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Practice Research in Social Work – Producing Robust Knowledge Helsinki, Finland May 30-31st 2012
Topic: Structures and models in generation knowledge and research Paper presentation:
Kerstin Johansson
University of Linkoping, Sweden ***
Work in progress, do not quote ore copy!
Practice Research and the a new knowledge-based practice in Swedish social work The report from 2008 Evidence-based practice in social services – to the benefit of the operator (SOU 2008: 18) states that the knowledge base in the social services in Sweden are undeveloped and that social service is not enough conducted on the basis of knowledge of the effect of different actions, approaches and methods. This report, among other reports and studies, has formed a starting point for a far-reaching effort to develop social work that is now taking place in Sweden. This effort towards a strengthened knowledge development and a so-called “evidence-based practice” (EBP) in Swedish Social Work practice are stated by the Swedish government (Social Ministry) and the The Swedish Association of Local Authorities and Regions (SALAR/SKL).
In a study conducted during 2009-2011 this intervention was studied. The study includes interviews and informal discussions with actors at national and regional level, involvement in and observations at conferences, meetings and seminars as well as text and document analysis. My study shoes that Swedish social work is in many aspects at a cross-road. This on going intervention is one example of this. The aim of this article is to discuss this intervention, possible developments of the social work profession and the position of Practice Research in this intervention.
Towards a strengthened knowledge development and a so-called “evidence-based practice” (EBP) in Swedish Social Work practice
Socialstyrelsen (Swedish national social services), often through the Institute for methods in social work (IMS), has during the 1990s and now into the 2000s been giving guidelines to the local social work and worked towards a knowledge-based development of social work. In the report (2008:18) which now constitutes the "future of social work" four development areas are described as particularly important:
More research and qualified assessments of the social work results, quality and efficiency.
Better conditions for the profession to develop an evidence-based practice.
A better structure for following up activities (verksamhetsuppföljning)
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The report states that "the SALAR/SKL, The Social ministry and the State need to develop joint long-term strategies in order to obtain authorization, knowledge-based social services" (SoU 2008: 18 s11). Unlike previous projects this report promised long-term and broad-based efforts to raise the
competence and quality of social services.
In May 2009 SALAR/SKL approved the agreement between them and the Government proposed in SOU 2008: 18 on a "platform for evidence-based practice in social services". The purpose of the platform, and the intervention, is to implement a long-term skilled development of social services.
This platform determines the orientation of the agreements between the Government and the Swedish Municipalities and County Councils (SKL) if concerted and long-term efforts in support of an evidence-based practice in social services. … The development of evidence-based practice in social services required a single-minded commitment to the principals as well as their continued support be designed strategically to help to increase the effectiveness of skill
development and knowledge-based implementation. (Agreement 2010)
Evidence-based practice” (EBP)
This agreement is based, as well as the report 2008:18, from a translation of David Sacketts definition of evidence-based medicine (2000) to the social service sector. This original definition has been replaced with a definition from the Hayes:
Figure 1 (Haynes et. Al 2002) The four circles are integrated and can be translated to:
The currently best scientific knowledge about the specific effects
The clients experience and expectations
The local situation and circumstances
The professional’s expertise
In an article (Denvall & Johansson 2012) this intervention is discussed. The analyse in the article certifies the image of an intervention which content is unclear and is expected to be completed by
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negotiations; it is to be clarified and processed in the future. The research shows an agreement that is ambiguous in its content with many issues left open. It has no guidance on what kind of knowledge the scientific community should contribute with, how professional officers informed experience should be utilized when making decisions or suggestions how users', patients' and clients' opinions could be systematized. This could be perceived as a desire for a democratic process and the importance of collecting stakeholders making the issue mature gradually. A more critical picture emerges of a watered-down, empty program with inadequate analysis.
The unclear intervention opens up for opportunities as well as a debate about EBP, which at least initially is likely to be something other than "for the benefit of the patient." It implies a change in separation of powers and unsought questions are raised about who is negotiating with whom, and about the transparency of the process.
Swedish social work is at a cross-road, what will, if anything, this intervention lead to? This on-going intervention (together with other changes in Swedish social work) can develop in many directions. Several questions develop from the intervention described above. This article deals with two of them. The first is about the possible developments of the social work profession and the second is about Practice Research in Sweden and its connection to this intervention.
The professionals in a "knowledge-based social service"
The professionals have never been more important for society's well-being. Professional knowledge and expertise is the core of modern society. How such professional expertise is developed, how it is used, by whom it is used and for what purposes is one of the most crucial issues that all modern societies face today. (Sullivan 2000: 668)
How will the social work profession develop? The last in line -EBP- has had a significant impact on this. Bergmark and Lundström (2011) identify two basic models or ideas about how an evidence-based practice (EBP) should be put in to practice. The first model assumes an "enlightened practitioners"(ibid p.165) an expert, or "knowledge expert" (ibid p. 166). The second model is about practitioners
following the guidelines; "rather than having unrealistic expectations of practitioners to use research, social work and its researchers should take responsibility and step up the efforts to create tools for decision-making in social work" (Rosen et. Al. 2003 Bergmark and Lundström 2011 p. 167).
What models, stated above can be seen in the local practices due to the ongoing intervention. I think it is too soon to say. I would describe the local practices in my study with to pictures “business as usual” and “methods and models”. Professionals I have met either conduct their profession as
“business as usual” meaning they work and often work very hard with less time and money or they believe that “methods and models” will solve their difficult situation. They follow the method and talks
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only about this and they appear to have forgotten about the clients and the foundations of social work. This is alarming and should be studied and discussed much more.
On other important conclusion from my study is that the debate and research on de professionals work is more focused on post-implementation than about how the professional field shall be included as a central player in the ongoing process. There is therefore important for the profession itself and for professional researchers to step into the debate and contribute to research. Several researchers discuss how work is framed in EBP:
The complexity of the work increases when the professionals must take into account all existing evidence and how this will relate to a single users life situation at a particular time "(Jegerby 2008: 163).
This is about questioning the very basis of the social work practice
Doubts about one of these discussions – Professor of social work, Sven-Axel Månsson — identified as a discrepancy between, on the one hand, the social work complex and elusive and using methods that are interactive based in institutions, and on the other hand an evidence based program that pretends to be able to capture this complex in simple measurable categories and clear the bleed dimensions. (Bergmark & Lundström 2006: 109).
Bergmark and Lundström mean that EBP "is based on the idea of a rational procedure that generates enlightened practitioners" (2006: 103). EBP is often described as a project that aims to ensure that "doing things right" or to examine "what works" (Jegerby 2008, Socialstyrelsen 2008, 2009, SOU 2008: 18). A transparent argument is a prerequisite for this. The profession is changing, it is important to study and understand this. This is important but equally important is to understand the context. Towards a knowledge-based social service with many implications
It is obvious how this agreement (see Introduction), reflects on today's changing conditions for the welfare of production. Knowledge formation and political interventions in both social work and other areas, is currently engaged in discussions about the future. The main task seems to be to prepare citizens/patients, students, and professionals at various levels for a future that is perceived as more uncertain and risky than ever. The future, both political as well as scientific, is about that the social work practice needs to be "more evidence-based – for the benefit of the user." It seems that this is not only be about preparing social work for "the future", it is also about the here and now, organize and control the citizens, professionals, organizations, institutions and discourses, in order to achieve certain political goals.
This work can also be understood as a social phenomenon and it can be understood as a social construct created by political, economic and social conditions in which different groupings with great power and influence has a significant role Malcome Payne (2002).
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As an important contextual perspective for this study is the link to power, control, and today's social development with its liberal character (Johansson, 2007). On important question that arise is the connection to knowledge. This intervention is about knowledge and knowledge means power
(Johansson, forthcoming). The "new" social work needs EBP but must also be based on in-depth and applied understanding of processes and contexts.
This means that further research (both applied and basic research) is needed, more scientific disciplines need to be invited to the field and to actively work to develop a reflective practice and increased knowledge of and integration of the various actors (at different levels) work is needed. Development will serve as a basis for the twenty-first century continued social work and affect all actors in the field. Research on organization and long-term skill development is central to this transformation.
Practice Research
As I have demonstrated social work is both as practice and knowledge field contested and there are multiple parallel interventions in Sweden towards a so-called EBP. The actors are many and they have different positions and agendas. One, of several weaknesses in this whole knowledge based practice of Swedish social services is that the client perspective is unclear in the present situation, the intervention has a weak connection to the professions, it is not professional-driven which for example the
development of evidence-based medicine are and its links to academic research is weak.
The intervention has a clear link to the in Sweden common so called research and development organizations (FoU-enheter) This form of FoU-research has existed for several decades, and is sometimes seen as a critique to the University research and can be understood as a response to
demands from the local practice (Börjeson, 2002; Nowotny, Scott & Gibbons, 2001). The Swedish FoU has a strong position today compared to other countries (Kirk 1999). Practice Research is a vague concept in Sweden as I understand it and I hope that the position of Practice research as it is stated in the Salisbury statement (2008) can develop to play on important part of the ongoing development I Swedish social work.
In June 2008, a group of interested professionals began to answer questions about how professional practice can be researched better this by formulating an international statement on practice research. This was the start of the so called Salisbury Statement
The statement is not intended to be definitive or conclusive, but simply aims to begin tracing the contours of practice research at this point in time as it continues to evolve. …(The Statement 2008)
The statement states that
The current global context demands effective practice from professionals. Economic and social changes mean more accountability is required yet the climate is of increasing unpredictability
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which compounds the difficulties in achieving accountability. There needs to be a shift in the way practice is researched so that it provides relevant knowledge for better practice in complex and uncertain situations……(the Statement 2008)
Practice research (PR) has emerged as a viable research approach in several professions oriented domains; for example in social work (Pain, 2011; Salisbury Forum Group, 2011. There are several threads, that I find useful for the ongoing development in Sweden, coming together within a practice research approach (Goldkuhl & Julkunen, 2011):
• Considering the empirical field in terms of practices
• Research dealing with topics that are highly relevant to practice
• An interest for what is actually going on in practices (not just what people think is going on) • Inquiries are conducted dependent on problematic situations in practices
• An helping and guiding knowledge interest
• Collaboration with and involvement of practitioners in the research process
A first step towards a more developed PR in Sweden is to see this kind of research equally important as other kind of research and that universities work more closely to the FoU-units (some are some are not).
I would like to see more research conducted in close cooperation with the practice field, where the currently best scientific knowledge about the specific effects, the clients-experience and expectations, the local situation and circumstances together with the professional expertise together will form a strengthened and knowledge based development and a so-called evidence-based practice (EBP) in Swedish Social Work. Let us even call it Practice Research and give it an important status in Social work research.
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References
Bergmark, Å & Lundström T (2011) xx i Bohlin, Ingemar & Sager, Mårten (2011) (red.) Evidensens många ansikten. Arkiv förlag. Lund
Bohlin, Ingemar & Sager, Mårten (2011) (red.) Evidensens många ansikten. Arkiv förlag. Lund
Börjeson, B. (2002) Att forska är nödvändigt. I Angsell, G-L. (red) 20 år av forskning och utveckling. Jubileumsskrift.
Denvall & Johansson 2012 Kejsarens nya kläder –implementering av evidensbaserad praktik i socialt arbete SVT kommande.
Evetts, Julia and Lennart Svensson. 2008. “Professional work in Europe: Concepts, theories, and methodologies.” European Societies 10(4): 525-544.
Fixsen, Dean, Sandra Naoom, Karen Blase, Robert Friedman & Frances Wallace (2005) Implementation Research: A Synthesis of the Literature .Tampa: University of South Florida.
Foucault, M, (1993), Diskursens ordning, Stockholm/Stehag: Brutus Östlings Bokförlag
Foucault, M. (1994) ”Governmentality” In McNay (1994) Foucault: A Crititical Introduction. Cambridge: Polity
Press
Freidson, E. (2001) Professionalism: The third logic. Cambridge: Polity Press.
Goldkuhl G, Julkunen I (2011) Theory and inquiry in practice research: Introduction, Systems, Signs & Actions,Vol 5 (1), p 1-6
Greenhalgh, T., and Robert, G., and MacFarlane, F., and Bate, P., and Kyriakidou, O., (2004) Diffusion of
Grimen H og Terum L I red. (2009) Evidensbasert profesjonsutØvelse Oslo: abstrakt forlag
Hardgreaves, A (2003) Teaching in the Knowledge Society: Education in the Age of Security. Maidenhad: Open University
Press.
Hasenfeld Y.(1983) Human Service Orgnizations. Englewood Cliffs NJ; Prentice & Hall.
Haynes, R.H., Devereaux, P.J. & Guyatt, G.H. (2002). Physicians´and patients choices in evidence based praktice: Evidence does not make decisions, people do. British Medical Journey, 324, 1350.
Högskoleverket 2009. Utvärdering av socionomutbildningen vid svenska universitet och högskolor. Rapport 2009:36 R.
Stockholm.
Hydén M Evidence-beased social work på svenska - att sammanställa systematiska kunskapsöversikter. I SVT 2008:1
Jegerby, Ulla (2008). Evidensbaserad praktik i socialt arbete. Stockholm: Gothia
Johansson K (2007) ”Välfärdsstat som styrning” i Viljan att styra: Individ, samhälle och välfärdens styrningspraktiker.
Sophia Lövgren & Kerstin Johansson red. Studentlitteratur: Lund.
Johansson, Staffan (2010) “Implementing evidence-based practices and programmes in the human services: lessons from research in public administration”. European Journal of Social Work, 13 (1): 109–125. Kirk S (1999) Good intentions are not enough. practice guidelines for social work. Research on social work
practice 9:302-310.
Krogstrup, Hanne (2011) Kampen om evidens. Resultatmålning, effektevaluering og evidens. Köpenhamn: Hans Reitzels forlag.
Lipsky, M. (1980) Steet-Level-Bureaurcracy: The Dilemmas of Individuals in Public Services. Vambridge, Mass.:MIT Press.
Månsson, S-A (2003) Att förstå sociala insatser värde, Nordisk Sosialt Arbeid, Vol. 23, No. 2, s 73–80.
Månsson, Sven-Axel (2007). Evidensbaserad kunskap eller intelligent handlande i socialt arbete. Göteborgs universitet: Institutet för socialt arbete
Nowotny, H., Scott, P. & Gibbons, M. (2001) Rethinking Science, Knowledge and the Public in an Age of Uncertainty.
Cambridge: Polity Press.
Nutley, S. och Davies, H. (2001) Making a reality of evidence-based practice i Davies, H. T. O., Nutley, S., M. och
Smith, P., C. (Red) What works? Evidence-based policy and practice in public service Bristol: The Policy Press.).
ÖK 2009 Överenskommelse mellan staten och Sveriges Kommuner och Landsting om Plattform för evidensbaserad praktik inom socialtjänsten. SKL Dnr o9/1838
ÖK 2010 Plattform för arbetet med att utveckla en evidensbaserad praktik i socialtjänsten – en
överenskommelse mellan staten och Sveriges Kommuner och Landsting. Bilaga till protokoll vid regeringssammanträde 2010-06-17 nr III:8
120610
ÖK 2011 Stöd till en evidensbaserad praktik för god kvalitet inom socialtjänstens område – överenskommelse för 2011 mellan staten och Sveriges Kommuner och Landsting Bilaga till protokoll vid
regeringssammanträde 2011-01-27 nr II:2
Petterson, Lars & Wigzell, Kerstin (1999). Socialtjänstens klienter har rätt till professionell hjälp. Dagens nyheter 6/10 1999.
Sackett., D. L. mfl. (2000) Evidence-based medicine. Second edition London: Churchill Livingstone.
Sahlin-Andersson, K (1989) Oklarhetens strategi. Organisering av projektsamarbete. Lund: Studentlitteratur. Salisbury Forum Group (2011) The Salisbury Statement, Social Work & Society, Vol 9
Scott, W. R. (2008) Institutions and Organizations: Ideas and Interests. Sage Publications; Los Angeles.
SKL (2009) (PGÄ) Program för god äldreomsorg - överenskommelse mellan staten och SKL, Bilaga till Regeringssammanträde 2009-12-10.
SKL (2010) Kunskap till praktik i praktiken. Delrapport 201009-30. www.skl.se
SKL (2010a) Överenskommelser mellan staten och Sveriges kommuner och landsting på äldreområdet 2010. SKL cirkulär 10:11 daterat 2010-02-10 1.
SKL (2010b) Att bygga strukturer för kunskapsutveckling inom socialtjänsten och delar av hälso- och sjukvård. Sammanfattning
av 21 avsiktsförklaringar, SKL, november 2010.
SKL (2011) Missbruks- och beroendevård i Kronobergslän –Riktlinjer för socialtjänst och hälso- och sjukvårdens verksamheter för
personer med missbruks- och beroendeproblem 20110101-20121213. http//:kunskaptillpraktik.skl.se/aktuellt
Socialstyrelsen För en kunskapsbaserad socialtjänst: redovisning av ett regeringsuppdrag åren 2001-2003, Stockholm:
Socialstyrelsen, 2004
SOU 2008:18. Evidensbaserad praktik inom socialtjänsten - till nytta för brukaren. Betänkande av utredningen för
kunskapsbaserad socialtjänst.
Stockholm: Socialtjänstförvaltningen i Stockholms stad.
Sullivan, William. 2000. “Medicine under threat: professionalism and professional identity.” Canadian Medical Association Journal 162 (March): 668-669.
