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Abstract

Using a modified version of an existing documentation review worksheet, researchers conducted an exploratory study that examined the quality of documentation among senior BSW social work majors in their last semester, in which they complete a 500-hour field practicum. Results showed that one percent of students documented a client strength and 45.9 percent of students did not sign the document. Additionally, 96 percent of the documents were legible, and 81 percent of students included service provision in their documentation. Recommendations for further research and suggestions for replication are included.

Keywords: documentation, BSW students, writing skills standards

Introduction and Background

Professional documentation is paramount for social workers in any setting. At graduation, and upon completion of field practicum, Bachelor of Social Work (BSW) majors should demonstrate effectiveness in important documentation standards related to both format and content. While college students may consider themselves good writers, many have difficulty formulating appropriate content for documentation such as case notes, assessments, and evaluations. Common problems include grammar, use of syntax, and synthesizing appropriate material to include in the documentation (Berner, 1998; Hacker, 1996; Sidell, 2011; Straus, 2007; Wilson, 1980). However, for students to advance beyond basic writing skills they must learn what is expected (Sidell, 2011; Woody et al., 2014). Gibbs and Blakely (2000) inform that social workers are to have clear communication skills as they will write various documents that benefit clients and agencies, assist in furthering the development of future services, and a plethora of other tasks. Woody et al. (2014) note that professional writing can be both powerful and expressive. This type of writing shows connection between the social worker, client, and resources.

Professional writing skills, especially those skills that are necessary for professional documentation, can be difficult to learn and teach. Students learn American Psychological Association (APA) or Modern Language Association (MLA) writing skills, which are important but not always transferable to professional practice (Anderson, 2003; Sidell, 2011; Simon & Soven, 1990; Waller, 2000). While educational programs are adept at APA style writing, there is less emphasis placed on what key standards of documentation students are most skilled in, and in what areas students need improvements. This research evaluates one BSW program’s students’ professional writing abilities as they near completion of their field practicum and prepare to enter the professional workforce.

Literature Review

Baccalaureate social work educators have articulated their concerns regarding college students’ lack of professional writing skills for the last twenty years (Woody et al., 2014). While literature has repeatedly shown that baccalaureate and graduate students have poor documentation skills, there is a lack of research regarding techniques for advancing student writing (Alter & Adkins, 2001, 2006; Falk & Ross, 2001). Notably, there is little research that has assessed tools to evaluate writing interventions and analyze student writing (Woody et al., 2014).

Writing is indispensable for any career, but in the social work field it is a necessity to be competent in professional writing (Falk & Ross, 2001; Woody et al., 2014). Debates on writing styles occur in both the curriculum and the profession. There are preferences for reflective writing as well as formal documentation—the main writing style for organizations and private practice (Alter & Adkins, 2001; Rai, 2004, 2006). Social work students would be better served with a more formal education in all modes of writing. When students find their professional voice, a professional identity will follow. An important component of that professional voice is acquiring superior writing skills that convey well-composed and clear documentation (Falk & Ross, 2001; Green & Simon, 2012). Falk and Ross (2001) identify several purposes of professional writing, including the ability to communicate with others, and to define, evaluate, and understand others’ point of view. There is a common phrase within the social work profession that states, “If it is not written, it did not happen” (Young, 2014, p. 19).

Falk and Ross (2001) provide categories on ways to improve social work documentation and specific techniques to teach students professional writing skills. Critical thinking, organization, combining of thoughts, and problem solving are four key components that are necessary for documentation (Waller, 2000). Students need to be educated on the basics such as spelling, punctuation, sentence structure and overall instruction on how to structure the written word (Weisman & Zornado, 2013). Professionals view unclear documentation as a liability in the field of social work, especially when insurance plays a significant role in reimbursement decisions (Horton & Diaz, 2011).

Professionals need to consider varied environmental factors, advancement of new cultural norms, self-efficacy, and student understanding, expectation, and effort when undertaking the task of comprehending student documentation skills. Literature suggests that previous experiences compound student writing problems. For example, research shows that communication in the social work field has become multifaceted due to the advancement of enlarged demographics and multi-cultural diversity (Jani & Mellinger, 2015).

The academy has developed several well-known programs such as Writing Across the Curriculum (WAC). While these programs target all students in any discipline, they do not address specific professional writing requirements. The Council on Social Work Education (CSWE) has a required competency that schools of social work hold students accountable to demonstrate competence in communication skills, both oral and written as well as electronic (Jani & Mellinger, 2015). Interestingly enough, required documentation is not part of the standards of the CSWE (CSWE, 2015). Although foundation courses typically address grammar, there is little preparation provided for students to learn professional documentation, which would prepare them for the social work field. One specific implication is that there is minimal agreement as to which assessment methods instructors should utilize in order to evaluate students’ proficiency to incorporate skills, knowledge, and values in undergraduate social work programs (Anderson & Harris, 2004).

Professionals have developed a paucity of tools specific to social work efforts to teach documentation skills. Wilson (1980) wrote a seminal book on how to teach social work writing skills. There was little written to advance the topic of teaching these skills until Sidell’s book (2011) which provided a self-review worksheet useful in assessing professional social work writing. This worksheet identifies 11 standards for documentation, including aspects of both format and content, and can be used to assess the professionalism of social work writing.

Notably, Kahn, and Holody (2012) report the lack of applicable academic interventions to assist undergraduates has stymied students’ ability to write in a professional manner. It would seem important to also include graduate students, especially those who are lacking professional writing skills and may be inadequate writers. While field instructors can assist students in mastering required social work skills learned in their internships, all educators have a responsibility to instruct students in professional writing (Green & Simon, 2012; Kagle & Kopels, 2008; Sidell, 2011; Tebb, 1991). While students are noted to have developed exemplary social work knowledge prior to entering their field placements, their professional writing inabilities can present a barrier. Field instruction manuals can empower students to demonstrate professional writing skills, as they provide an overview of the required writing formats that is pedagogical (Green & Simon, 2012; Kahn & Holody, 2012). Dolejs and Grant (2000) suggest that the need for students to learn and develop effective professional writing skills has been left unfulfilled, with no answer as to how students should be taught and by whom (whether English professors, social work educators, or others).

Writing skills encompass more than just grammar and syntax (Glicken, 2008; Sidell, 2011; Simon & Soven, 1990; Wilson, 1980; Woody et al., 2014). WAC stresses the position of “writing to learn” is as important as “learning to write” (Moor, Jenson-Hart, & Hooper, 2012, p. 65). Weismean and Zornado (2018) address attention to diversity and self-reflection as important components of professional writing. There is a need for more practice and education on intensive reflective writing, of which little has been published. For example, one practice uses a contemporary composition theory which assists students to not only learn to write professionally, but also learn how to advocate more effectively (Waller, Carroll, & Roemer, 1996). Another uses a strengths-based approach by implementing WAC techniques (Moor et al., 2012).

The need for social work students to know how to write professionally is apparent, especially as they enter their field practicums. An overabundance of the various methods, tools, and programs with which to teach students how to write professionally is less clear (Ames, 2008; Green & Simon, 2012; Kagle & Kopels, 2008; Sidell, 2011; Weisman & Zornado, 2013; Woody et al., 2014). Assessments that are more specific are needed to target exactly where students are lacking in professional writing skills. Such assessments would identify students who need to improve their writing. A lack of research focusing on the ability of students to include the core standards in their professional documentation is the focus of this exploratory research.

Method

This research study asked the following questions: Which standard of documentation do BSW students appear to have mastered by graduation? In which standards do the students appear to be lacking? In order to answer these questions, the authors collected data from one BSW program’s senior seminar class. The data was collected during the students’ 500-hour field placement, which occurred during the last semester of their BSW program.

Since 2009, CSWE has required the use of a competency-based approach to assess student learning (CSWE, 2015). One baccalaureate social work program located in a rural community in the North-Central United States chose to assess student performance utilizing a Practice Behavior Analysis (PBA). A PBA is a live extended role-play of a typical day in the life of a social worker from the area of practice in which the student has completed a field practicum experience. The student performs the role-play in the last required course of the curriculum taken concurrently with field practicum. Each PBA contains a minimum of three different “case scenarios.” The student being assessed acts as the social worker, peers play the role of clients, and professors may play the role of supervisors. All are intended to simulate a typical day at the agency. Instructors assess student competency as he or she manages the situations, which are not shared in advance. Following the 30-45 minute role-play, the instructors ask the student to “document your day as it would be required by the agency in which you are completing your field practicum.” The results of this written portion of the PBA were used for this study. Strengths and gaps in student knowledge and areas for programmatic improvement were identified.

The researchers obtained permission to use a modified version of the self-review worksheet (Appendix A) developed by Sidell (2011). The researchers modified this tool, with the author’s permission, and used it as the basis for this study. The first change that was incorporated was the format section was modified to reflect dates, signatures, and legible entries. The second change that was incorporated was the content section was modified to reflect the referral, client feelings, confidentiality, clear plans, indication of service provisions, comprehensive assessment, client strengths, and referrals noted. Researchers did not incorporate best and worst note along with how to improve the record as the student works were only being critiqued for the above listed purposes (Sidell, 2011). The documentation review worksheet (Appendix A) contains three format and eight content areas (Table 1). The researchers evaluated each documentation sample they had collected individually using this tool. The appropriate and required Institutional Review Board (IRB) permission was obtained and all appropriate policies and procedures were adhered to prior to data collection. According to Rubin and Babbie (2007), the tool would be considered valid if it measures the construct in question. While the researchers did not test the 11-item instrument for reliability, it appeared to have face validity in that each item related to key standards of documentation. With 22 years of combined experience working in the social work field which required documentation of client interaction, the researchers each assessed for face validity separately. Both researchers felt that the tool had face validity in that it appeared to adequately measure the key standards of documentation.

Prior to evaluating the samples, each researcher read over the chapter in Sidell (2011) on documenting client progress. In order to ensure interrater reliability, the two researchers discussed the document review worksheet and each of the 11 standards that were to be evaluated. According to Craig (2009), interrater reliability is established when multiple researchers come to the same conclusion when evaluating a data set. The researchers compared scores and there was 100 percent agreement between the two researcher’s scores on the 125 samples that were reviewed, providing evidence of interrater reliability.

The researchers first chose to read each sample while evaluating it for the 11 key standards of documentation. As the sample case note was being read aloud, each researcher assessed for the presence of the key standards and if there was a need for it to be present at all. If the scenario in which the student had acted did not require the specific key standard, then the researchers checked the “not applicable” box of the review sheet. This made for more accurate data collection and consistency of assessment methods, as the researchers did not simply check “No” for a key standard that was missing when in fact it was most appropriate for it to be missing.

The sample consisted of all student PBA assignments for the field seminar course from January 2015 through May 2016, which resulted in 125 possible writing samples (N=125), written by 47 students. Some students completed multiple writing samples as they reported that their agency would require more than one note for the PBA that they completed. Other students reported that certain aspects of their PBA would not require documentation from the agency in which they were completing their field practicum, such as when a student met with a supervisor. Of the students who completed the assignment, 44 were female and three were male; 39 were identified as Caucasian, seven African-American, and one identified as other; 28 completed their practicums in a rural setting while the other 19 completed theirs in an urban setting (Table 2). Table 2 provides a more detailed review of the students’ demographics. All students were from the same baccalaureate social work program at a University which is state affiliated with a student population less than 4,000. It is located in the mid-Atlantic region in a rural area. While the program is located in a rural setting, students can, and often do, complete their internships in urban settings. The settings in which the 47 students were placed included: hospital, elder rehabilitation, school, children and youth, mental health, partial hospitalization programs, residential treatment facilities, elder abuse prevention, and higher education. Each writing sample consisted of one interaction between the student, who was acting in the social worker role, and a client, supervisor, community member, administrator, or colleague. Of the 125 samples, the researchers determined 124 eligible for evaluation. The researchers chose to exclude one sample due to the student not following assignment directions.

Results

Students in the sample appear to have mastered two of the standards of documentation studied: writing legibly and proper documentation of what services were provided. Table 1 presents 118 out of 124 notes were legible (95.1%). It should be noted that while most agencies now can access technology and utilize typing of notes to avoid the lack of legibility being an issue, there are still several agencies who allow handwritten documentation. As for clearly documenting the service that the student provided, there were 24 notes that the researchers determined that documentation of service provision was not applicable. Of the remaining 100 students, 81 percent clearly stated the service provided.

There were important findings in this study related to areas of documentation that this sample of students are lacking. Researchers expected that there might be some improvement needed in the key standards under context but were surprised to find that 45.9 percent of student samples did not include signatures. This finding was surprising as the researchers believe students receive instruction throughout the curriculum on the importance of a signature. Further exploration of this finding is indicated. As Sidell (2011) points out, without the signature of the author, one should not consider a social work case note to be complete.

A second finding showed that only 1 percent of the samples documented a client strength. When it comes to social work documentation, it is essential that students understand and incorporate client strengths in their assessments and case notes. According to O’Hare (2009), an assessment serves several purposes, which include assisting the social worker in better understanding the clients’ issues as well as strengths, guiding the development of an appropriate treatment plan or intervention, and providing a foundation on which the social worker can monitor the effectiveness of the helping process. In order for a social worker to conduct a thorough assessment, the social worker must attend to all client dimensions, including his or her problems as well as strengths (Sidell, 2011). Clearly, the fact that all but one of the students omitted client strengths from their documented client interactions shows that there is a need for more emphasis on the documentation of client strengths, especially within those courses in which students practice documentation.

Discussion and Limitations

With some of the findings of this research clearly demonstrating a need for future development of social work documentation skills, it is necessary for social work educators to understand the importance of incorporation of documentation throughout the curriculum and to emphasize the assessment of appropriate documentation skills within the field practicum. Sidell (2011) points to multiple ways in which social work educators can assist social work students to improve their documentation skills. Two specific ways that educators can assist are to provide resources in the practice courses as well as in the field practicum experience, in the form of assignments, to assist with documenting proficiently and enhancing the value placed on the case record. Kagle and Kopels (2008) recommend that social workers should have minimum guidelines that address the purpose, type, and intended use of records as well as what specific information should be included. The researchers agree that similar recommendations could be expected by BSW students as they enter the field.

The CSWE has required the professional demonstration of both oral and written communication skills for years. As in previous years, CSWE also requires the demonstration of these competencies in the standards released in 2015 (CSWE, 2015). While this has the potential to assist social workers in obtaining critical documentation skills (Jani & Mellinger, 2015), each baccalaureate program can operationalize this competency differently. With this being known, the inclusion of assignments from only one baccalaureate social work program is a limitation. It would be a recommendation of the researchers to conduct future research that would span across multiple baccalaureate social work programs to test for generalizability.

The replication of this exploratory study could prove useful to any university campus choosing to conduct a similar inquiry. The study not only provided very valuable data, ideas, and discussion about curriculum design that could easily improve the documentation skills of the students on this particular campus, but it also brings to light a new tool that can be utilized to measure them for one’s own program. Additionally, the researchers chose to complete this study to seek ways in which this specific social work program could incorporate pedagogy throughout the program’s offered courses that will assist in improving students’ ability to document all of the key standards. The researchers chose the proposed research question in order to evaluate and implement improvements in one program, not for the purpose of generalization. The research still provided valuable information to the social work faculty that assisted in providing needed changes to the present social work courses offered on this campus.

Another limitation of this study was the lack of diversity among the sample under study. The researchers recommend conducting further exploratory studies similar in nature to this one on campuses where the social work student population is more diverse. While the researchers are unsure of what may come from a more diverse group of students, they feel that it would not be possible to generalize the results of such research without data collection from a more diverse population. In this study, there were only three males, seven African-Americans, and one student who identified as other, proving not to be a very diverse population.

Lastly, the tool that the researchers used for this exploratory study has not yet been tested for reliability or validity. While the tool itself proved useful and appeared to have face validity, its reliability and validity are largely unknown. To conduct further research using this tool, the researchers recommend conducting field-testing of the tool.

Practice Implications and Future Research

While providing some invaluable information for this BSW program, there is a clear need for further research. In order to discover if this research is generalizable across baccalaureate programs, the researchers recommend that other social work professionals reproduce this study at a variety of baccalaureate social work programs. This would assist in recognizing if the deficits in documentation of key standards that were identified among this group of students exists in more than just this particular social work program. It may help point to a further need for social work educators to place increased emphasis on social work documentation.

Next, researchers plan to answer the question of how best to teach strengths-based documentation. Sidell (2011) provides multiple documentation activities throughout her book that could easily be weaved throughout the coursework of a baccalaureate social work program. Requiring that students purchase this book early in the major and incorporating these activities in multiple courses would provide students with documentation practice and incorporate rich perspectives from multiple professors who would be providing feedback on such assignments. Sidell’s (2011) book is required within the study sample’s program, but only for use in one practice course which is taken during the junior or senior year.

Although effective documentation is extremely important, this research clearly pointed out that some BSW students are entering the profession with deficits in their writing skills. To address these deficits, it may be necessary for social work programs to implement some pedagogical strategies into the social work curriculum that will specifically focus on the areas of need found in this study. While social work programs often focus on strengths, it may be useful to remind of the importance of implementing this standard into teaching professional documentation. Additionally, ensuring that the faculty are not only teaching the importance of documentation but all elements of documentation, including both format and content, is essential. This will help students recognize the importance the profession places on documentation skills and better prepare them for the writing and documentation demand in the workplace.

Lastly, ensuring that strengths-based professional documentation is a required component of the field education experience must be explored. It was found while completing this research that some students are not required to document at all within their field practicum assigned agencies. While the University cannot require that the agency complete documentation, it can require that the student complete a series of documentation assignments over the course of their time in field practicum. Incorporating this requirement into the learning plan or the field education syllabus as an assignment will ensure that all students are exposed to documentation and are obtaining feedback from a supervisor on their quality of documentation, including both content and format.

Conclusion

While social work students know about and hear the term “documentation” often, the research suggests that not all aspects of documentation are areas in which graduating BSW students excel. While social work professors will often use phrases such as “if it is not documented, it did not happen” throughout social work courses to encourage students to improve their documentation habits (Sidell, 2011), this study illustrated a clear need to implement pedagogical strategies that will improve the documentation abilities of students. Implementing more documentation activities throughout the BSW curriculum is the purview of course instructors, particularly those teaching practice classes and acting as faculty liaisons during the completion of students’ field practicum experiences.

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Appendix A
Documentation Review Worksheet

Yes No N/A Comments
Format:
1. All entries dated?
2. All entries signed?
3. All entries legible?
Content:
1. Reason for referral stated?
2. Client feelings noted?
3. Confidentiality, informed consent noted?
4. Clear plans established?
5. Service provisions clearly indicated?
6. Comprehensive assessment noted?
7. Client strengths noted?
8. Referrals noted?

*Modified and used with permission from Dr. Nancy L. Sidell, PhD, from Social Work Documentation: A Guide to strengthening Your Case Recording, pg. 159.

Table 1
Number of standards found in writing samples (N = 124)

Key standard Yes Total Yes % No Total No % N/A
Format:
1. All entries dated? 96 77.4 28 22.5
2. All entries signed? 67 55 57 45.9
3. All entries legible? 118 95.1 6 4.8
Content:
1. Reason for referral stated? 66 80.4 16 19.5 42
2. Client feelings noted? 52 49 54 50.9 18
3. Confidentiality, informed consent noted? 9 20 36 80 79
4. Clear plans established? 103 91.1 10 8.8 11
5. Service provisions clearly indicated? 81 81 19 19 24
6. Comprehensive assessment noted? 56 57.7 41 42.2 27
7. Client strengths noted? 1 1 99 99 24
8. Referrals noted? 48 62.3 29 37.6 47

Table 2
Demographic Data of Participants (N = 47)

Spring 2015 Summer 2015 Spring 2016 Three Combined Semesters
Gender n % n % n % n %
Female 14 87.5 15 100 15 93.75 44 93.6
Male 2 12.5 0 0 1 6.25 3 6.4
Setting
Urban 6 37.5 10 66.6 3 18.75 19 40.4
Rural 10 62.5 5 33.3 13 81.25 28 59.6
Ethnicity
Caucasian 13 81.25 12 80 14 87.5 39 83
African-American 3 18.75 2 13.3 2 12.5 7 14.9
Other 0 0 1 6.7 0 0 1 2.1