Challenges for evaluating effectiveness in social work

Social work, like other professions, draws on a range of knowledge. It is the art of being a good professional to synthesise and deploy that diverse knowledge to best support each individual. To do this requires each professional to periodically step back from particular cases and review and reflect on that knowledge base and its relevance and implications for practice.

“The need to understand what works in current social work practice is vital if we are to understand the effectiveness of social work models of intervention and develop an evidence base that helps raise the quality of social work.” Lyn Romeo, Chief Social Worker (Adults), page 3 of the report.

To assist social workers, their managers, policy makers, and researchers in doing this Moriarty and Manthorpe were commissioned to undertake a systematic scooping review of the research on the effectiveness of social work with adults. They see their work contributing to the important role that Croisdale-Appleby argued for in his review of social work with adults, namely that of

“the social worker as a social scientist . . . . seeking to further the understanding of social work through evidence gathering and through research” (Croisdale-Appleby 2014: 15)

Methods

Moriarty and Manthorpe undertook a scoping review of the evidence of effectiveness across the broad range of roles encompassed in social work with adults. They acknowledge and discuss fully that there is no one definition of what a scoping review is, nor of what counts as effectiveness in this field. They discuss the strengths and limitations of their approach and the review.

They also discuss the long-running debates about the roles of evidence and of evidence-based/informed practice in social work. They settle on a position that ‘much greater recognition of the nuanced and complex nature of effectiveness in social work and the types of different knowledge that contribute to it has developed’ (p. 7) This, of course, requires great professionalism in terms of reflection on this knowledge and on how best to use it to help individuals. They are very conscious of the need to be attuned to the contextual nature of social work practice.

The fact that Moriarty and Manthorpe draw their evidence from beyond the UK and across different historical periods of care policies and systems (they only included literature since 1995, but even over that time there have been significant changes in practice environments), also adds to the need for careful reflection about how to draw and apply to practice conclusions from the evidence.

This was a scoping review of the evidence of effectiveness across a broad spectrum of adult social work contexts.

Results

Moriarty and Manthorpe discuss the evidence across different aspects of social work practice (e.g. assessments, safeguarding and care management) and in different contexts and with diverse client groups (e.g. in end of life care, in health care, with people with learning disabilities, with older people, and with people living with mental health problems). They skilfully collate, analyse and report a wide array of evidence in relation to all these aspects of social work with adults. The evidence base for effectiveness across these aspects of care is highly uneven, being more developed for some areas (e.g. care management) than for others (e.g. assessments).

Effectiveness has been defined in many ways across the studies reviewed. This is no doubt in part because of the importance of context in understanding effectiveness. Effectiveness in safeguarding, for example, might mean, as the authors report, something other than a simple binary distinction between success or failure. Measuring effectiveness in social work with adults is, thus, complex and complicated. Consequently, it is difficult to define and assess the effectiveness of social workers in relation to other professions.

The authors report that there is very limited evidence about the environments and structures in which social workers work and the impact of these on practice and outcomes. Given the understanding that social work practice is highly contextual, this seems to be a very wide gap in the evidence base. It means a limited evidence base, for example, to guide organisational development and good change management to support and improve social work practice.

The authors discuss the challenge of capacity to undertake high quality research in adult social work if we are to develop the evidence base further and in a timely manner. They also discuss the continuing methodological challenges and developments inherent in further research to improve the evidence. This includes the challenge to those running large-scale research projects, including clinical trials, to include a social work perspective more often.

Moriarty and Manthorpe also raise issues about the reporting of research studies, such as making it clearer the degree to which social workers were involved in the delivery of interventions, and ensuring that reports have sufficient detail and clarity to be of use to social workers for improving their practice.

Key issues highlighted by the review are definitions of effectiveness, capacity, methodology and reporting of studies.

Conclusions

This is a comprehensive review and discussion of the research and the evidence we have to date across the broad spectrum of social work with adults. It is difficult to draw from it a summary of the specific implications for practice in a short blog. Individual practitioners and their managers should read and digest the report to extract specific lessons relevant to their practice and organisations.

An implication of this is that practitioners and managers need time and space to be able to do this. They also need opportunities to do this with colleagues, to collective make sense of the implications of the findings in the report.

Strengths and weaknesses

Moriarty and Manthorpe are also clear about the limitations of their review and the evidence base they were working with:

“Despite some overall positive findings, the limited scale of research on social work with adults, both in terms of the topics covered and its capacity to produce generalisable results also needs to be addressed.” (p. 26)

They assert that part of addressing the challenge is about a need for continuing capacity and methodological development in social work research. But, we also need assurance that the current evidence (especially this report) is being used locally to reflect on and improve practice.

Summary

Individual research projects very rarely give absolute evidence of what a social worker, or others, should do in a specific situation. Similarly, no systematic scoping review of evidence can give this. Rather, such reports should be resources in an on-going reflection about the state of knowledge for a field and its implications for practice, policy and research.

Moriarty and Manthorpe have provided an invaluable resource in this process. Although the report is 51 pages long, the substance of the discussions about the evidence is conveyed concisely and clearly in many fewer pages than this total (there are many pages of references for more detailed follow-on reading). It is a highly accessible report of a complex and complicated field and deserves to be widely read and considered.