Child Security Work - Essay Example

Running Head: EVIDENCE BASED PRACTICE Evidence Based Practice [The Writer’s Name] [The Name of the Institution] Evidence Based Practice It is obvious that child security work has, in current times, become more and more multifaceted. It is gradually more politicised and subject to media attention. The numbers of child protection workers have enlarged but the magnitude of notifications and workloads have amplified even more. Child protection services are all the time more anxious about whether abuse has taken place and with risk assessment processes. And there is an escalating trend for welfare services to be afforded with voluntary agencies as more and more of the direct service work is constricted out—often leading to rising division of services. There is a divergence of views among both academics and practitioners on this issue. Some support the notion of evidence based or empirical practice. They argue that it is possible and desirable to measure the effectiveness of different programs and direct-practice approaches and they argue that interventions should be based on the findings of effectiveness research. Others argue that the concept of evidence-based practice is flawed. A number of studies have been undertaken which have examined the use of particular types of interventions and how these relate to client outcomes. For example a study by Laurence Shulman (1991, 76-80) undertaken in Canada asked clients a range of questions about their workers; for example, did the worker help them to clarify the purpose of the intervention, did the worker help to put their feelings into words, did the worker break down their concerns into manageable parts. Shulman found that when the workers did these things their clients felt that their workers were helpful, they were less likely to go to court and they had fewer days in care, compared to when workers did not do these things. Other studies have also found that when child protection workers have particular skills their clients do better. The rivals of evidence-based practice disagree further that it is not likely to measure the one-sided realities of client's lives. That the endeavour to expand quantifiable results unavoidably ignores hard to describe perceptions such as self-worth or empowerment. It also ignores more macro objectives relating to social change and community development. In response to this argument it cannot be suggested that evidence-based practice provides all the answers. Nevertheless, some things can be measured and it is valuable to measure them. Perhaps the challenge for evidence based practice is to try to capture some of the more elusive concepts, such as empowerment. Again, in this regard, the opponents of evidence-based practice frequently disagree that each client position is exclusively individual; it is not probable to generalise from one situation to another. Nevertheless, much of the research and literature reviews in child protection and in other safety settings imply that there is often uniformity across populations and character situations. Conceivably the dispute about the exclusive individuality of the client group just points to the requirement for more and more research in diverse settings so knowledge can be additionally developed about what works pre-eminent in what circumstances. Besides this, another conviction which is offered by critics of evidence based practice is that even if the results are clearly and constantly affirmative, it may not be probable to decide what has led to the positive outcomes. How can you know if it is the worker's interference that has made the distinction, rather than the multitude of other factors which may manipulate the lives of client families? On the other hand, research methodology is adequately complicated to give us a fair suggestion of the amount to which an intervention might have been liable for the outcomes rather than other factors, such as the maturation of family members or a supportive neighbour. (Maluccio, 2000, 67-73) When repeated studies with large samples continue to find particular approaches related to positive outcomes, it is likely there is a cause-and-effect relationship. This is even more likely if there is a theory which can explain the relationship. For example, the setting of client-defined goals is not only related to positive outcomes, its value is supported by motivational theories that suggest people are more likely to change if they work towards their own goals. The questions which researchers ask and the outcome measures they use are not the clients' questions and outcome measures, and again they may not take account of the subjective realities of those clients' lives. On the other hand much of the more recent research is qualitative in nature and focuses on clients' subjective perceptions. (Gibbs, 2001, 323-35) Evidence or knowledge about good practice may come from many sources, for example, from international and local journals, books, seminars and conferences and from practice experience. Some evidence, however, is more reliable and more valuable than other evidence. The most valuable form of evidence is often found in refereed international journals, such as Child Abuse Review or Child Abuse and Neglect. The fact that the evidence for a particular way of working is found in international refereed journals suggests it is likely to be sound, because these journals only publish articles which have been read and critiqued by at least two anonymous reviewers. If the methodology is unsound the article will usually be rejected. Workers can also learn about effective practice through attending seminars and conferences. In fact, often the most up-to-date information about research is available at conferences. Conferences can also be a venue for hearing unsubstantiated opinion and the evidence-based practitioner needs to be careful to examine the sources of the material presented. Some conference presentations would not meet the standards required of reputable journals. Workers can also develop their knowledge of evidence-based practice through the information they gather from their clients. The evidence-based practitioner is likely to ask his or her clients about whether or not the services those clients have received have been helpful or unhelpful and how they can be made more helpful. The workers will, of course, be cautious about how this information is used because it is difficult to generalise from a small number of cases and because the worker may not use a systematic method of gathering information. Further, the clients' view of what is helpful is also only one outcome measure. Nevertheless, the evidence-based practitioner over time will begin to develop an understanding of what seems to work best in particular situations. This can then be married with the evidence from the other sources referred to above. The evidence-based practitioner is able to gather evidence from articles, from books, from conferences and from seminars, and from his or her own practice. This builds on the workers' undergraduate or post-graduate education, which should provide information about effective practice in the human services, about how to gather information about what works and about the differences between sound and unsound research. The evidence-based practitioner can then use the knowledge about what works in day to-day work with clients. There have been many examples of intervention methods in human services that have been popular but have ultimately proved to be unsuccessful—psychodynamic groups for young offenders and programs based on fear of punishment (Andrews 2001, 210-18) provide two examples. No matter how popular or appealing a new intervention model may be, it is not possible to know whether it works until some research has been carried out. Evidence-based practitioners should be cautious about using new models until the evidence for their effectiveness is available. Not to do so is to risk doing more harm than good. Other problem workers may face in gathering information about what works relates to the articles and books themselves. Despite the reviewing processes, books and articles might contain unsupported generalisations or they might be based on studies with poor methodology. The evidence-based practitioner needs some knowledge of research methodology and the ability to discriminate between a sound study and a shoddy one. Hopefully, the worker's professional education will have provided some knowledge about research. Certainly, critical ability is likely to be helpful in the development of an evidence-based approach. The evidence-based practitioner may face yet another problem—time. The evidence-based practitioner should make a habit of critically reading books and articles about child abuse and child welfare, however, many conscientious and hardworking child protection workers will find they simply do not have the time to do this. At the end of a busy day the last thing you might feel like doing is sitting down to read child abuse articles or learning about research methodology. Unfortunately, the benefits which come from evidence-based work cannot be achieved without some endeavour on the part of workers, or some input from the management of child protection services. Effective child protection services need managers and workers who accept the notion of evidence based practice. The more effective services will provide incentives for workers to read books and articles, they will maintain up-to date libraries, they will sponsor staff to attend conferences and seminars and also allow time for ongoing training and higher education. Armed with the evidence, the evidence-based practitioner can attempt to work in a way which is consistent with the research about what works. It seems clear that workers who make use of certain skills do better with their clients. It might also be anticipated that those workers who have good skills and good client outcomes would enjoy their work more. It might also be anticipated that staff supervisors who model and encourage effective practice skills would foster those skills in their staff. Staff supervisors with good skills might even have good outcomes among clients within their teams. In child protection work, the way in which the client is defined is important. In fact it has been argued that defining abusive parents as clients can lead to inappropriate interventions which help the abusers rather than the abused (Stanley and Goddard 2002, 46-54). Child protection work is about protecting children or young people and it can be argued, therefore, that the client is the child or the young person. On the other hand, there are many occasions when the best way to help a child is by working with a mother or a father or others directly involved in the life of that child. (Ethier, 2000, 19-36) 'Evidence' has several facets which are treated in this paper. The first concerns the nature of evidence itself. Evidence-based medicine (EBM) has been defined as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual, clinical expertise with the best available external clinical evidence from systematic research. Evidence-based practice is a broadening, to healthcare in general, of the principles of EBM. Evidence-based practice (EBP) does not eschew the role of clinical experience but simply argues that it is such experience which will complement and enable the appropriate interpretation of available evidence-so that it is only in the absence of an evidence-based approach that reliance upon clinical experience alone becomes inadvisable. The paper examines some of the problems which arise when considering an EBP approach in the psychodynamic psychotherapies. A requirement of EBP is that clinical decision-making be largely informed by good evidence concerning best practice. What constitutes good evidence might at first be thought to be simple; namely, that it is evidence from research carried out with sufficient scientific rigour to be both believable (e.g., internally valid) and applicable (i.e., generalisable-or, roughly speaking, externally valid). On this basis, a series of assumptions are made about what constitutes acceptable evidence, and a hierarchy of value is typically ascribed to different sources of evidence: RCTs are thought to yield stronger evidence than open case series, which yield stronger evidence than clinician consensus, which may yield stronger evidence than patient views about effectiveness, etc. Using such a hierarchy it becomes possible to identify the evidential criteria whereby treatments may justifiably be described as empirically 'validated' or 'supported'. As evidence accumulates treatments can be seen as increasingly supported from an empirical standpoint. Lists can then be drawn up of treatments, with a sufficiently solid empirical base for use in routine care and incorporation in clinical guidelines-with the assumption that empirically poorly supported therapies must remain 'experimental' until they accumulate adequate empirical support. Similarly, the importance of double-blind methodology in assessing the effects of treatment is axiomatic where pharmacotherapy research is concerned (Burns, 1994, 110-17)). It is hopelessly impractical-and hence irrelevant-for psychotherapy outcome evaluation. The rationale for using double-blind methodology is to minimise the potential biasing effects on patient and/or therapist which may arise from knowledge about and attitudes towards the treatment concerned. Neither patient nor therapist can remain blind to the fact of receiving or giving psychotherapy, however, and once again, more sophisticated methods are needed to examine the extent to which the patient and therapist's knowledge and attitudes influence therapeutic outcome. In contrast there may be methodological criteria of special relevance to psychotherapy research-which may be of lesser importance in other kinds of treatment trial. An example might be the extent to which the quality of the therapy, which was delivered in the trial, has been demonstrated or can reasonably be assumed. Variations in pill content and quality are likely to be small in drug trials. Variations in the content and quality of psychotherapy could be considerable. Comparative psychotherapy studies involving psychodynamic approaches have sometimes used expert therapists which found psychoanalytic therapy to be equivalent in effectiveness to behaviour therapy and superior to a waiting list control condition. Others have used non-expert therapist’s study-where the psychodynamic therapy was used as a control for non-specific factors and, not surprisingly, was less effective than social skills training or drug treatment. The list of criteria for assessing methodological quality in outcome studies in any therapy domain is likely to be long. It will include considerations of adequacy of design, sample, measurement, therapy integrity, follow-up periods, data analysis and reporting, as well as other features. Scoring criteria have frequently been employed to assess methodological adequacy, particularly for use in systematic reviews, and there is some evidence to suggest that as methodological adequacy drops, so the apparent effects of treatment (i.e., effect sizes) go up. At the very least this underlines the importance of paying adequate regard to the evaluative methods employed in individual studies. In view of the inevitably imperfect nature of applied research, reviewers cannot realistically exclude all studies which fail on a single criterion of methodological adequacy. Thus the relative weighting given to different methodological criteria will influence the likelihood that studies appear in reviews and hence contribute, either positively or negatively, to the evidence base relating to particular therapies. The Bellack et al. study, using psychodynamic psychotherapy as a placebo, meets many of the criteria of a good-quality study and therefore finds its way into reviews of the efficacy of PDP, albeit as a study that is acknowledged to add little to our understanding of its outcome. The Sloan et al. study, whilst in some ways providing a far more valid test of (expert) therapy on a (clinically representative) group of mixed neurotic patients, is excluded from some recent reviews for failing to meet the criterion of specificity of patient sample. The above example reinforces the point that a single set of 'evidence-based' research criteria cannot respond across the board to the needs of reviewers-or of individual clinicians who, in the absence of clear guidelines, are trying to find their way through the maze of research relevant to their particular area of practice. (Karamoa, 2002, 415-21) It is a commonplace in scientific circles that two narrative reviews of the same source material may arrive at different conclusions. Clarity is achieved in systematic reviews and meta-analyses through explicit stipulation of the rules, whereby individual studies contribute to conclusions. This clarity should not be confused with certainty about the correctness of the chosen rules. (Triseliotis, 1998, 22-35) It is not suggested here that, were a differently organised set of cogent scientific criteria applied to the evaluation of outcome studies on PDP, the present dearth of acceptable evidence would suddenly be transformed into a plethora. It is simply proposed that proper attention be paid to the adoption of psychotherapeutically relevant methods in psychotherapy evaluation research. References Andrews, D.A., 2001, `Effective Practice Future Directions' in Andrews, D., Hollin, C., Raynor, P., Trotter, C., and Armstrong, B., Sustaining Effectiveness in Working with Offenders, Cognitive Centre Foundation, Cardiff, UK. 210-18 Burns, P., 1994, Pro-social Practices in Community Corrections, honours thesis, Monash University, Department of Social Work, Melbourne, Australia. 110-17 Ethier, L.S., et al., 2000, `Impact of a multi-dimensional intervention program applied to families at risk for child neglect', Child Abuse Review, vol. 9, pp. 19—36 Gibbs, J., 2001, `Maintaining Front-Line Workers in Child Protection: A Case for Refocusing Supervision', Child Abuse Review, vol. 10, no. 5, pp. 323—35 Karamoa, J., Lynch, M. and Kinnair, D., 2002, `A Continuum of Child Rearing: Responding to Traditional Practices', Child Abuse Review, vol. 11, pp. 415—21 Maluccio, A., Ainsworth, F. and Thoburn, J., 2000, Child Welfare Outcome Research in the United Kingdom, United States and Australia, Child Welfare League of America, Washington DC, USA. 67-73 Shulman, L., 1991, Interactional Social Work Practice, FE Peacock, Illinois, USA. 76-80 Stanley, J. and Goddard, C., 2002, `Failures in Child Protection: A Case Study', Child Abuse Review, vol. 6, pp. 46—54 Triseliotis, J., Borland, M., Hill, M. and Lambert, L., 1998, `Social Work Supervision of Young People', Child and Family Social Work, vol. 3, pp. 22—35 Read More