Using an Evidence-Based Approach to Improve Clinical Skills Among MSW Students

BACKGROUND AND PURPOSE:  Evidence-based practice (EBP) emphasizes the use of research findings to aid clinical decision-making (McCracken & Marsh, 2007).  However, scholars have noted such an approach misses the use of important “practice-based evidences” (PBE) needed to deliver clinically effective practice (Gilgun, 2005; Staller, 2006).  Practitioner expertise, which entails sophisticated micro-level counseling skills, cultural competency, and an ability to reflect on interpersonal biases, can be used the administration of EBP (McCracken & Marsh, 2007; Gilgun, 2005). However, few studies evaluate the extent to which a given clinical course equips students with these essential skills.  This pilot study evaluates the efficacy of one course to increase MSW students’ counseling self-efficacy prior to their internship.  The course uses a case study approach to EBP and teaches how the triangulation of clinical data (PBE): case history, manifest problems, and latent meaning derived in the clinical encounter can be used to assist in the delivery of EBP.  Such an approach to EBP teaches students how to understand and prioritize various PBE available to the clinician.

METHOD: A pre-and post-test design was used to compare the effects of the course on the students’ perceived counseling self-efficacy (n=18).   Eighteen students (16 female; 2 male) were administered the Counseling Self-Estimate Inventory (COSE) during the first week of the course and again fourteen weeks later. The COSE, a 37-item instrument, assesses a person’s perceived self-efficacy in five domains: (a) the ability to appropriately respond to a client (micro skills), (b) understanding the counseling process, (c) dealing with difficult client behaviors, (d) cultural competence, and (e) the capacity to assess one’s own biases (values) (Larson et al., 1992). The Wilcoxon Signed-Ranks Test (WSRT) was used analyze the data (Siegel & Castellan, 1988).

RESULTS: The sample was mostly young, white women (average age 29).  Two thirds of the sample reported prior work experience in human services. The WSRT indicates that the change in mean test scores from pre-test to post-test (149.7 and 160.9, respectively) was significant (Z = 2.55, p< .05) with a large effect size (r = 0.6). Test scores in each of the five domains also significantly increase: (a) micro skills (Z = 3.63, p< .00, r = 0.86), (b) counseling process (Z = 2.77, p< .01, r = 0.65), (c) dealing with difficult client behaviors (Z = 2.69, p< .01, r = 0.63), (d) cultural competence (Z=2.4, p< .05, r = 0.57), and (e) values (Z = 2.52, p< .05, r = 0.59).  Among these domains, micro skills showed the largest change.

CONCLUSION AND IMPLICATIONS: Although exploratory and based on a small sample, the findings are promising.  The COSE reflected significant positive change in two of the ten Council on Social Work Education 2008 Educational Policy and Accreditation Standards (EPAS) requirements: (a) improvement of students’ practice skills (EP 2.1.10) and (b) their ability to function as a professional social worker (EP 2.1.1).  Such findings suggest that taking a PBE approach to EBP could facilitate the acquisition of competencies associated with effective clinical practice.