Gabriel Fernandez: The Importance of Clinical Significance

Background and Purpose: Evidence-based practice has become a widely acceptable and common approach for social workers. When conducting their interventions, social workers often use statistical significance as the gold standard to demonstrate the effectiveness of an intervention. However, clinical significance, often used as a tool of assessment in the health field is useful and appropriate in the context of social work practice. However, clinical significance is an important issue that has often been omitted from the discussion regarding the assessment of an intervention's effectiveness. Clinical significance should include input from clients, clinicians and policymakers. By including the domain of clinical significance into the determination of overall effectiveness as well as statistical significance, social work practitioners can be certain that the client, who is the ultimate arbiter of treatment success, is included in the process of making decisions about the treatment they receive. An important example of clinical significance is the death of Gabriel Fernandez in 2013, an eight year old child who died in the hands of his parents and how his death shocked the Los Angeles county child welfare system. Not only did this one case bring lawsuits to child welfare workers and supervisor for the first time in Los Angeles, it also questioned social workers' misuse of the automatic risk assessment system that was set up with statistical significance. This study intends to ascertain how clinical significance has an important role in micro, mezzo and macro social work practice.

Methods: A two-pronged approach is used to measure clinical significance in this study. Six episodes of the documentary, The Trials of Gabriel Fernandez, were used as an analytical tool to assess the clinical significance of the case. Two social work faculty reviewed all 6 episodes of the documentary and used qualitative approach to classify different individuals, agencies, and systems that these episodes mentioned. A review of the literature was also conducted to examine the role of clinical significance in social work literature.

Results: Death is considered as the worst outcome of any intervention and therefore, taking clinical significance to the extreme end of the measure. The death of Gabriel, who is an active case in the child welfare system, not only impacted the immediate family system, but affected other micro, mezzo, and macro systems. The role and responsibilities of child welfare workers were intensely scrutinized by the media in this case. It also impacted the judicial, and social work education system in very significant and negative ways.

Conclusion and Implications: High impact cases such as Gabriel's should be examined and used as teaching materials in BASW and MSW training. Social work programs and faculty should also bring the county child welfare key stake holders together to process and learn from this negative and clinically significant outcome. Social workers must first consider the safety of our clients. Having clinical significance is as important as statistical significance. However, the term needs to be clearly defined and used consistently across different disciplines.tract 11817 modified by 172.127.0.131 on 5-9-2020-->