The Significance of Evidence-based Practice in Social Work Activities - Assignment Example

Critically analyze the strengths and weaknesses of using an evidence-based approach for child sexual abuse in foster care, referring to recent research findings: Note: In the study, the researchers do not set out their ontological positions or refer in any way, to any issues of epistemology. Introduction: In the last few decades, there has been an increasing liking for the evidence-based practice in the UK especially in areas related to health service and social work. Evidenced based practices could be defined as a practice which, while maintaining scientific hypothesis, also, simultaneously, produces information that underpins practice based research on the best possible research evidences at one’s disposal. Thus, this definition is rooted to the framework that places significance on the special features and results of development in the local settings, the connections between the settings and its consequences and the powers that go to explain the connections between the features and its results. (Carl & Cutspec 2002). The terms ‘evidence- based practice’ and ‘evidence -based approach’ appear mainly in the addictions field and rehabilitation field. The researches that focus on the social progress in health related areas make use of this practice in their findings. They employ very systematic and well-defined process in the evolution of their results. This interest for evidence-based practice will continue to occupy a prime position among such researches. The social service sector makes the best use of this practice and it is expected that there will be more sectors using this method in the future. Even the policy makers use this term in many areas of decision-making. According to the Friday Focus of the Drug Scope Drug Data Update, such a forum discussed the question "If we did have an evidence-based policy and practice, what would they look like?" (Friday focus: evidence based research. 2005). Many researchers doubt the validity of evidence based practice in social work as it is adapted from the way it was successfully employed in medicine and health care. Infact, the concept of Evidence Based Social Work is a much discussed and less implemented in its pure form. Therefore, one can state that it is a concept awaiting implementation. According to Sackett et al (1997), The EBP model has its base in three factors-practitioner’s individual expertise, best evidence and the client values and expectations. For Haynes, Devereaux, and Guyatt (2002), the newest EBP model consists of four factors, namely clinical state and circumstances, clinical expertise, client preferences and actions, and research evidence. (Muller & Shlonsky 2004). Gibbs in 2003 came out with six important steps of EBP, which would help any practitioner of the theory to apply it in social issues like child sexual abuse in foster care. They include:- 1. Converting information need (prevention, assessment, treatment, risk) into an answerable question. 2. Tracking down current best evidence. 3. Critically appraising the evidence. 4. Integrating critical appraisal with practice experience, client’s strengths, values, and circumstances. 5. Evaluating effectiveness and efficiency in existing steps 1-4 and seek ways to improve then next time. 6. Teaching others to follow the same process. (Muller & Shlonsky 2004). In today’s context, Evidence Based Practice in social work has been a question of debates and discussions for many of its characteristics. Whereas some social workers questioned the validity of this method, others most often acclaim it. There are many ways of looking at this concept, which differ in their emphasis. This essay attempts to make a probe into the issue of child sexual abuse in foster care in U.K, with a special reference to the evidence-based practice. The article ‘Some Considerations on the Validity of Evidence-Based Practice in Social Work’ by Stephan A Webb argues that the practice “proposes a particular deterministic version of rationality which is unsatisfactory.” “Evidence-based practice”, according to him, “is derived from ideas based on optimal behaviour in a planned and systematically organized environment.” This view presents a different concept of the existing belief. Webb also argues that social workers engage in a “reflexive understanding” and the complex process of decision-making are not rationally determined. The paper focuses on a serious critique of the practice. (Webb 2001, P. 57-79). Critiques of Evidence-based Practices: There has been a fabulous expansion of the evidence-based practice which is crucial in many respects. However, there have been many criticisms of the practice as well in medicine and other social service areas. As Liz Trinder remarks, “Supporters and advocates of evidence-based practice claim that the approach results in the best practice and the best use of resources. In contrast, opponents have countered with claims that evidence-based practice is a covert method of rationing resources, is overly simplistic and constrains professional autonomy.” (p. 2). (Trinder & Reynolds 2000). We cannot just assume that evidence-based actually works. On the merits of evidence-based practice also there is no guarantee. Sackett et al (1997) and Gibbs (2003) identify the major hallmarks of EBP as individualized assessment (strengths, needs, values, preferences of client), well- formulated question (database query), well-executed search of research literature, deciding its applicability to clients, and considering the evidence together with the values and preferences of the client. (Muller & Shlonsky 2004). Scholars as well as researchers have conducted many studies and researches on the issue of sexual abuse of foster children. The increasing number of sexual abuse committed on foster children made Roberts state that “it must be happening in some foster homes at the moment." (Roberts 1986). In order to establish the issue of child sexual abuse in the foster care cenetrs of the UK, I think, the following scholarly researches conducted in the field of child sexual abuse will be effective. One of the researches that I have relied upon in order to stress the child abuse is “London Child Protection Committee - 05 October 2005, Improving Responses to Child Sexual Abuse in London.” The most important reason for me to consider this report is that it is very useful as we get “some initial thinking on improving responses to child sexual abuse in London and sets out some possible areas for further action” (McCollum 2005). Based on the studies available, the committee makes certain recommendations to the best protection of the interest of the children in the UK, especially with regard to the sexual abuse against them. In an attempt to improve responses to child sexual abuses in London the report considers in the detail the extent to which such issues exist in London. The report makes it clear that “Child sexual abuse is largely hidden and unreported” and the findings of the NSPCC survey are given in order to make clear the adverse childhood experiences. Accordingly, 1% of children experienced sexual abuse by a parent or carer during childhood. 3% suffered sexual abuse by another relative during childhood. 11% of children experienced sexual abuse by people known but unrelated to them. 5% of children experienced sexual abuse by an adult stranger or someone they had just met. 21% of girls and 11% of boys have experienced some form of child sexual abuse. 16% of girls aged 12 or under had been sexually abused. (Cawson et al 2000). The CWASU self completion questionnaire on prevalence of sexual abuse, is also a useful consideration in the report. It is also clear in the report that the UK studies on child sexual abuse is very minimal. This provides an extensive report on the way the things are on and the way things need to be directed for the protection of the children’s interest in the UK. Thus, the report by Hilary McCollum, Director Social Policy & Grants, ALG is of the best consideration in this study. (McCollum 2005). Another useful analysis of the child sexual abuse that I followed in this paper is the work titled ‘The Real Controversy about Child Sexual Abuse Research: Contradictory Findings and Critical Issues Not Addressed by Rind, Tromovitch, and Bauserman in Their 1998 Outcomes Meta-Analysis’ by Tice, Pamela Paradise et al. In this work, the authors present a review of all types of child sexual abuse research that were ignored by Rind, Tromovitch, and Bauserman in their 1998 meta-analytic study. The eight major findings that are addressed in the work particularly take my interest. The importance of the study is that they demonstrate the narrow focus of the meta-analysis. The study, in my consideration, is that it gives evidence to the seriousness of the child sexual abuse. All of the studies emphasise the importance of considering the issue of child sexual abuse. The analysis is of great significance considering the nature if this paper and the seriousness of child sexual abuse. (Tice et al. 2001, p.157-82) However, Pringle, on the other hand, believes that there is a greater amount of child sexual abuse perpetrated by people in foster placements and he observes that it is “common to take referral of adolescents who had been abused in local authority foster placements." (Pringle 1993, P.4-19). Sinclair (1995) studied the effects of group therapy and responsive treatment for 43 girls aged between 12-18 years living in a group home setting. The SAY Group (sexually abused youths and socially aware Youth) used a “cognitive –behavioural approach with a PTSD orientation” and included a congenial environment for seeking solutions for recognition, affective and behavioural problems. The different interventions include the youth self report the Child behaviour checklists and the Reynolds adolescent’s depression Scale. The results of this study reflect a conspicuous decrease in the problem behaviours and its outward manifestation by the group. (Feit et al 2004). His experience of working with an independent agency that specialized in family placement of teenagers who were sexually abused convinced him that children in foster care are proportionally more susceptible to being abused. Thus, it is difficult to determine the exact rate of sexual abuse in foster care even though one can say that child sexual abuse in foster care is higher compared to that of the rate among general population in UK. Yet, there are contradictory opinions that the issue is very much overemphasised and it makes a judicious understanding of the fact impossible. An evidence-based research and practice can best serve the purpose. There is a point of confusion regarding the application of ‘evidence-based practice’ in these peculiar cases of child sexual abuse in UK. It is primarily because of the critique of the practice put forward by social activists like Webb. In his article Webb tries to refute the “emerging panacea of evidence-based practice.” His critique of the practice includes many issues. He states, “the presuppositions made for an evidence-based methodology as practice are problematic.” Webb went on to criticise the practitioners of this practice. He believed that the practices undertaken by social activist especially their “decision making and prediction outcomes does not adhere to the tenets suggested in evidence-based- practice.” The arguments of Webb against the practice also include the ineffectiveness of it when he says, “the use of evidence in practice does not function or work in the way that the evidence-based proponents suggests it does.” In reply to the critique of Webb, Brian Sheldon’s ‘The Validity of Evidence-Based Practice in Social Work: A Reply to Stephan Webb’ points out that the practice immunizes the people “against accepting famous ideas just because they are famous” (Sheldon 2001 P. 801-809) and this reply helps in a better understanding of the scope of the practice in relation to the issue of child sexual abuse in foster care in the UK. He refers to special cases in his work where the accepted ideas were challenged in a searching to find out the truth behind them. For example, the popular idea that the child sexual abuse was widespread and common in Britain in the 1980s “fed by bad medicine, and politically inspired feminist psychology,” according to him, can be corrected by evidence-based training and practice and he has evidence for the same. He argues that the criticism against the practice as too scientific which human nature does not cater to is invalid. This is due to a distorted notion of science. There is strong ideological basis for Evidence-based practice. There is no reason why we doubt the effectiveness of this practice in social works and related areas. The relevance of this practice is clear when we deal with the problem of sexual abuse of children in foster care in the UK. On child sexual abuses Child sexual abuse in the UK persists in many forms and it has been a question of controversy for quite a long time. However, there are differing perspectives about whether such a problem ever exists or not, there is no doubt about the numerous consequences and effects of sexual abuse of any sort. It is sad to note that there have not been much studies concerning abuse of children in the UK. The studies conducted in the UK are more in the form of sexual allegations regarding foster care and subsequent investigations. The rate of sexual abuse of children in foster cares seemed to be low. For example, “In an international study of allegations of abuse in foster care, 59 social services and social work departments returned questionnaires and identified 305 abuse investigations during the year under study; representing 4% of foster homes. Just over one-fifth of the cases (67) were substantiated and in a further fifth of cases investigating staff were not able to determine whether or not abuse had occurred.” (Kendrick 1998). This has tangible and intangible results on the society and so the controversy regarding their truths gets prime focus. An evidence-based research on the issue makes things clear. Causes of the malady To study the causes of child abuses also an evidence-based study is recommendable. The findings of such a research will include mental illness Psychological factors and the notion that the abusers might have experienced such abuses themselves etc are some of the reasons for child sexual abuse. The prevalence of child sexual abuse in foster care prompts one to consider the underlying factors that cause child sexual abuse. These factors can vary from social isolation, unsatisfactory marital sexual relationships of the perpetrators, family dysfunction or involvement, lack of motherly care and affection, alcoholism and the hypersexual urges of both the perpetrators and the children. Even though the perpetrators can never blame the children for being seductive or provocative, one cannot negate cases of collaboration where the victims enjoy the sexual abuse. Faller observes that “While some children who have been sexually abused may appear somewhat seductive, this is a result of the sexual abuse, not a cause. (Faller 1988). The sexually ill-treated child, at times, tends to provoke other children in the family for the same. As Roberts’s remarks, “The most immediate problem for many foster families is that the sexually abused child will teach other children in the home sexual play.” (Roberts 1986, P.8-11). Sexual abuse in foster care can be eliminated only with concerted and sustained efforts. The foster parents as well as the actual parents should well be aware of the threat that haunts the UK society. Special counselling and training sessions are to be provided by the Government. As suggested by Finkelhor, “Classes, literature, and briefings could be made mandatory for all those in the household, explicitly discussing sexual abuse, in the hope of thereby deterring some possible perpetrators.” (Finkelhor 1988). Another major setback in the issue of child abuse is the inexperienced and untrained staff in charge of foster care centres: “majority of staff responsible for children in foster care do not have the information, skills or training necessary to respond to the needs of sexually abused and abusing children.” (Merrick & Allen 2007). One can never forget the good work done and the commitment shown by many of the staffs. The greatest setback and the most severe blemish in the sphere of residential and foster care is the abuse shown by the staff to the children. As Lindsay comments, “abuse by staff is not a great problem in terms of frequency of occurrence, but it is a great problem in terms of the seriousness of the offence, and of the uncertainty and anxiety the whole issue causes throughout the service as a whole." (Lindsay 1997). Thus, for the prevention of maltreatment in foster care, there should be careful selection, preparation, and training both for the foster carers and the staff. Family preservation programs can ensure much more safety to children than in foster care. Studies have pointed out that “children left in their own homes typically do better than comparably maltreated children placed in foster care.” (Foster Care vs. Family preservation. 2007). There is no doubt that children in foster care suffer from insecure feelings and emotional imbalances. Very often people around them take advantage of this factor and much more than the physical harm done to them it is the emotional harm of foster care that creates never erasable scars in the minds of victims of sexual abuse under foster Care. Lack of authoritative research A key factor to remember with regard to child sexual abuses in the UK is that there have not been many authoritative studies about them. As Doran and Brannan observes, “The lack of research and the piecemeal implementation of recommendations following a number of inquiries leaves one feeling that professionals have not addressed their responsibility for the abuse and protection of children.” (Doran & Brannan 1996, P.155 - 166). Nevertheless, there is a false notion that child sexual abuse is very common in the foster care centres. The common belief, here, becomes the accepted fact. This is against the evidence-based practice principle that only evidences make truth. We can very well repute this false belief about the child sexual abuse in the foster care units of the UK that it is a common phenomenon. An evidence-based research alone solves the issue; decision-making can be made in the best way when we base our reasoning on evidence. Thus, we understand that to get a clear picture about the child sexual abuse in foster cares of the UK when we undertake an evidence-based research. This makes the relevance of the practice in our context even higher. As McNeece and Thyer put it evidence-based practice which means “the integration of the best research evidence with clinical expertise and client values in making practice decisions” is “clinically relevant research from basic and applied scientific investigations, especially drawing from intervention research evaluating the outcomes of social work services, and from studies on the reliability and validity of assessment measures.” (McNeece & Thyer 2004, P. 7-25). Strengths of the practice:- Thus, this practice can be applied in the issues related with child sexual abuse in foster care centres. There are many areas of the child sexual abuse in foster care where the evidence-based practice is applicable including research on the facts about child sexual abuse in the foster care of UK. There are many observations that go in support of evidence-based practice. “Evidence-based practice is an idea whose time has come. Few concepts can have achieved the status of unchallengeable common sense in such a short space of time, and across such a broad range of professional activity.” (Trinder & Reynolds 2000). The main strengths of the evidence-based practice, according to the general belief, include better informed practitioners, the well formed process of spread of the best evidence, clarification of the known and unknown things to aim further research, the limited possibility of misinterpretation and so on. Yet the defects of the practice cannot be overlooked. Gray (2001) considers EB Policy Process as a cycle of finding and appraising evidence, capacity building and getting evidence into practice. Sackett et al (2000) puts forward some positive arguments in favour of the practice of Evidence-Based Social Work (EBSW). According to him, EBSW enhances decision quality, fosters learning of assessment skills, incorporates client values and expectations, makes best use of best evidence and identifies gaps in knowledge. Similarly, Gambrill (2003) argues that EBSW promotes transparency and honesty as it follows a systematic approach for integrating practical, ethical and evidentiary issues. (Muller & Shlonsky 2004). Limitations of evidence-based study Another commendable insight into the practice is provided by Tanenbaum: “Attempts to implement EBP will falter on epistemological and organizational barriers. Still, as a public idea--that more science will bring about better mental health practice--EBP may well serve political purposes, especially in the U.S. public mental health system, where more overtly ideological policies have been inadequate in the past. EBP, as a public idea, has the advantage of ambiguity, accountability, quantifiability, etc.” (Tanenbaum 2003). The main weaknesses of the practice include the notions that it needs much time and resources to develop the skills to carry out these practices, there is not enough evidence about the practices, they reduce the professional judgment, they influence legal proceedings, there is suppression of creativity etc. Two major limitations of the practice are the shortage of reliable evidences and the authority of evidences available: “Evidence users accept evidence that has been vetted by others- thus replacing one authority for another. But what is the basis for the authority of the evidence appraisers?” (Muller & Shlonsky 2004). Thus, even though there are considerable limitations for the evidence- based practice, it is widely applied due to its strengths and practical usage. It is a popular notion that such abuses are widespread in the UK, but, yet there are many mysterious factors behind that make us think that all is not true. We might have come across news items that read, “Two men who sexually abused young boys placed in their foster care have been sent to prison” and many such. (Foster carers jailed over abuse. 2006). However, it does not tell the whole story. For example in early summer 1987, there were many allegations of sexual abuses occurring in Cleveland in the North-East of England. Allegations based on unproven medical diagnosis caused social workers to neglect the importance of foster care there. There had been many negative effects of this false allegations on the parents, children and the social workers the most crucial being “the climate of fear which was created and engendered in the parents of young children by events in Cleveland in 1987, not only in Cleveland but the rest of the UK.” (Pragnell 2002). Conclusion: In order to provide a safe and caring atmosphere for children in residential and foster care, a multi- faceted action plan is required. There should be more scientific researches oriented towards the nature and underlying causes of the issue and subsequent follow up policies and procedures are to be undertaken. It is high time that the issues concerned with sexual abuse under foster care are properly addressed. Evidence-based practices suit the purpose the most. Thus, in conclusion, we are convinced that the evidence-based practice is of major significance in the social work activities in general and in the issue of child sexual abuse in the foster care in the UK in particular. There is no doubt that child sex abuse is a very much planned and calculated act by the offender, and so, such offenders deserve social and judicial punishment. The evidence- based practice deserves prime importance whenever one deals with a problematic and quite confusing issue like the child sexual abuse in foster care in U.K. Bibliography CARL, Dunst J & Cutspec, Patricia A (2002). An Evidence- based approach to documenting the characteristics and consequences of early interventionist practices. Centerscope. V.1, N.2. Last accessed 6 November 2007 at: http://www.researchtopractice.info/centerscopes/centerscope_vol1_no2.pdf Cawson et al., 2000. Child maltreatment in the United Kingdom. A study of the prevalence of child abuse and neglect. Doran, C. & Brannan, C. ed., 1996. Institutional abuse, in Bibby, P. Organized Abuse: the Current Debate. Aldershot: Arena. p. 155-166. Faller, K., 1988. Child Sexual Abuse: An Interdisciplinary Manual for Diagnosis. Case Management and Treatment. Macmillan, Basingstoke. Finkelhor, D. et al., 1988. Nursery Crimes: Sexual Abuse in Day Care. Sage Publications, Newbury Park Foster carers jailed over abuse. (2006). [online]. BBC News. Last accessed 2 November 2007 at: http://news.bbc.co.uk/2/hi/uk_news/england/bradford/5109518.stm. Foster Care vs. Family preservation. (2007). The Track Record on Safety and Well-being. [online]. National Coalition for Child Protection Reform. Last accessed 2 November 2007 at: http://www.nccpr.org/newissues/1.html. FREIT, Marvin D et al. (2004). Journal of Evidence-Based Social Work. V. 1, No.4. Last accessed 6 November 2007 at: http://www.haworthpress.com/store/sampletext/J394.pdf Friday focus: Evidence based research. (2005). [online]. Drug Scope. Last accessed 2 November 2007 at: http://drugscope.blogspot.com/2005/11/friday-focus-evidence-based-research.html Kendrick, Andrew (1998). Abuse of Children in Residential and Foster Care. A Brief Review. University of Dundee. [online]. SIRCC. Last accessed 2 November 2007 at: http://www.sircc.strath.ac.uk/research/kendrick.html Linsday, M., 1997. The Tip of the Iceberg": Sexual Abuse in the Context of Residential Child Care. The Centre for Residential Child Care. Glasgow. McNeece, C.A. & Thyer, B.A (2004). Evidence-Based Practice and Social Work. Journal of Evidence Based Social Work. P.7-25. Last accessed 2 November 2007 at: http://www.haworthpress.com/store/sampletext/J394.pdf. McCollum, Hilary (2005). London Child Protection Committee. Improving Responses to Child Sexual Abuse in London. P. 9. Last accessed 14 December 2007 at: http://www.londonscb.gov.uk/files/meetings/051005-8.%20Child%20Sexual%20Abuse%20-%20Draft%20Report%20Oct%2005.doc MERRICK, Michael V & ALLEN, Betsy (2007). Parenting Children Surviving Sexual Abuse. [online]. Last accessed 2 November 2007 at: http://www.geocities.com/mandy62657/parenting1.html Muller, Edward & Shlonsky, Aron., 2004. The Challenges Facing Evidence- Based Social Work. From Concept to Implementation Pringle, K., 1993. Child Sexual Abuse Perpetrated by Welfare Personnel and the Problem of Men. Critical Social Policy. Vol. 36. p. 4–19. PRAGNELL, Charles (2002). The Cleveland Child Sexual Abuse. An Abuse and Misuse of Professional Power. [online]. Last accessed 2 November 2007 at: http://www.childrenuk.co.uk/choct2002/choct2002/pragnell%20cleveland%20abuse.html Roberts, J., 1986. Fostering the Sexually Abused Child, Adoption and Fostering. 10(1), p. 8-11. Sinclair, J & Jones, M., 1995. Outcome of group treatment for sexually abused adolescent females living in a group home setting. Journal of Interpersonal Violence, 10. p. 533-542. Sheldon, B., 2001. The Validity of Evidence-Based Practice in Social Work: A Reply to Stephen Webb. British Journal of Social Work. p. 801-809. TANENBAUM, S (2003). Evidence-based practice in mental health: practical weaknesses meet political strengths. [online]. NCBI. Last accessed 11 November 2007 at: http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=12787192&cmd=showdetailview&indexed=google Tice, Pamela Paradise et al., 2001. The Real Controversy about Child Sexual Abuse Research. Contradictory Findings and Critical Issues Not Addressed by Rind, Tromovitch, and Bauserman in Their 1998 Outcomes Meta-Analysis. Journal of Child Sexual Abuse. Vol. 9. N.3-4. p.157-82. Trinder, Liz & Reynolds, Shirley., 2000. Description. Evidence-Based Practice: A Critical Appraisal. Blackwell Publishing. Webb, Stephan A., 2001. Some Considerations on the Validity of Evidence-based Practice in Social Work. British Journal of Social Work. Webb, S. A., 2001. Some Considerations on the Validity of Evidence-Based Practice in Social Work. British Journal of Social Work 31. p. 57-79. Read More