What Motivates Social Workers in Training to Use Evidence-Based Assessment?

Background

Evidence-based assessment (EBA), the use of standardized assessment tools for case conceptualization and monitoring, is broadly supported for a wide range of social and mental health services and is consistently linked to improved client outcomes. Insufficient use of EBA across clinical settings has been related to detrimental consequences, such as undetected depression and preventable suicides. However, the use of EBA remains low across multiple professions engaged in social and mental health services, including social work. EBA use among social workers is particularly important to study because social workers comprise almost 50% of the US mental health workforce. There is a need to develop targeted strategies to increase the use of EBA. Little research has highlighted proximal, modifiable determinants of EBA use that would serve as effective targets for implementation strategies.    

 

Methods

The present study is the first to address this gap by applying an established behavior prediction theory, Unified Theory of Behavior, to better understand decision-making regarding the use of EBA among MSW students. We focused on three classes of proximal determinants of intentions among MSW students to use EBA that are theoretically most malleable: (a) behavioral beliefs, (b) injunctive social norms, and (c) self-efficacy.

Participants (N=241), students in their second year of MSW training at New York University (NYU) School of Social Work, completed a voluntary survey. Respondents averaged 26.9 years of age (SD = 6.1), were largely female (83.8%) and of diverse ethnic backgrounds (56.4% Caucasian, 14.1% African American, 9.5 % Asian, 3.4% other; 13.7% identified as Latinx). 

We used open-ended elicitation approach to explore behavioral beliefs about EBA specifically salient to social work trainees. Established close-ended scales were used to measure intentions to use EBA (α=0.92), EBA-related social norms (α=0.86) and EBA-related self-efficacy (α=0.90).

The theoretical model was tested via structural equation modeling (SEM) approach using the Mplus software package with robust (Huber-White) maximum likelihood algorithms and formal multiple group comparisons among age groups of students. We then used collinearity-neutral dominance analysis to analyze the relative importance of behavioral beliefs, injunctive norms and self-efficacy, for determining the EBA intentions.

 

Results

Parameter estimates significantly differed for the younger (under 29 years of age) and the older groups of MSW trainees. Our models explained a substantial portion of variance in the EBA intentions: 35.1% for the younger group, and 69.8%, for the older group. Social norms were the most consequential class of determinants: they accounted for 63% of explained outcome variance for the younger group, and 47% of explained outcome variance, for the older group. Respected colleagues in the field were the most influential normative referents: their perceived opinion determined EBA intentions stronger than perceived opinions of professors, clinical supervisors, and professional role models.

 

Conclusions 

Injunctive norms provide strong targets for implementation strategies to increase EBA use among early-career social workers. Respected colleagues in the field are the strongest normative referents for nascent social workers. There are fundamental age-related differences in the patterns of decision-making among MSW students suggesting tailored implementation approaches.