Category Archives: Education

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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Social Work education; is there a future under neoliberalism?

As an ideology, neoliberalism perpetuates the belief that the market cannot only solve all problems but also serves as a model for structuring all social relations. It is steeped in the language of self-help, choice and individual responsibility,   purposely ignoring the effects of  inequalities in power, wealth and income and how these shape individuals and families lives. As such, it supports a society which cruelly others those who require support, and is scornful of a critical and politicised social work profession founded on compassion and notions of social justice, equality and respect.

Back in 2013 Michael Gove, then education secretary, claimed too many social workers had been filled with idealistic dogma and theories of society that viewed people as victims of social injustice. Gove vowed to “strip this sort of thinking out of the profession”.

More recently Ray Jones argues politicians are stealthily trying to take control of social work, possibly because social workers expose the failings of their ideologically driven policies?

Maybe this is why Government would like to diminish the role of Universities in social work education, to depoliticise the profession and create a beige curriculum.  A painting by numbers programme of training, rather than a vibrant colourful education that prepares social workers to support, and challenge those in power. The extension of neoliberal ideology and discourse into higher education already provides a framework to socialise academia into working in a manner akin to managerialism i.e targets/NSS, where knowledge is viewed as a commodity for customers (students) to purchase and consume.  Packaged as one dimensional capabilities rather than multifaceted knowledge and skills .

(see Grant and Radcliffe, 2015, whose paper on higher education in mental health nursing has many synergies with social work).

Arguably an effective social work profession is a political profession as well, able to critique and analyse, to challenge, rather than accept the status quo.  As Henry Giroux eloquently states

“At a time of increased repression, it is all the more crucial for educators to reject the notion that public and higher education are simply sites for training students for the workforce, and that the culture of education is synonymous with the culture of business. At issue here is the need for educators to recognize the power of education in creating the formative cultures necessary to challenge the various threats being mobilized against the ideas of justice and democracy, while also fighting for those public spheres, ideals, values, and policies that offer alternative modes of identity, thinking, social relations, and politics.

Pedagogy is always about power, because it cannot be separated from how subjectivities are formed or desires mobilized, how some experiences are legitimated and others are not, or how some knowledge is considered acceptable while other forms are excluded from the curriculum.”

Whilst we have a plethora of educational routes into social work, Frontline;Think Ahead;Step-up;Apprencticeships and HEI’s no one appears to be asking any political leader of any persuasion one very important question as far as I can see.

Given our politicians feel their governments policies and leadership over the last 3 decades has led to continuous improvements, why is society in such need for ever increasing numbers of social workers?

If we can move beyond the divisive  narratives of  ‘broken families’, ‘recruitment and retention’, ‘the demographic time bomb’, ‘austerity’ and ‘we can’t afford X’,  and consider addressing the structural issues that impact on individuals lives, such as housing, benefit reforms, energy prices, the environment, job insecurity, food insecurity, low wages, affordable higher education etc, we might then be able to formulate a different ideology, a different discourse, one that unites us for the good of all.

 

‘Old age,more feared than death’…… have we ever cared about older people?

Has there ever been a ‘golden age’ where older people were consistently valued, respected cared for and protected by family and the institutions that make up wider society?

The World Health Organisation suggests the abuse of older people occurs in many parts of the world with little recognition or response. This serious social problem is often downplayed or hidden from the public view, and considered mostly a private matter. Even today, the abuse of older people continues to be a taboo, mostly underestimated and ignored by societies across the world. However, evidence is accumulating to indicate that the abuse of older people in the UK is an important public health and societal problem.

The full extent of abuse is unknown, however, its social and moral significance is obvious. As such, it demands an active response, one which focuses on protecting the rights of older persons, and a change in our perspective on whom, and what, we value in society.

Although representations of old age and societal responses to older people have differed over time it could be argued old age has always been viewed as negative.

In ancient Greece old age was portrayed as sad, with the Greeks love of beauty marginalising the old. Although some commentators suggest the reality was more complex with the portrayal of older people in the classics as ‘both pejorative and complimentary’ (Thane, p.32). For Plato reverence toward old people was a guarantee of social and political stability, whereas Aristotle disagreed with such positive images. Cicero’s work De Senectute, written in 44 BC, points to the variety in individual experiences of ageing, acknowledging that for those who are poor and without mental capacity ageing is miserable, however, suggesting older people need to strive throughout their life to remain intellectually and physically able.

Arguably this belief still underpins social care legislation and policy today in respect of older people.

It has been suggested older people’s status in society is linked to their ability to participate in society from an economic perspective, especially in terms of activity in paid employment. Historically where older people have been unable to participate in paid employment, help and support has been provided through a mixture of family and state support, with an emphasis by government on the former rather than the latter. However, commentators suggest, post industrial revolution, another victim of change were older people. The old did not merely lose power, they also lost respect. The rise of the alms-houses, and institutionalised poor-relief, may indicate their children were increasingly shedding responsibility for their support and transferring it to the community.

Although Thane  argued, this may have been due to families own depths of poverty, rather than lack of care or a shedding of responsibility.

The abuse of older people was not something government identified as a problem throughout this period, although, self-neglect was identified as an issue which government sought to address in the 1948 National Assistance Act.

This is not to say it did not occur, for example, the 1942 Exceptional Needs Enquiry found most older people living with families were there under sufferance. They were often less well off than those who lived with strangers, and lacked essential items of clothing, bedding or household equipment as families used any provision, such as clothing coupons, for personal use. Whether this constituted abuse is not clear as many families who cared for older relatives were often living in poverty themselves and older people often willingly gave their families any support they could, even if this meant going without themselves. Of course, records do not exist to either confirm or deny whether such relationships were abusive or mutually supportive, however, it might suggest in terms of individual worth and personal identity, a cultural norm existed where the welfare of the younger generation was prioritised over that of the old by both young and old.

However, Peter Townsend’s landmark study  of long-stay institutional care for older people in 1950’s Britain, provides a little more insight into the experiences of older people receiving care. One of the interviews he recorded was with a matron of a small private residential home in Greater London, which Townsend suggested was by far the worst home he had visited, was clearly describing abuse, as defined in legislation today.

This suggests the abuse of older people has been going on for a long time. It is increasingly clear the abuse of older people exists, and as a society we cannot ignore it any longer.