SOWK 6003 Social Work Research

Week 1

Dr. Paul Wong, D.Psyc.(Clinical)

Lecture 1

• Overview of Course

• Definition and Purposes of Research

• Research and Social Work

• Ways of Knowing

• Evidence-based practice

• Practice!

How I teach?

• Two major principles:

1. Based on a “"Tell me, I'll forget. Show me, I'll remember. Involve me, I'll understand" principle. Thus, I will do some lecturing, you will have many opportunities to discuss, practice, interact during the lectures.

How I teach?

• 2. Principle of adult learning (Field, 1990): – Become ready to learn when they recognize a deficiency in their

own skills and accept that they need to take action to remedy it; – Want learning to be problem-based, leading to the solution of

particular problems facing the individual; – Want to be treated as adults, enjoying the respect of the

instructor and of other learners, and to have the experience they bring with them accepted as valid;

– Bring to the learning situation their unique mix of characteristics such as self-confidence and self-image, learning style, and personality.

Overview of the course

Please read the course outline

carefully

What is Research?

1 : careful or diligent search2 : studious inquiry or examination,

especially investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws

3 : the collecting of information about a particular subject

Social work research is to…

• provide the practical knowledge that social workers need to solve the problems they confront;

• give the field the information it needs to alleviate human suffering and promote social welfare; and

• recognizing when particular interventions for particular practice situations have been supported by adequate scientific evidence.

Besides research, there are other ways of knowing our world:

E.g., How do you know food are better after being cook?

• Tradition – e.g., “The Chinese way of cooking include steam, stir, fried, brew, etc”

• Authority – e.g., “Doctors recommended that we should have your food cooked to well-done”

• Common sense e.g., “There are virus and germs in raw meat”

• Popular media e.g., “Yan can cook shows that food taste good after diligently cooked”

Using the Scientific Method to know something:

Questioning things and search for evidence as the basis of making decisions

Key features:

a. everything is open to questions: knowledge is provisional and subject to refutation

b. empirical: evidence based on systematic and comprehensive observations

c. pursuit of objectivity through specified procedures

d. replication

Unscientific social work/psychology practice:

E.g., Families and friends of suicide • Inaccurate observation• Overgeneralization• Selective observation• Ego involvement in

understanding• Premature closure of inquiry

Evidence-based Practice

Why Evidence-based practice?

• increase understanding of health pathologies that produce the foundation in developing precisely targeted interventions.

• advancement in clinical research methodologies that produce new evidence for effectiveness of interventions

• global concerns over expenses of health care (Huppert, Fabbro, & Barlow, 2006).

• implications over legal concern (Havighurst, Hutt, McNeil & Miller, 2001).

EBM as “the integration of best research

evidence with clinical expertise and

patient values”

Components of Clinical Expertise

• assessment, diagnostic judgment, systematic case formulation, and treatment planning

• clinical decision making, treatment implementation, and monitoring of patient progress

• interpersonal expertise• continual self-reflection and acquisition of skills• appropriate evaluation and use of research evidence in

both basic and applied psychological science• understanding the influence of individual and cultural

differences on treatment• seeking available resources• having a cogent rationale for clinical strategies

Patient characteristics, culture, and preferences

• exploring “what works for whom”• Patient characteristics: functional status, readiness to

change, and level of social support,• Social factors and cultural background• Familial factors• Current environment context, stressors• Developmental considerations• Problem variations: Comorbidity and polysymptomatic

presenations• Personal preferences, values, and preferences related to

treatment (goals, beliefs, worldviews, and treatment expectations)

Evidence-based Practice

• de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and

• stresses the examination of evidence from clinical research. (Evidence-Based Medicine Working

Group, 1992)

• APA Presidential Task Force on Evidence-Based Practice in 2005

• ‘ the purpose …to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention (p. 5)

Evidence-Based Practice in Psychology (EBPP) (Levant, 2005)

Evidence-based practice in Social Work

• The NASW Code of Ethics states that "Social workers should critically examine and keep current with emerging knowledge relevant to social work and fully use evaluation and research evidence in their professional practice" (5.02(c)).

• This guideline also pertains to the ethical mandate of informed consent, because professionals need to know the evidentiary basis for alternative practices and policies in order to fully honor the informed consent principle (Gambrill, 2003)."

Steps in evidence-based practice

1. Formulate a question to answer practice needs;

2. Search for the evidence;3. Critically appraise the relevant studies

you find; 4. Determine which evidence-based

intervention is most appropriate for your particular client;

5. Apply the evidence-based intervention; and

6. Evaluate and feedback

Level and Quality of Evidences

UK: 5 Levels of Evidence (Centre for Evidence-based Medicine, University of Oxford, 2009)

http://www.cebm.net/index.aspx?o=1025

A few key terms to remember: • Case-control study: Involves identifying patients who have the outcome of interest

(cases) and control patients without the same outcome, and looking to see if they had the exposure of interest.

• Clinical Expertise: refers to competence attained…through education, training, and experience resulting in effective practice

• Cohort study: Involves the identification of two groups (cohorts) of patients, one which did receive the exposure of interest, and one which did not, and following these cohorts forward for the outcome of interest.

• Effectiveness: A measure of the benefit resulting from an intervention for a given health problem under usual conditions of clinical care for a particular group.

• Efficacy: A measure of the benefit resulting from an intervention for a given health problem under the ideal conditions of an investigation.

• Heterogeneity: In systematic reviews, the amount of incompatibility between trials included in the review, whether clinical (ie the studies are clinically different) or statistical (ie the results are different from one another).

• p value: The probability that a particular result would have happened by chance. • Randomised controlled clinical trial: A group of patients is randomised into an

experimental group and a control group. These groups are followed up for the variables/outcomes of interest

• Sensitivity: The proportion of people with disease who have a positive test.• Specificity: The proportion of people free of a disease who have a negative test.• Systematic review: An article in which the authors have systematically searched for,

appraised, and summarised all of the medical literature for a specific topic.

ChallengesChallenges in applying EBP in counseling settings

• Based on studies of clients unlike those typically encountered in everyday life practice;

• Lack of evidences over choices of multiple evidences;

• Manualized brief intervention vs process-oriented intervention

• Technicalization vs professionalism• Use of RCT in clinical settings• Knowledge, skills and attitudes (of you and

your supervisors/organizations)

In-class activities: Complete Step 1 & 2 of EBP

1. Form 3 groups: a. Use www.google.comb. Use www.scholargoogle.comc. Use www.campellcollaboration.org

2. Search for evidence-based practice on ???

3. Discuss “how that you found there can help you practice an evidence-based intervention for your client’s presenting problem”.

Homework

Repeat the in-class activity with a real problem that you encounter at work using the Cochrane Collaboration and Campbell Collaboration

References

Bulter, I. (2002). A code of ethics for social work and social care research. British Journal of Social Work, 32, 239-248.

Evidence-Based Medicine Working Group (1992). Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. JAMA, 268(17):2420-2425.

Gambrill, E. (2003). Evidence-based practice: Sea change or the emperor's new clothes? Journal of Social Work Education, 39(1), 3-23. Havighurst, C. C., Hutt, P. B., McNeil, B. J., & Miller, W. (2001). Evidence: Its meanings in health care and in law. Journal in Health Politics, Policy and Law. 21(2), 195-215.

Huppert, J. D., Fabbro, A., & Barlow, D. H. (2006). Evidence-based practice and psychological treatment. In G. M. Reed & E. Eisman (eds.) Evidence-based psychotherapy: Where practice and research meets (p. 131 – 152). Washington, DC: American Psychological Association.

Levant, R. F. (2005, July 1). Report of the 2005 presidential task force on evidence-based practice. Retrieved June 20, 2008 from http://www.apa.org/practice/ebpreport.pdf

Lewis, J. (2003). Design issues. In J. Ritchie & J. Lewis (Eds.), Qualitative research practice : a guide for social science students and researchers (pp. 47-76). London: SAGE.

McLeod, J. (2001). Qualitative research in counselling and psychotherapy. London: SAGE.McNeece, C. A. & Thyer, B. A. (2004). Evidence based practice and social work. Journal of Evidence-

Based Social Work. 1(1), 7 - 25.Rubin, A. & Babbie, E. R. (2008). Research Methods for Social Work. 6th edition. Belmont, CA:

Thomson.Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996).

Editorial: Evidence based Medicine: what it is and what it isn't. BMJ, 312, p. 71-72.Willig, C. (2001). Introducing qualitative research in psychology : adventures in theory and method.

Buckingham: Open University Press.