Children in need/children and families;
- Support for social/health care interface (adult/statutory duty of partnership);
- Social exclusion.
Research that has been supported by these schemes is beginning to contribute to a cumulative body of knowledge on the effectiveness of social care policies and interventions. It is also the case that projects supported by WORD have produced evidence to inform the policy development and debates at the Health and Social Services Committee of the National Assembly.
Improving Awareness of R&D
The ability to use evidence in decision making must go hand in hand with an improved awareness of R&D by the policy and practice communities. The strategy suggested three approaches to improving awareness, these were:
- improved knowledge of R&D processes;
- improved knowledge of research evidence;
- improved awareness of research findings.
The first point outlined above has also been addressed through specific events and presentations to the above communities by both WORD personnel and researchers. Topics of such presentations have either related to funding mechanisms or have been related to research themes focusing on projects around client groups. An initial pilot of these events was undertaken during 1998/99 and it is envisaged that they will continue to be held in the future with a wider recipient audience. In addition, WORD held a joint conference with the WLGA relating to aspects of community care (Partnerships for Progress).
The second and third of these points relate largely to improving access to information through the provision of databases and appropriate dissemination. Several developments have occurred including the publication of a series of summaries by WORD titled 'Spotlight'. Access to information has also been provided via the WORD website and newsletter.
The Research Support Units established in 1999 in North Wales, Cardiff and Swansea have a role for the dissemination of research findings. This role will be developing over coming months along with their role as information providers to services. The research support units also have in training and supporting practitioners wishing to undertake research projects. WORD is currently in the process of preparing a dissemination strategy that will encapsulate all of these issues and cover the provision of proactive and reactive information for both social care and health.
Increased Practitioner Involvement
Although improved dissemination allows a greater degree of access to information and evidence this does not ensure the use of results by these communities. The social care strategy suggested that this was partly an issue of ownership and this may be addressed increasing the involvement of practitioners and policy makers at all stages in the research and development process.
To this end WORD have sought to engage the practice and policy making community in priority setting, involvement in/undertaking research projects (through schemes such as secondments and small grants) and dissemination of research results (through the Social Care Network and the Social Services Research Group). The involvement of practitioners and policy makers particularly at the priority setting stage is essential in ensuring that the R&D agenda is perceived as reflecting the concerns of these communities and is therefore relevant.
I have used the WORD research strategy for social care as the starting point because is has provided an important focus for social care research in Wales. Over the two years since it was established there have been:
10 commissioned pieces of work;
10 responsive grants;
4 secondment grants to support and develop the research skill base;
23 small grants.
This has provided the basis for a considerable growth in involvement in social care research in Wales. I have deliberately addressed social care research in this paper rather than social work research. Social work plays a pivotal role in social care in helping people understand and respond to complex social needs. But social care encompasses a wide spectrum of responses to those needs and provides the wider social context for that response. It is in understanding and responding to social need that I believe social work makes a distinctive contribution. Research can contribute to both improving our understanding and the effectiveness of our response.
I undertook to consider how we might further advance our present strategy within the context of the Assembly. There are a number of initiatives underway including:
- the transfer of WORD to the Assembly;
- the development of Social Care Institute for Excellence;
- development of contacts between the Assembly and the academic community.
There is also a growing and active consideration of possible areas for development and interest including:
- Research Ethics and Governance in Social Care - WORD sponsored a recent seminar, which had a positive response, towards developing an ethical framework for social care research in Wales.
- Engaging the university and academic sector in policy debate and exchanges of ideas through seminars, secondments, informal exchange and specific commissions.
- Mechanisms for commissioning and sponsoring research.
We need to find ways of engaging with a wide range of communities in commissioning research including:
- the academic community;
- partner agencies.
We have not been good at asking the right questions and the research community has been constrained by its own interests and requirements eg the Research Assessment Exercise. The policy community often needs quick answers and some questions or issues are unreasearchable. We need help in identifying the big questions that are researchable -
eg What is the contribution and impact of social care on health and the provision of health?
I have touched on how I see research contributing to the development of effective practice and services. I have also described the present state of development of social research in Wales. We want to build on the progress made in recent years as WORD comes within the umbrella of the Assembly. In particular, we want to work with the full range of partners to identify the big questions for research in social care in Wales - How we can enhance the contribution of the research in order to improve social care, the quality, range and effectiveness of our responses.
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