Practice Evaluation Strategies Among Licensed Clinical Social Workers

Purpose:  This study describes beliefs about practice evaluation strategies among social workers as contrasted with recommendations in social work research for how these practice evaluation strategies should be used.  Social workers in clinical settings can use practice evaluation strategies to monitor the effectiveness of their interventions in terms of client change. Practice evaluation strategies in social work range in style from the formal-analytic tools of single-subject designs, software applications, rapid assessment instruments, clinical practice guidelines, and evidence-based practice algorithms, to the everyday informal-interactive tools of clinical supervision, consultation with colleagues, use of client statements, and clinical experience. Two decades of studies have consistently demonstrated that social workers prefer and use most often informal-interactive tools for evaluating practice effectiveness.  We call this phenomenon the informal-interactive tool preference.  With the arrival of the evidence-based practice movement in social work, however, social work researchers started recommending that informal-interactive tools should be supplemented and balanced with formal-analytic tools when evaluating practice effectiveness. Acknowledging the informal-interactive tool preference among social workers, social work researchers have attributed this preference to a lack of training in, agency support for, and behaviorist orientation to formal-analytic tools.  Missing from American and British social work research is a study that can explain why, in a more nuanced and complex way, the informal-interactive tool preference still remains a stand-alone method for evaluating practice effectiveness.

Method: Twelve licensed clinical social workers were recruited to participate in a three-hour focus group on the use of practice evaluation strategies in clinical social work practice. Focus group participants consisted of six male and six female social workers (racially and ethically diverse, ages 26 – 65).  Primary inclusion criteria was two-year post licensure experience and current, full-time employment in direct social work practice.  Participants responded to twenty five questions as represented in twenty years of social work literature and research on practice evaluation strategies among clinical social workers. Focus group results were transcribed and analyzed by three members of the research team using the qualitative software package Atlas.ti.  Conceptually clustered matrices were then constructed to detect patterns in themes across focus group participants.

Results:  The analyses yielded descriptive information about why the social workers endorsed the informal-interactive tool preference.  Prominent reasons for the preference included: (a) it is a good fit with the exigencies of clinical settings, (b) consultations with colleagues offers a more accurate assessment of clients than standardized instruments, (c) trainers in evidence-based algorithms do not seem confident about the algorithms when training experienced clinicians, (d) national research organizations do not keep practice guidelines current, (e) clinical expertise exceeds software and single-subject designs, and (f) client outcomes did not improve after clinicians supplemented informal-interactive tools with formal-analytics tools.

Conclusion and Implications:  This study provides complex and nuanced information for social work researchers who are interested in learning why, after nearly a decade of the evidence-based practice movement in social work, the informal-interactive tool preference among social workers remains a stand-alone method for evaluating practice effectiveness.