Download a PDF of this article
Social workers have struggled to eliminate the 20-year science-to-service gap. Western Michigan University has employed a four-step method for getting started on research in field, which has helped students with efficiently researching best practice in their field placement. The proposed method includes: the “I wonder” question, the keyword find, the one-hour literature review, and the final research question. This method can get field stakeholders, students and agencies started in implementing and publicizing research on best practices.
Science to Service Gap
National reports developed by the Department of Health and Human Services (1999), the Institute of Medicine (2006), and the New Freedom Commission on Mental Health (2003) all speak to a 20-year “science to service” gap that exists in health and mental health between the research on best clinical practices and the implementation of those practices with individuals and families. Translational research is designed to lessen this gap and get best practices into the hands of practitioners. Social work “is ideally positioned to significantly influence the national translational research agenda because of its prominent placement in the human services sector and due to a strong interdisciplinary focus in much of its training and research” (Brekke, Ell, & Palinkas, 2007, p. 123). Social work educators have striven to connect practitioners as well as students in a practical way with the knowledge about evidence-based practice taught in class (Adams, LeCroy, & Matto, 2009). Teaching research/practice evaluation skills (among others) and measuring student competency in those skills have taken center stage in social work education (McCracken & Marsh, 2008; Regehr, Bogo, Donovan, Lin, & Regehr, 2012). Equally important, a number of social work schools, especially those connected with the Hartford Geriatric Initiative (Social Work Leadership Institute, 2008; Hooyman, 2009; Greenfield, Morton, Birkenmaier, & Rowan, 2013), have focused on the interdisciplinary teaching of best practices (in the case of the Hartford initiative, with older adults) which can be applied both in internship and in practice after graduation. The George Warren Brown School has collaborated closely with agencies in teaching and implementing evidence-based practice (EBP) with students in field and field instructors in both micro and macro practice settings (Edmond, Megivern, Williams, Rochman, & Howard, 2006; Bricout, Pollio, Edmond, & Moore McBride, 2008). However, not all schools of social work have the resources to mount such ambitious projects, and even the George Warren Brown School project cites time as a major barrier in EBP implementation in field and practice (Edmond et al., 2006).
In field education, students, field faculty, and field instructors are directly engaged in practice and learning to develop competencies in areas specified by the Council on Social Work Education, including the incorporation of evidence-based interventions and knowledge from practice to inform research (Council on Social Work Education [CSWE], 2008). Field faculty, students, and field instructors can be involved in the translation of research into practice, and practice into research, an area of scholarship that can have significant impact on the science-to-service gap (Palinkas & Soydan, 2012). Field can teach students and remind field instructors of the three factors to consider in empirically-based interventions in field and elsewhere: the best research evidence, clinical expertise about a presenting client issue, and client values and expectations (Thyer & Pignotti, 2011). This article will describe the efforts of field educators to translate knowledge about evidence-based practice in a clear and understandable way to students and field instructors at Western Michigan University. At Western Michigan University, like in many schools, the research competency has always been a harder competency for students to understand and apply. Learning contracts may set a goal to “incorporate research into field, and understand best practices,” however in reality when faculty or field instructors ask students about how that this goal is actualized in their specific field placement students are often baffled.
This difficulty with conceptualizing and implementing evidence in field led to several initiatives at Western Michigan University. First, the process of researching a problem within field started to be explicitly taught in field seminars in the BSW and MSW Foundation placements. The resource librarian presented to students how to access research in social work. The levels of evidence (Sackett, Straus, Richardson, Rosenburg, & Haynes, 2000) were presented, and students were encouraged to be consumers and evaluators of the evidence to support or refute a specific practice in field. Discussions during field visits began to include focus on specific practices in their field site that students could research by accessing available supporting evidence. Because time to complete adequate research in field is still an issue, an abbreviated and simplified method of analysis was developed and implemented in collaboration with field students, field instructors, and field faculty.
Some students have adopted the process of efficiently incorporating EBP research into field more than others. However, exciting research by students has been completed. Three research projects involving Western Michigan students, faculty, and field faculty illustrate four easy steps for translating practice knowledge to research and research to practice.
Translating Practice Knowledge to Research and Research to Practice: Four Easy Steps
Despite the real barriers to using evidence-based practices in social work, McCracken and Marsh (2008) have described an efficient five-step model for the implementation of EBP in social work:
1. Convert the need for information into an answerable question;
2. Track down the maximum efficiency the best evidence with which to answer that question;
3. Critically appraise that evidence for its maximum validity and usefulness;
4. Integrate the critical appraisal with practitioner clinical expertise, client values, preferences, and clinical circumstances and apply the results to practice; and
5. Evaluate the outcome. (p. 302)
Although this process is efficient, that does not mean that it is simple or routinely practiced. Since time in field and social work practice are at a premium, a model needs to be easy to use, time-limited, and address the research practice behaviors of social work education (CSWE, 2008). Although the McCracken and Marsh (2008) process delineated above might be useful for experienced practitioners, a simpler and time-limited approach can help field faculty, students, and instructors get started with research as part of the field placement.
Field faculty at Western Michigan University adapted the McCracken and Marsh (2008) principles to incorporate four relatively easy steps: the “I wonder” question, the keyword find, the one-hour literature review, and the final research question. Using these four steps led to three successful projects incorporating evidence-based practice. Starting and completing such research process builds momentum for continuing development of applications of best practice in social work settings.
The “I Wonder” Question. In social work practice there is often an air of wonder about how things work. This is one of the most fascinating parts of the process preceding the development and testing of a promising practice (Drake et al., 2001). What we now know as an evidence-based practice (EBP) was once an idea of a skilled practitioner, asking an “I wonder” question. It became an EBP after significant study, ideally in multiple randomized control trials or systematic reviews, before receiving a “seal of approval as being evidence-based” (Rubin & Parish, 2007, p. 406). The following are three examples of “I wonder” questions posed by field students and faculty at Western Michigan:
1) I wonder if there are really good parenting classes for Latino teen parents.
2) I wonder if field students with criminal records have a higher rate of field placement terminations.
3) I wonder if college students who are hungry do worse in school.
The important feature is to think about why things happen the way they do in social work practice, individually or in collaboration with colleagues, and ask that first broad question. This type of “I wonder” question comes up frequently in field visits when discussions between field faculty, field instructors, and field students lead to this magical curiosity. Field students may even be better at asking the “I wonder” questions because they genuinely want to know how things work, and don’t have the practice experience to know the history of a presenting problem, policy, or intervention.
The Keyword Find. The beginning of the inquiry process leads to the important competencies of accessing sources of information and applying them to practice (CSWE, 2008). The next step is identifying search terms, or keywords, to do an initial search of the evidence. (Terms used in academic journals may differ from those used in practice settings.) Keyword phrases can be placed in quotes to get a more exact search. Where there are several common suffixes, the root word may be marked with an asterisk so that the keyword can search for multiple suffixes. Examples of key words for the three questions above include:
1) Hispanic and “adolescent” and “parent*”
2) “social work field education” and “criminal history”
3) “hunger” and “college students” and “academ*”
Keywords often have to be refined once the literature review begins based upon the number and quality of evidence found, which will be covered in the next step.
The One-Hour Literature Review. Completing reviews of literature is laborious. But it is important to understand just a little about what literature exists to determine if the line of inquiry is meaningful, and what research has been done to date on the topic. Knowing where to look for the highest quality evidence is important. The levels of evidence, as described in Sackett et al. (2000), include (from lowest to highest) expert opinion or case study, cohort studies, single randomized control studies, and finally synthesis articles including systematic reviews. High-quality systematic reviews are a good place to start. The Cochrane Library (http://www.thecochranelibrary.com/view/0/index.html) and Campbell Collaboration Library (http://www.campbellcollaboration.org/library) are both strong sources for systematic reviews, organized by disorder or presenting problem, and can be searched using the keywords developed in the previous step. Both sets of systematic reviews have handy plain-language explanation of findings. Although they are not a substitute for a thorough review of the methods and results, they will indicate whether the line of inquiry is meaningful. For best practices endorsed by federal agencies, a keyword search using the Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Registry of Evidence-based Programs and Practices (NREPP) (www.nrepp.samhsa.gov) might have useful results.
Individual articles of interest, including randomized controlled trials and cohort studies, can be found on a variety of databases available through most schools of social work, including SCOPUS, Social Work Abstracts, and PsycInfo. Since these databases may be accessible only within a university setting, as they are subscription-based (Grady, 2010), field students and faculty may need to take the lead in this one-hour literature search and share their information with agency social workers. Once articles have been found, it is most efficient to look through the titles first, and then the abstracts. Often search databases will also provide a list of articles in which the original article was cited, and the citations for that article; articles that are most important in the research are cited frequently. It should take about an hour to find and retrieve a short list of four or five articles, including any systematic reviews available. The overview of literature will indicate the state of the research on the subject, as well as how the issue is defined.
1) The literature review on parent education discovered specific practices, like ParentCorps, a culturally responsive parent teaching model evaluated by NREPP (SAMHSA, 2015; Brotman et al., 2011).
2) The faculty member seeking to explore the relationship between criminal history and field education failure among social work students found that there was very little available research on the subject.
3) In the student project on hunger, an overview of research on hunger among college students showed that there is a difference between hunger (a feeling) and food insecurity (a state of consistently not having enough food).
The Research Question. The last part of the work to get started is to formulate a more refined research question, sometimes referred to as a P.I.C.O. question. In a P.I.C.O. question, the P (patient or population), I (intervention), C (comparison), and O (outcome) are all considered (Sackett et al., 2000). This format sets up the field faculty, students, and instructors for further research and frames questions in a way that they could be answered through further research (Drisko, 2014). Examples of P.I.C.O. questions from the initial “I wonder” questions include:
1) For Latino and African American parents in high school (P), does completing Parent Training Coalition classes (I), as compared to traditional parenting classes offered by the public schools (C) impact substantiated cases of abuse and neglect (O)?
2) For students in an MSW program involved in field education (P), does the presence of a previous misdemeanor or felony criminal history (I), or no criminal history (C), impact scores on the learning contracts in one or all competencies (O)?
3) In students in college enrolled full-time (P), does self-reported food insecurity (I) or lack thereof (C) correlate to GPA (O)?
There are several options to move forward. First, with the appropriate literature review, a case study describing an individual case could be completed. These case studies are particularly appropriate when little high quality research exists on a topic of interest. It is also easier to see how a study could be designed in each of these three cases, through administrative records review or survey development. Whichever selection, the field student should incorporate these activities into their learning contract and field experience and evaluation.
At Western Michigan University, this process has yielded the following research projects in collaboration with field students, field instructors, and field faculty:
1) An outcome measure pilot of participant satisfaction with parenting class models, and a comparison of parenting class participation and referrals to Child Protective Services;
2) A faculty member research project on criminal history and admissions and field outcomes being completed as part of a dissertation;
3) A convenience sample survey of health and human services students about food insecurity and use of a potential campus food pantry, and research poster of the same.
Conclusion
The push in social work and related fields to use empirically-based interventions to treat clients has been a growing trend over the last two decades. A number of social work schools, especially those connected with initiatives like the Hartford Foundation Geriatric Program, have collaborated with agencies to encourage evidence-based practice. Yet a gap still exists between what we know and what we do about practice research; for example, many social work schools do not have the opportunity of such formal, funded research collaborations. CSWE (2008) is clear about the need for field faculty and field instructors to support students in the development of practice-based research and research-based practice. Field faculty, instructors, and students are poised to address this gap, but they need encouragement and direction in this area. This article provides a four-step model to get research inquiry started in field education. Finding, and funding, accessible models like this is a crucial step to advance field education and research in the field. It is not an end, but a beginning to decreasing the science-to-service gap and making the best practices available to clients and practitioners alike.
__________________________________________________
Adams, K., LeCroy, C., & Matto, H. C. (2009). Limitations of evidence-based practice for social work education: Unpacking the complexity. Journal of Social Work Education, 45(20),165-186.
Brekke, J. S., Ell, K., & Palinkas, L. A. (2007). Translational science at the National Institute of Mental Health: Can social work take its rightful place? Research on Social WorkPractice, 17, 123-133.
Bricout, J. C., Pollio, D. E., Edmond, T., & Moore McBride, A. (2008). Macro practice teaching and curriculum development from an evidence-based perspective. Journal of Evidence-Based Social Work, 5(3-4), 597-621.
Brotman, L., Calzada, E., Huang, K. Y., Kingston, S., Dawson-McClure, A. S., Kamboukos, D., . . . Petkova, E. (2011). Promoting effective parenting practices and preventing child behavior problems in school among ethnically diverse families from underserved, urban communities. Child Development, 82(1), 258–276.
Council on Social Work Education. (2008). Educational policy and accreditation standards. Alexandria, VA: Council on Social Work Education.
Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
Drake, R. E., Goldman, H. H., Leff, H. S., Lehman, A. F., Dixon, L., Mueser, K. T., & Torrey, W. C. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52, 179-192.
Drisko, J. (2014). Research evidence and social work practice: The place of evidence-based practice. Clinical Social Work Journal, 42, 123-133.
Edmond, T., Megivern, D., Williams, C., Rochman, E., & Howard, M. (2006). Integrating evidence-based practice and social work field education. Journal of Social Work Education, 42(2), 377-396.
Grady, M. D. (2010). The missing link: The role of social work schools and evidence-based practice. Journal of Evidence-Based Social Work, 7(5), 400-411.
Greenfield, E. A., Morton, C., Birkenmaier, J., & Rowan, N. L. (2013). Optimizing geriatric social work education: Program and individual characteristics that promote competencies. Journal of Gerontological Social Work, 56(4), 356-377.
Hooyman, N. R. (2009). Transforming social work education: The first decade of the Hartford Geriatric Social Work Initiative. Alexandria, VA: CSW Press.
Institute of Medicine. (2006). Improving the quality of health care for mental and substance-use conditions. Washington, DC: National Academies Press.
McCracken, S., & Marsh, J. (2008). Practitioner expertise in evidence-based practice decision-making. Research on Social Work Practice, 18, 301-310.
New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Washington, DC: U.S. Department of Health and Human Services.
Palinkas, L. A., & Soydan, H. (2012). New horizons of translational research and research translation in social work. Research on Social Work Practice, 22(1), 85-92.
Regehr, C., Bogo, M., Donovan, K., Lim, A., & Regehr, G. (2012). Evaluating a scale to measure student competencies in macro social work practice. Journal of Social Service Research, 38(1), 100-109.
Rubin, A., & Parrish, D. (2007). Challenges to the future of evidence-based practice in social work education. Journal of Social Work Education, 43, 405-428.
Sackett, D., Straus, S., Richardson, W., Rosenburg, W., & Haynes, R. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Edinburgh, Scotland: Churchill Livingstone.
Substance Abuse and Mental Health Services Administration’s National Registry for Evidence-based Programs and Practices. (2015, April 2). ParentCorps. Retrieved from http://nrepp.samhsa.gov/ViewIntervention.aspx?id=246
Social Work Leadership Institute. (2008). Implementation of the Hartford Partnership Program for aging education lessons from the field. Retrieved from http://socialwork.nyam.org/nsw/ppp/about.php
Thyer, B. A., & Pignotti, M. (2011). Evidence-based practices do not exist. Clinical Social Work Journal, 39(4), 328-333.