Social Work Approaching Evidence-Based Practice. Rethinking Social Work

Abstract: The Swedish public sector has undergone major changes over the last decades, with increased demands to be effective and perform their tasks with high quality, but also with the demand to increase the influence of users and citizens over the support given. This development has influenced how social services organise and how their work is perform, and is one motive given as to why evidence-based practice was introduced. This development can also be traced back to the manager philosophy new public management and neo-liberalism. Evidence-based practice has its origin in evidence-based medicine, which had a large impact internationally from the 1990s. Although there are different opinions concerning how evidence-based practice should be understood is often described on the basis of Sackett et al.’s (2000) definition which regards evidence-based practice as an integration of different knowledge sources – the best evidence, clinical or professional expertise and the values and preferences of users. The professional have the responsibility to use all these knowledge sources in the daily work. The purpose of this thesis is to describe and analyse different processes of the introduction of evidence-based practice. One aspect is what these processes have contributed to in terms of organising ways of working and management within social services; another aspect concerns what this means for social work. With a combination of new institutional organisational theory and Berger and Luckmann’s (1967) insights into the social construction of everyday life, it is possible to analyse the introduction of evidence-based practice as a process, moving between a macro, meso and micro perspective. The empirical base for this thesis is interviews with 33 personnel from different professions and organisations. Those interviewed from the social services include social workers within individual and family services and socialservices managers, as well as regional representatives from a Research and Development Unit. To understand the development of evidence-based practice and its proliferation into social services I also interviewed doctors from health care in a County Council. New institutional organisational theory is useful for understanding how different ways of organising activities are spread between and within organisations. With concepts used in new institutional theory, the focus is on how evidence-based practice travels from medicine to social work, and from a national level to the local social services level, via the regional level. Giddens (1990) terms ‘disemedding’ and ‘reembedding’ are used. Different isomorphic processes are recognised in these processes, as well as strategies to decouple or loosely couple evidence-based practice from social services ordinary activities as a way to gain legitimacy. The main findings in the thesis are that evidence-based practice has been introduced with evidence-based medicine as a role model, and that this has been done from different conditions. As is described in the interviews, the development of evidencebased practice has been controlled from national organisations such as the government, the National Board of Health and Welfare and in recent years also the Swedish Association of Local Authorities and Region, while the development within the medical area was governed by national organisations but performed by the medical profession, which advocated the introduction of evidence-based practice within the profession. The regional representatives largely support the myth that is presented of evidence-based practice, and have a central responsibility in the national initiatives conducted; they are intermediary between the national initiatives on development work and the local practice. When evidence-based practice is introduced in social work this has entailed loosely coupling between the myth about evidence-based practice and the ordinary activities, this strategy is especially obvious among social services managers. Furthermore, when a medical model of evidence-based practice is used, although with a broader approach, the introduction of evidence-based practice does not reflect the social workers’ education, profession and ways of working in the same way as evidence-based medicine reflects the doctors’ education, profession and way of working. The intention to analyse the introduction of evidence-based practice from a micro perspective is about understanding how evidence-based practice is received by the social worker and their managers. When the interviews with the doctors, social workers and managers are analysed there is less coherence between evidence-based practice and social workers’ work than between evidence-based medicine and doctors’ work. This means that social workers have to shape and construct their daily work anew through internalising the new habits and routines into everyday work, something that takes energy and time, which most interviewees feel does not exist. This thesis also highlights the need for social work to approach evidence-based practice both at an organisational and a structural level, and from the level where the daily work is performed by social workers. Finally, there exists among almost all interviewees a great interest in introducing evidence-based practice, especially among the social workers, but at the moment it is not re-embedded in social work.