Competency in Generalist Practice: A Guide to Theory and Evidence-Based Decision Making PDF
Preview Competency in Generalist Practice: A Guide to Theory and Evidence-Based Decision Making
Competency in Generalist Practice: A Guide to Theory and Evidence-Based Decision Making ELIZABETH MOORE PLIONIS OXFORD UNIVERSITY PRESS COMPETENCY IN GENERALIST PRACTICE This page intentionally left blank COMPETENCY IN GENERALIST PRACTICE A GUIDE TO THEORY AND EVIDENCE-BASED DECISION MAKING Elizabeth Moore Plionis 1 2007 1 Oxford University Press,Inc.,publishes works that further Oxford University’s objective ofexcellence in research,scholarship,and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2007 by Oxford University Press,Inc. Published by Oxford University Press,Inc. 198 Madison Avenue,New York,New York 10016 www.oup.com Oxford is a registered trademark ofOxford University Press All rights reserved.No part ofthis publication may be reproduced, stored in a retrieval system,or transmitted,in any form or by any means, electronic,mechanical,photocopying,recording,or otherwise, without the prior permission ofOxford University Press. Library ofCongress Cataloging-in-Publication Data Plionis,Elizabeth Moore. Competency in generalist practice :a guide to theory and evidence-based decision making / Elizabeth Moore Plionis.— 1st ed. p. cm. Includes bibliographical references and index. ISBN-13 978-0-19-517799-2 ISBN 0-19-517799-1 1. Social service—Decision making. 2. Evidence-based social work. 3. Core competencies. 4. Social work education. I. Title. HV41.P56 2007 361.3—dc22 2006007094 1 3 5 7 9 8 6 4 2 Printed in the United States ofAmerica on acid-free paper I dedicate this book to my husband, Dimitri, and my children, Alex, Dean, Nick, and Elena; and to my mother, Bessie, my father, James, and my brothers, Jim and Terry. I thank you for your constant emotional, intellectual, and creative support. You have sustained and enriched my life beyond belief. I also dedicate this book to Mrs. McCree. This page intentionally left blank Preface As an educator with more than 25 years ofexperience,I have observed two devel- opments that have had a dramatic impact on teaching students how to make competent practice decisions.The first development is generalist practice.Gener- alist practice requires students to engage in the open assessment ofthe different- sized systems found in direct and indirect practice.Students must consider multiple theories prior to reaching a decision in a specific case or situation. The second development is evidence-based practice.Evidence-based practice requires students to additionally evaluate a vast empirical literature when de- termining which intervention is better than another.Presented with an array of evidence and method and theory choices,students report having considerable difficulty in deciding which intervention is the best under the circumstances ofa specific case or situation.Until now,tools for teaching students how to make such a decision did not exist.Students have traditionally been taught to apply a domi- nant theory (for exampl e,psychodynamic theory) to one system size (for exam- ple,the individual). This process does not lend itself to complex case data requiring the use of more than one method and more than one theory when targeting more than one system size in the same case.For instance,advocacy may be needed to change an organizational policy to ensure that a specific client receives needed treatment. As a consequence, many clients (subpopulation) will benefit from the policy change. I have written this book to assist teachers,supervisors,and students in navi- gating existing knowledge and a vast empirical literature when making case- specific decisions in accord with the standard of best practices. Best practice is defined as the conscientious, explicit, and judicious selection of an effective (evidence-based) and appropriate intervention strategy for a specific client or sit- uation (Sackett, Richardson, Rosenberg, & Haynes, 1997). If one is to consider viii Preface systems in direct and indirect practice in the same case,students need a text that teaches such content side by side. The skills associated with direct and indirect practice are different and cannot be merged or interchanged one for the other. Thus the book presents different skill sets needed for direct and indirect practice in alternating chapters.The framework is integrative without being reductionist. Several factors have prompted me to write this book.First,I have been influ- enced by students who observe that there are too many theories and no mecha- nism to help them know which theory is better than another in a specific case and bythose who feel a disconnect between what is being taught in the classroom and what they experience in their field placements.Similarly,students express a dis- connect (and polarization) between direct and indirect courses in the curriculum. Students in policy, advocacy, management, and community practice frequently observe that they are being taught content relevant to clinical students at the cost ofnot getting content they need for their practice area.Clinical students similarly perceive that their policy courses have little relevance to their clinical practice. Generally,students express frustration with first-year descriptive survey courses that rarely lead to reasonable prescriptive interventions for the cases they en- counter in the field. Second, I have been motivated by the dismay instructors and students feel when faced with the large number ofrequired and supplemental texts needed for a course.Books tend either to be specialized or too general.To compensate,in- structors prepare reading packets or place readings on electronic reserve. Stu- dents complain about difficulties in accessing such materials and the cost of purchasing more than one text per course.They observe that much of what is in their required text either needs to be supplemented or goes unused. This book significantly reduces the number of course-required and supplemental texts and the need for instructor-prepared packets ofreadings. Third,I have been influenced by the need for teaching tools.This text com- bines classic teaching tools with new teaching tools.The decision tree that is a key feature ofthis book is a teaching innovation that helps instructors,field supervi- sors,and students manage the multiple variables identified in open assessment.It rank orders the obtained information to create a hierarchy where decisions are prioritized.For instance,the decision tree begins by assigning priority to those facts of the case that have life-threatening and survival relevance. It goes on to consider crisis intervention,urgent concrete services,advocacy,and clinical inter- ventions with individuals,families,and groups.The user applies overarching cul- tural and ethical principles at the outset and during each step ofusing the decision tree.Process recordings (beginning,ethnographic,and advanced theory-driven) illustrate work with individuals,families,groups,and agency management,while cases and treatment matrices correspond step by step to the decision hierarchy. Finally,decision schemas summarize the content of each chapter and guide stu- dents in using chapter-specific information and evidence to arrive at a competent decision for that step. Preface ix Fourth,I have been influenced by the need to differentiate theories appropri- ate for clinical practice (borrowed from biology,psychology,and social psychol- ogy) from those appropriate for nonclinical practice.Students in policy,advocacy, management,and community practice observe that they are taught the skills they need but not the theories from which the skills are derived. These theories are borrowed from sociology (conflict and order, common good versus individual rights), political science, economics, and administration. All students, whether they develop,implement,administer,or offer direct face-to-face services,must be aware that the policies and programs with which they are associated are norma- tive in their end goals.Therefore,all students need to be taught the comparative theories ofsocial justice found in moral philosophy. The overarching theme laced throughout the book is that of competency. Competency in social work practice requires that students acquire and value skill sets for both direct and indirect practice, critically assess the available empirical evidence when making decisions, realistically appraise a variety oftheories,and master the art and science ofrelationship building in direct and indirect practice. It is my hope that this text presents complex material and a range ofskill sets in a substantive and practical way to help students to become competent social workers.
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