The ambiguity of ‘evidence based practice’

It has also become apparent how the contested nature of ‘subjectivity’ in EBP serves those in power well. By excluding the ‘subjective’ voice of those in society who are marginalised, their stories, their experiences and their knowledge is discarded, branded as unscientific, not rigorous, not valid …… whose interests does this serve?

Uncertainty is an inevitable aspect of social work practice, yet, the creation of certainty is a fundamental tendency of the human mind, and it is not just our perceptual system which automatically seeks to transform uncertainty into certainty. Government and wider society demand a high level of certainty from social workers, especially following high profile tragedies, and subsequent reports identifying ‘failings’ in practice. As a response to such ‘failings’ the concept of ‘evidence based practice’ (EBP) has proliferated in social work.

EBP is presented as a model of critical appraisal, designed to inform practice, where the practitioner has a relatively autonomous role in searching for, and critically analysing, research evidence to inform their decision making. The latest guidance on the refreshed PCF articulates this commitment once again, and adds an additional expectation that social workers also generate ‘evidence’ to inform practice.

‘More reference throughout to importance of evidence and evidence-informed practice and the inclusion of more reference to ‘evaluation’ alongside ‘research as key source of evidence and engagement of practitioners in evidence/knowledge generation.‘ (BASW,2018)

Whilst practitioners and educators strive to adhere to this principle it could be argued as a ‘professional capability’ this ignores the complexity associated with notions of EBP at both a practical and philosophical level.

Is EBP at odds with real work social work?

Practitioners across allied professional groups are constantly called upon to manage uncertainty, ambiguity and complexity where there often seems to be a plurality of ways to understand what is happening in practice contexts.

From a philosophical perspective EBP appears to operate on modernist foundations.  For example seeking to adhere to methodological and analytic standards of rigour, which demonstrate the reliability of a scientific approach, because this will provide clarity in establishing the ‘right’ evidence is combined to create systematic and cohesive frameworks of knowledge. The belief that by adopting this approach one can achieve a level of certainty is alluring, yet, arguably, unrealistic in social work practice, and indeed may lead practitioners into a false sense of security when making decisions based on EBP.

Postmodernist frameworks are of benefit here to thinking about the multiple discourses at play in social work practices, and understandings the dynamics between them – particularly concerning power. This includes shifting from singular forms of objective understanding, to consider the diversity of subjective knowledges at play in practice contexts. This requires practitioner and academics to appreciate how objective knowledge is a contested concept which can lead to a fruitless search in complex situations for certainties that may not exist.

Peshkin (1988) provides an interesting perspective which extends, and troubles, the notion of objectivity by suggesting the ‘taboo’ of subjectivity stems from a misunderstanding of its potential role in EBP. It is our own subjective involvement in practice—not the precise replication of the event—which can provide strong theoretical insight. However, we are somewhat conditioned as practitioners and academics to see subjectivity as a ‘contaminant’. Yet, that contaminant is always present, one can never get away from one self. As Alan Peshkin eloquently reminds us

“Whatever the substance of one’s persuasions at a given point, one’s subjectivity is like a garment that cannot be removed. It is insistently present in both the research and non-research aspects of our life. … our subjectivity lies inert, unexamined when it counts ….. ” (Peshkin 1988, p.17)

The key point here is that subjectivity cannot be removed. It shapes and mediates our thinking and action in a whole range of ways. Therefore, it needs to be valued understood and utilised . Instead of trying to remove the garment and declare ourselves clean of subjectivity, it is important to acknowledge it, and draw upon it in deep analysis to inform decision making.

(for an alternative critique of post modernism in social work click here)

The practical application of EBP

Research from Scandinavia suggests whilst practitioners support the notion of EBP it is rarely applied in a way that is conducive to improved decision making. Their findings highlighted a number of fundamental flaws, which may be relevant to practice in the UK. Firstly, the research found professional autonomy is not a given , suggesting the greatest barrier to practitioners engaging in EBP is the organisational context.

The research identified five significant organisational issues which impeded practitioners from adopting a more focused EBP approach to inform practice;

  1. No access to databases where they can search for, and evaluate research
  2. Time constraints
  3. ‘Organisational logic’ (predictability) prioritised over a ‘logic of care’ (unpredictability)
  4. A focus on following organisational guidelines which aligns EBP with organisational logic to guide decision making
  5. Financial considerations taking priority over research findings to inform practice

The research concludes whilst social workers were not content with the current conception of  EBP they felt incapable of challenging it. The issues highlighted in this research provide little that is new, previous research seems to support these recent findings and arguably leaves practitioners in an untenable position, from both a philosophical and a ‘professional capability’ perspective.

Creating an alternative approach in my practice

Just as practitioners may find themselves out of kilter with EBP, I too have experienced the oppressive effects of  the polarity that exists in understanding EBP when combined with organisational logic in a Higher Education setting.

As a lecturer I am more used to drawing on the objective research knowledge of ‘expert’ academic others to inform my practice, where objectivity and evidence based practice is privileged as an expression of professionalism. However, the eloquent exploration  by Staller (2007) of the interaction between a social worker and sexually abused child resonates with my experience of the polarity which exists in presenting objectivity as synominous with professionalism as she writes

He speaks about his responsibility to retrieve objective stories from sexually abused children, knowing He holds their heart in His hands‘ (p.766). Going onto to suggest ‘His need to get an “objective” story is because the alternative is subjective or fictitious’ (Staller,2007;p.776).

Staller’s experience of encountering this exchange provided a ‘trigger’ moment. Her experience has become the ‘data’ which she will explore from every angle possible to locate that moment within the social, cultural and political realms. This process then has the potential to extract new learning from her experience, to create and share knowledge which will enhance practice.

Reading Stallers work provided a ‘trigger’ moment for me, where I filtered its meaning using the theoretical lenses of modernism and post modernism,   to try and be aware of, and make sense of, how I decide what ‘counts’ as knowledge and how I create and transform data into knowledge, and then ‘evidence’ to support my professional self.  I also had to locate my thoughts in the wider context of the organisation I work in, and the current  structural frameworks which directly influence current practice within higher education (i.e. the use of metrics to ‘rate’ the quality me and my institution, and so inform prospective students how ‘good’ I am, we are – I will leave this for another blog!)

It has also become apparent how the contested nature of ‘subjectivity’ in EBP serves those in power well. By excluding the ‘subjective’ voice of those in society who are marginalised, their stories, their experiences and their knowledge is discarded, branded as unscientific, not rigorous, not valid …… whose interests does this serve? 

(WARNING – Shameless plug here: From this, and subsequent experiences,  my colleagues Annastasia Maksymluk  , who has used auto-ethnography in curriculum development & Andy Whiteford , who focuses on sustainability, and I have collaborated to create a ‘no smoke and mirrors’ research and writing partnership, from which we developed  an open access on-line peer reviewed journal the Journal of auto-ethnography for health and social care). We encourage submissions to the journal from anyone who wants to be part of producing evidence to inform practice;  students, professionals, service users, patients – all are welcome!

Conclusion

Regardless of whatever EBP might, or might not be, it appears practitioners are currently expected to work within a model of EBP which might be more accurately conceptualised as OBP, Operational Based Practice , where professional decision making is centred in processes designed to meeting organisational demands. This is problematic because

“ …it is argued that whatever group controls the way things are seen in some ways also has the power to control the ways things are. Whoever’s interpretation gets accepted will doubtless control how the idea is enacted.” Fook (2002:37).

From this perspective the production, and application, of ‘evidence’ is the product of deliberate, conscious human design, which is amenable to a whole host of organisational, ethical and political requirements. Evidence is not value-free and we need to ask what values and processes currently underpin the discourse that surrounds and shapes EBP in education, research and practice and whether these align to the professions values and ethics?

From a logic perspective EBP provides a neat linear model of deliberated decision making. However, real world social work is rarely a logical, or a linear activity, dealing as it does with often complex and chaotic human lives. Lives where meaning is constructed by a variety of individuals, and subjected to a plethora of structural and organisational filters that heavily influence the practice of decision makers and the lives of those they work with.

Whilst the notion of EBP has provided the profession, regulators, educators and government, with a seemingly straightforward response to improving decision making in complex cases, the structural realities of practice continue to be ignored, as do the structural inequalities that exist in many of the lives practitioners work with.

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1 thought on “The ambiguity of ‘evidence based practice’

  1. Reblogged this on Di Galpin and commented:

    It has also become apparent how the contested nature of ‘subjectivity’ in EBP serves those in power well. By excluding the ‘subjective’ voice of those in society who are marginalised, their stories, their experiences and their knowledge is discarded, branded as unscientific, not rigorous, not valid …… whose interests does this serve?

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