Use of Research Among Social Work Clinicians

44 Pages·2015·0.42 MB·English

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Master of Social Work Clinical Research Papers School of Social Work
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Justin Jeffrey
St. Catherine University
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Jeffrey, Justin. (2013). Use of Research Among Social Work Clinicians. Retrieved from Sophia, the St.
Catherine University repository website: https://sophia.stkate.edu/msw_papers/201
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Use of Research Among Social Work Clinicians

By

Justin Jeffrey, B.A., Ph.D.

MSW Clinical Research Paper
Presented to the Faculty of the
School of Social Work
St. Catherine University and the University of St. Thomas
St. Paul, Minnesota
In Partial fulfillment of the Requirements for the Degree of

Master of Social Work

Committee Members
Colin Hollidge, Ph.D., LICSW (Chair)
Theresa McPartlin, MSW, LICSW
Scott Washburn, MA, LADC

The Clinical Research Project is a graduation requirement for MSW students at St. Catherine
University/University of St. Thomas School of Social Work in St. Paul, Minnesota and is conducted within a nine-
month time frame to demonstrate facility with basic social research methods. Students must independently
conceptualize a research a research problem, formulate a research implement the project, and publicly present the
findings of the study. This project is neither a Master’s thesis nor a dissertation.
GRSW 682 Use of Research Among Social Work Clinicians 2

Abstract
This study used a quantitative research design to examine the extent to which clinical
social workers (LICSW’s) stay abreast of clinical social work research. This study also
examined whether social workers who use different therapeutic approaches differ at all in their
research behaviors. Participants responded to an online survey administered using
Surveymonkey (n=80).
The study found that clinical social workers engage in a variety of research behaviors,
and that these behaviors closely mirror the findings of a recent study on this same topic. Nearly
a quarter of licensed social workers report that they never or rarely read scholarly journal articles
on social work, and more than half do not receive any formal supervision. The study did not find
any relationship between preferred treatment approach and research behaviors. Findings suggest
that social workers have room to improve in terms of their use of research. Future studies could
include qualitative research on the reasons why many clinical social workers do not engage in
various behaviors to stay abreast of clinical research.
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Acknowledgements
I would like to first thank my committee members. I am thankful to my committee chair,
Colin Hollidge. for your valuable feedback and enthusiasm for my project. I also appreciated
your help in keeping this project in proper perspective as I finished up my final year as a
graduate student. I am also grateful to Scott Washburn and Theresa McPartlin, who gave me
timely and helpful feedback throughout the writing process.
I should also thank the 80 participants who responded to my survey. They took time out
of their schedules to assist an MSW student in the creation of research. The topic of this project
concerns the research behaviors of social workers, and these respondents demonstrated one way
in which one can help this cause.
Finally, I am grateful to my family and friends for their help and encouragement during
these two extremely busy years of graduate school. I have worked with and learned from some
excellent future (and present) social workers, and I have benefitted incredibly from your input.
To these classmates, as well as other friends and family, I have relied on your support heavily,
and I feel extremely grateful for all you have done.
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Table of Contents

Introduction 5
Literature Review 8
The proper role of evidence-based practice in clinical social work 8
Evidence-based practice in the Education of Social Work Students 10
Evidence-based practice among practicing clinicians 12
Practitioner use of social work research 14
Conceptual Framework 18
Methodology 20
Findings 23
Descriptive Statistics 23
Inferential Statistics 26
Discussion 30
Conclusion 33
References 34
Appendix A 37
Appendix B 39
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Introduction
Over the past several decades pressure has grown for social work practitioners to
incorporate evidence-based research (EBR) into their practice (Wharton & Bolland, 2012).
Some interpret this movement as a push to embrace a particular approach to therapy, such as
cognitive or behavior-based models that may have a greater body of statistical evidence to shore
up their claims. But with the more recent trend of attempting to provide evidence for the (once
thought) more difficult to measure practices that fall under the broad umbrella of
“psychodynamic,” the push for providing evidence-supported practice is now not so approach-
specific (Shedler, 2010). Incorporating evidence-based research into practice no longer requires
the use of particular cognitive or behavior-based models, but instead involves the broader
requirement to incorporate reputable research on clinical practice in general. Research exists in
support of a wide variety of clinical approaches—to make sure one is applying these approaches
correctly, and staying abreast of clinical developments, social workers need to use clinical
research as it continues to develop within the profession.
Social workers have a reputation from those outside the discipline—not entirely
deserved, probably, though likely not without a grain of truth either—of overly relying on
empathy, intuition, and relationship to the neglect of theory. No doubt empathy is an important
part of building a therapeutic alliance, the significance of which has been estimated to account
for roughly 70% of therapeutic efficacy (Martin et al. 2000). Nevertheless, empathy alone has
been shown to be inadequate as an approach (Martin et al., 2000). Some studies even suggest
that there is a high prevalence of using “novel unsupported practices” among social workers, or,
more pejoratively, “psuedoscientific” approaches, despite the widespread call in the literature for
evidence-based practices (EBP) (practices based on EBR) (Pignotti &Thyer, 2009).
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The importance of evidence-based research to social work practice has been made
explicit by its governing bodies. For instance, the Educational Policy and Accreditation
Standards of the Council on Social Work Education (CSWE, 2008) makes explicit the
expectation that social work clinicians will incorporate evidence into their treatment approach:
2.1.3: Social workers distinguish, appraise, and integrate multiple sources of knowledge,
including research based knowledge and practice wisdom.
2.1.6: Social workers use practice experience to inform research, employ evidence-based
interventions, evaluate their own practice, and use research findings to improve practice, policy,
and social service delivery (Council on Social Work Education, 2008).
As though in recognition of this pressure to incorporate evidence into clinical practice,
debate—both formal and informal—has begun in recent years within the social work discipline
about the best way to do this, or whether to do it at all. Articles have been recently written about
the applicability of EBP to clinical research. Some researchers—especially, it seems, those who
are partial to psychodynamic approaches—are skeptical of the value or relevance of evidence-
based research. It is argued, for instance, that evidence-based research is conducted in rarified
environments of strictly controlled laboratory-type conditions that almost never obtain in the real
world (Thyer et al., 2011). Other clinicians, including those who favor a psychodynamic
approach, are open to such research, and welcome the empirical testing of psychodynamic
theory. They believe, and some have tried to show, that such an approach will survive such tests
intact (Shedler, 2010; Leichsenring & Rabung, 2008; Drisko, 2011).
This academic discussion of the relevance of evidence-based practice to clinical social
work has been lively and prolific, though only a few studies have ventured to test questions
about evidence-based practices in the field. Even these studies, though, have not probed the
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simple but interesting question about whether and how clinicians are actually attempting to learn
about current clinical research. (Wharton & Bolland, 2012). Barriers to such implementation
have been discussed (Wharton & Bolland, 2012) as have attitudes toward EBP and the effect
such attitudes on actual clinical social work practice.
For the purpose of my research question, evidence-based practice is “the integration of
the best research evidence with clinical expertise and patient values" (Sackett, et al. 1997). Note
that “best research evidence” does not refer only to randomized controlled studies but may also
include evidence from clinical experience or data gathered in some other way.
With this definition in mind, this research paper will study to what extent, and in what
ways, licensed clinical social workers (LCSWs) are attempting to stay abreast of the latest
research in the field of clinical social work. This study will also investigate whether clinical
approach correlates at all with research behavior. Approaches that will be investigated by this
study include psychodynamic theory, “eclectic” approaches, cognitive behavioral approaches,
behavioral approaches, and narrative approaches.
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Review of the Literature
This literature review will discuss four themes that recur in the literature relevant to
evidence-based practice among social work clinicians. These themes are: the proper role of
evidence-based practice in clinical social work; the teaching of evidence-based practices to social
work students; the actual employment of evidence-based practices among social work clinicians;
and the use of research by clinicians on evidence-based practices.

The proper role of evidence-based practice in clinical social work
Several articles discuss the appropriate way—or even whether it is appropriate at all—to
incorporate evidence into practice. For instance, Drisko (2011) writes that one should worry
about the possible political and economic pressures that may motivate some of the push to use
EBP. In an era of health care cost-cutting, the requirement that a treatment be “evidence-based”
could be used as a way to control costs merely dressed up in the guise of best practices. This
could thereby limit the options of quality therapy available to clients, marginalizing less
measurable treatments through insurance non-coverage. Psychodynamic treatment, for instance,
might in this way be put on the chopping block, as it is famously difficult to measure. (Note
though that in recent quantitative studies that made use of measurable client outcomes,
psychodynamic therapy has been shown efficacious (Leichsenring et al. 2008; Shedler 2012)).
Traditional talk therapy, according to its adherents, doesn’t just produce symptom relief and
easily quantifiable outcomes; some of what is valuable about such therapy is the process itself as
well as other more elusive qualities (Drisko 2011; Zayas et al. 2011). For instance, some
psychodynamic therapy takes as one of its goals personal development, development of the
personality over the life span, and other outcomes that are not specifically the remission of any
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type of symptom. A related concern is that clients should have a say in how they feel about the
outcome and the process of therapy, and that this data should be incorporated into studies about
therapy efficacy (Drisko 2011).
The incorporation of EBP into social work psychotherapy has been resisted on the
grounds that such practices are tested in artificial, laboratory type-environments, and produce
rigid lists of interventions that aren’t sufficiently fluid to deal with the client in his or her unique
context (Thyer et al., 2011). Others complain that not much evidence has yet been gathered on
practices other than CBT-- often equated with evidence based practices--making its explicit
incorporation difficult at best for those outside of this narrow field of practice (Shedler, 2010). A
more philosophical objection is that what gets counted as “evidence-based” is subjective, and
determined by the dominant culture at the time (Witkin, et al., 2001). For instance, some argue
that a narrow, empiricist view of evidence reigns in our culture at the moment. However (the
argument goes) philosophical fads should not dictate what type of therapy is counted as
legitimate.
Mental heath care consumers in the US are of two minds with respect to the
methodologies and goals of EBP (Tanenbaum, 2008). Their primary misgivings appear mirror to
some extent the criticisms that EBP faces from professionals, namely: that it can be short sighted
as well as irrelevant to individual real-life cases (Tannenbaum, 2008).
The voices expressing resistance to incorporating EBP into clinical social work are no
louder than those that encourage their merger. A review of the most recently published literature
on the topic reveals that the importance of grounding practice in EBR is often taken for granted.
In response to the objection that evidence-based practices are inflexible and difficult to tailor to
individual mental health issues, it has been argued that the programmatic “paint-by-numbers,”