Strategies for Promoting Client Self-Determination: A Systematic Synthesis of the Literature

Background: Self-determination remains one of the key ethical principles in social work. In spite of its centrality, contexts through which self-determination is promoted and enacted in social work practice can be varied and might be “more difficult with some clients than with others” (Barsky, 2014, p. 5).  The main research question that guided this systematic literature review was how do social workers promote client self-determination in their work?  The proposed presentation will summarize main themes gleaned from the literature on practices and strategies used in social work settings to support client self-determination. The significance of this research lies in that it attempts to operationalize self-determination based on strategies reported by practicing social workers. 

 

Methods: The method that was used to select the literature for this review involved a keyword search in EBSCOhost databases using the terms “self-determination and social work practice.” Included in the review were empirical studies that collected primary data from practicing social workers or case managers on how they promoted client self-determination in their work. Excluded were articles that involved students, scale development articles and surveys on attitudes to self-determination. The literature search was conducted in November 2017. This search yielded 722 published articles. The articles were filtered by the following terms “academic journals, peer reviewed, methodology” leaving 88 articles whose abstracts were read and the number reduced to 15 articles. Additional searches based on references led to 2 data sources. An initial sample of 17 articles and a dissertation were read and of these 9 were excluded leaving 8 articles. A data extraction form was developed and used to capture information from the identified literature focusing on the following topics: author, setting, participants, data collection methods, and reported self-determination practices and/or considerations.

Results:  Qualitative synthesis of the reviewed literature showed that the reviewed studies spanned across diverse practice settings including child welfare, older adult services, interprofessional settings and mental health. The reviewed studies had used qualitative methodologies with interviews being the most common as reported by 7 articles and the remaining 2 involving document review. Strategies used to promote self-determination involved  (1) giving clients a voice and opportunity to choose in their treatment planning (2) client education on program components and why certain decisions are made (3) honoring client’s right to say “No” (4) allowing client to lead and prioritize (5) embracing best practices in self-determination such as applying self-determination theory to promote client autonomy, competence and relatedness (6) valuing client perspectives (7) engaging third parties such as relatives and co-workers (8) observation of client demeanor and behaviors such as client enjoyment or sadness (9) developing a shared commitment at the organizational and individual worker level.

Implications:  The findings suggest that the enactment of self-determination is a collaborative process among practitioners, clients, relevant third party representatives such as clients’ natural supports and treatment teams.  Social workers can spearhead this shared engagement process so that clients and supportive relatives are valued contributors in client treatment and decision-making to promote client autonomy and competence.