Social care has long been treated as healthcare’s junior partner, facing an uphill struggle to define itself as a credible, professional sector. Part of this imbalance stems from medicine’s roots in scientific discovery, which has afforded status and power. Perhaps a masters of the universe attitude has prevailed, based on the idea that scientific discoveries offer certainties, clear pathways and clearer outcomes.
For social care and social work the picture has been less certain and certainly more contentious. The evidence base for the profession has long been questioned and challenged, including debates about what actually constitutes evidence. The Social Care Institute for Excellence (Scie) has even developed guidance for assessing the quality of different sources of knowledge.
In her reports on the child protection system, published in 2011, Eileen Munro talked about evidence being fundamental to social work practice. But there is a recognition in her final report (pdf), particularly with regard to methods, that it is “simply not a case of taking an intervention off the shelf and applying it to a child and family”. This points towards one of the biggest hurdles to evidence-based practice in social care: the unique and innumerable variations in context.
The families that practitioners work with are often disadvantaged, have a lack of social capital and experience fractious relationships between partners and other families members. These are compounded by environmental factors, such as poor housing, social isolation, deprivation and little access to social support or education and training.
Social workers and other practitioners must try and make sense of this context for a family. They must make assessments and judgments about a family situation, perhaps when looking at how safe a child is. This means navigating difficult terrain and understanding events and circumstances that are constantly changing. Social workers cannot just follow evidence-based guidelines or models when carrying out their practice. There are few, if any, neat and tidy outcomes, where a result exactly follows an intervention in the way predicted.
Instead, to improve practice, attention needs to be given to the way that practitioners form judgments and make decisions that benefit and protect service users. But this task is rather more complex and can be sidelined. This can mean that the processes involved in how practitioners make sense of the situations they face are not understood.
What does this mean in practice? The policies and guidance that regulate practice must be looked at. These are a starting point – guides within which the practitioner works. They demonstrate effectiveness through applying values central to social work to their practice, such as social justice, emancipation and equality. In times of political pressure, media scrutiny and high demand, the realisation of these values is by no means assured as social workers feel themselves being stretched in one direction and then another.
But social workers and other practitioners must also explore the values, biases and assumptions that may affect their practice. Without paying attention to how they make decisions, an immediate blind spot is created. If we don’t know how we’ve arrived at one decision over another, and can’t explicitly identify why we’ve arrived at that decision, then how do we know it’s the decision that best fits the situation and the service user?
To guard against this we must try to illuminate the way decisions are made. Social workers should be constructively challenged and questioned by their managers and peers. Questions like: “what made you feel like that?”, “how do you think those feelings impacted upon you and the family?”, “why was it that this particular thing caught your attention?” or “what’s similar or different in this case compared to others?”, should all be routinely asked.
These questions work best in safe and emotionally containing environments. Organisations are best able to offer such spaces if they are open and accept that mistakes do happen. There must be a recognition that, unfortunately, sometimes actions do have an adverse outcome. This acknowledgement should be coupled with a willingness to learn from any such eventuality.
Perhaps this is the tallest order of all, but it should not deter the profession from rising to the challenge. Social work must embrace the rich mix of knowledge that, if conditions allow, offers the opportunity for clear and more informed judgments to be made to the benefit of service users.
