(WITHDRAWN) Social Work Decision-Making in Situations of Risk and Uncertainty

Background:

Social workers are called upon by society to undertake high-stakes assessments and make decisions regarding the safety of others in situations of risk and uncertainty. Risk decisions in these situations are fraught: emotions are high; information is often incomplete, inadequate, or misleading; situations can deteriorate or change quickly with little warning; and public expectations and media scrutiny are intense. In the end, despite best intentions, skills, and efforts, the outcomes of these complex decisions are at times tragic.

In attempting to improve decision-making in high stakes areas, organizational procedures and public policies have moved away from a reliance on unstructured professional judgment, to actuarial measures and more recently standardized professional judgment tools. Research has demonstrated however, that the manner in which individual workers complete standardized tools for the same cases can be highly divergent, and that workers believe that the measures may over-predict risk and lead to punitive interventions. Some tools allow for “overrides” of actuarial measures when there is sufficient justification based on clinical or policy factors. What remains unclear are the individual processes by which social workers arrive at judgments that contradict or override standardized decision tools.

Based on our previous experimental design research, we submit that the manner in which professionals interpret and describe features of the client and their situation, is influenced by the professional’s expertise and personal experiences, the manner in which standardized decision-tools are used, and the organizational and societal context in which they are located.

This presentation describes the development of a personalized model for improving professional decision-making in situations of risk and uncertainty, through a deliberate multi-stage process. Building on our previous experimental design research, this project returns to an exploratory design, leading to the development of evidence-based models for improving social work decision-making that incorporate expert intuition, practice wisdom and actuarial tools.

Methods:

Using a design-research framework, this research sought to assist participants to develop a personalized model for improving professional decision-making involving: 1) assessment of competence and expertise using Objective Structured Clinical Evaluations (OSCEs); 2) monitoring and explicating decision-making through journaling biological, emotional and cognitive influences during real life moments of high risk clinical decision-making over four months; 3) engagement in a masterclass series on decision-making processes and risk tools; and 4) ongoing evaluation of the outcomes of practice decisions.

Findings:

This presentation will share preliminary findings from the first cohort of 13 experienced practitioners working in a large mental health facility. Initial data analysis of qualitative reflections demonstrated a new understanding of individual decision-making processes and the impact of factors such as: anticipatory anxiety, team processes, and the social judgment of others on a professional’s personal decisions.

Further data analyses presented will include: pre-existing traumatic workplace exposures and levels of distress; independent ratings of performance during pre and post intervention OSCEs; heart rate variability and personal reflections during decision-making moments; and shared insights.

Conclusion and Implications:

Based on participant feedback and analysis of qualitative data for the first cohort, this structured model for improving decision-making shows promise.