Producing Your Own Evidence for Evidence-Based Practice

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Producing Your Own Evidencefor Evidence-Based PracticeShinaz G. Jindani PhD a & Claudia P. Newman MSW ba Savannah State University , 418 East 56th Street,Savannah, GA, 31404, USAb Savannah State University , P.O. Box 13462,Savannah, GA, 31416-0462, USAPublished online: 03 Oct 2008.

To cite this article: Shinaz G. Jindani PhD & Claudia P. Newman MSW (2006) ProducingYour Own Evidence for Evidence-Based Practice, Journal of Evidence-Based SocialWork, 3:3-4, 115-125, DOI: 10.1300/J394v03n03_09

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Producing Your Own Evidencefor Evidence-Based Practice

Shinaz G. Jindani, PhDClaudia P. Newman, MSW

SUMMARY. For most social workers it is no longer possible to delaytechnological proficiency (Abell & Galinsky, 2002). In order to use evi-dence, one must constantly produce evidence throughout practice; everyday and where applicable in most helping situations. Computer AssistedTechnology (CAT) is one of the tools a social worker can use to producehis/her own evidence which can be used to maximize practice efficacy.Further combined with clinical observations, it can be used to preventmaking false case conclusions. Practitioners are encouraged to use CATto produce evidence which leads to more informed and judicious prac-tice. doi:10.1300/J394v03n03_09 [Article copies available for a fee from TheHaworth Document Delivery Service: 1-800-HAWORTH. E-mail address:<[email protected]> Website: <http://www.HaworthPress.com>© 2006 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Computer Assisted Technology, evidence-based prac-tice, single subject design, social work education

Shinaz G. Jindani is Associate Professor, Savannah State University, 418 East 56thStreet, Savannah GA 31404 (E-mail: [email protected]).

Claudia P. Newman is affiliated with Savannah State University, P.O. Box13462, Savannah GA 31416-0462 (E-mail: [email protected]) or (E-mail:[email protected]).

[Haworth co-indexing entry note]: “Producing Your Own Evidence for Evidence-Based Practice.”Jindani, Shinaz G., and Claudia P. Newman. Co-published simultaneously in Journal of Evidence-Based So-cial Work (The Haworth Press, Inc.) Vol. 3, No. 3/4, 2006, pp. 115-125; and: Information Technology andEvidence-Based Social Work Practice (ed: Judith M. Dunlop, and Michael J. Holosko) The Haworth Press,Inc., 2006, pp. 115-125. Single or multiple copies of this article are available for a fee from The HaworthDocument Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address:[email protected]].

Available online at http://jebsw.haworthpress.com© 2006 by The Haworth Press, Inc. All rights reserved.

doi:10.1300/J394v03n03_09 115

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INTRODUCTION

The use of Computer Assisted Technology (CAT) is not new to thesocial work profession. For most social workers it is no longer possi-ble to delay technological proficiency (Abell & Galinsky, 2002).Technology is routinely used by clinicians (Gripton & Licker, 1986),non-managerial social workers (Lohmann & Wolvovsky, 1979) andsocial work administrators (NASW, 1988). Social work education andtraining has a prime responsibility to prepare social workers who arenot only technologically proficient but also who are able to integrate itwith day-to-day practice. As such, they are able to produce their ownevidence for practice and take “appropriate action guided by evi-dence” (Gibbs, 2003, p. 6). Some of this is spurred by the need to pro-duce and use outcome data (NASW, 1998). Thus, teaching practicealong with CAT may enable social workers to measure their very ownpractice effectiveness in a timely manner.

Timely means using evidence at the most opportune moment suchthat it may enhance the helping process. It is a prerequisite that one musthave evidence in order to render more informed practice decisions and,more importantly, to use evidence at the most opportune moment. CATis one of the tools a social worker can use to produce his/her own evi-dence. CAT also complements the validity of the evidence gathered,when used appropriately.

CAT and Social Work Educators

Social work educators can use CAT to teach practice technology aspart of a curriculum to inform students’ practice and measurement of out-comes. According to the Council on Social Work Education (CSWE),“developing and applying instructional and practice-relevant technol-ogy” (CSWE, 2003, pg. 32) is one of the means to achieve the purpose ofsocial work education. For example, an accredited four-semester full-time MSW program at Savannah State University integrates such tech-nology in preparing MSW graduates. The first research methods course,offered during the first semester, teaches SPSS and the second researchmethods course, offered in third semester, teaches SINGWIN (Bloom,Fischer & Orme, 2003). The second course primarily includes single sub-ject design and program evaluation methodology. SINGWIN aids singlesubject design, is simple to use and produces graphs that can readily beused for helping processes.

116 INFORMATION TECHNOLOGY AND EVIDENCE-BASED SOCIAL WORK PRACTICE

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As part of their single subject design education, students, in consulta-tion with their Field Instructor, select a client and evaluate their prac-tice. Ethical practice is promoted as students are required to obtain“informed consent” from clients and a written permission from theirField Instructor. Students review evidence and select practice method-ology related to social work theory and within the ethical tenets of theprofession. They are required to review and consider published evi-dence and standardized scales and are also encouraged to customizetheir own measurement apparatus that considers both clients’ needs andtreatment goals.

Students must not only design their own apparatus but also conceptu-alize minimum and maximum possible points and define desired andundesired zones. This enables them to conduct an appraisal of the gen-eral tendency of scores; assessing whether such movement [is or is not]toward desired targets, goals and/or outcomes.

Students are required to log their data on a regular basis in SINGWINand conduct daily/weekly visual inspection of scores to determine if theclient is moving toward desired objectives. They are encouraged to usethis data to inform practice which may lead them to change and/or mod-ify treatment techniques, outcome measures and/or their research de-signs. The use of CAT makes it possible to “produce evidence as you goalong, and use it as you go along.” Thus they demonstrate an integrationof social work theory, ethics, field experience and technology. At the fi-nal stage of this process, students conduct statistical analyses to deter-mine if the helping process made a significant difference in a client’slife through the achievement of treatment goals. They interpret thesefindings, along with their qualitative notes, and try to ascertain if there isevidence of practice effectiveness.

CAT, however, cannot stand alone as a singular learning tool. It hasto be integrated throughout the overall curriculum and articulated inmission statements, program objectives and also curriculum outcomemeasures. All courses offered should demand some level of technologi-cal skills mastery such as library research, use of Internet and e-mail.This course uses a core text that includes SINGWIN. Students are toload this program “independently” on their home computers and use itfor the single subject design methods as needed. SINGWIN is demon-strated twice during the semester. Students may seek additional help if itis needed and they also have access to campus computers. At the end ofthe semester, students must submit a paper, write a research brief andpresent this brief which must include graphs from SINGWIN.

Section II: Educational Implications 117

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CAT and Social Work Practitioners

In order to demonstrate the integration of CAT, theory, practice andoutcome measures, an actual case study is presented here. It is not pre-sented in its entirety; only relevant aspects of this case are given to dem-onstrate the learning integration component.

CASE STUDY

A social work student was placed in a newly-renovated affordable 88apartment housing facility that employed a full-time social worker(field instructor) and provided social services. Ms. B. is a 44-year-oldsingle mother of two sons aged six and seven. She expressed her con-cern and urgency in securing a two-bedroom apartment to accommo-date her immediate family needs. At the time of the initial application,she was a tenant in a dilapidated, overpriced, and pest-infested housingunit where living conditions had adversely affected her overall physicalhealth. Ms. B. discussed concerns about the possibility of her childrenbeing bitten by [noticeable rats] in the apartment at night. She had onemonth left on her rental agreement and was presently receiving housingassistance.

Within two weeks, Ms. B. came to the office walking with the assis-tance of a cane. She was in great pain and reported an accident. Whileusing the bathroom, the ceiling collapsed and injured her back and a leg.This particular incident aggravated a previous injury that she sustainedin an automobile accident. It was imperative that Ms. B. secure ade-quate housing immediately.

The MSW student social worker assigned to the case used a systemsframework to conduct the assessment and, in partnership with Ms. B.,prepared treatment goals and obtained informed consent. Ms. B. was re-ferred to a local agency for disability services. The student initiated theprocess of seeking an apartment at the new facility. The assessmentnoted several factors such as lack of education, single parenthood andself-esteem issues. It was stated, “Lack of housing (independent vari-able) is associated with high level of anxiety (dependent variable).” Af-ter the client’s consent and an approval from the Field Instructor, thestudent proposed A-B single subject research design and developedanxiety and self-esteem scales. Students are encouraged to develop anduse more than one measure since multiple measures increase confi-dence and provide an idea about the validity of measures by examining


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interrelationships among different measures (Bloom, Fischer & Orme,2003, p. 318). Anxiety and self-esteem scales were designed with 10items in each and were measured on a five-point Likert scale, where 1 =“None of the time” and 5 = “All of the time.” It included items such as “Ifeel overwhelmed” for the anxiety scale and “I feel that I need moreself-confidence” for the self-esteem scale. The student’s footnotestated, “questions extracted from: Walter W. Hudson & Neil Abell,Copyright 1992.”

The student used maximum possible data points (Ma = 50), mini-mum possible data points (Mi = 10) and a cutting point of (Cu = 30) thatidentified desired and undesired zones. Students are expected to usetheir knowledge of evidence-based practice, consider standardizedscales and use conventional wisdom to chart a line that identified de-sired zones. For the anxiety scale, lower than 30 was the desired zone.For the self-esteem scale, higher than 30 was the desired zone. Initiallyfour baseline data points were gathered and entered in SINGWIN whichproduced instant graphs (Figure 1 & Figure 4). The graphs presented inthese figures are celeration line graphs that “describe a trend line withinand across phases” (Bloom, Fischer & Orme, 2003, p. 580). Based onbaseline data, a celeration line indicates how the scores are likely toprogress without intervention. Visual inspection of the graphs showsthat, for both scales, scores belonged in “Undesired Zone,” i.e., above30 for the anxiety scale and below 30 for the self-esteem scale and werelikely to be in that direction without any intervention. See Figures 1through 6.

It took a full four weeks to provide Ms. B. with housing and to com-plete the move to a newly built apartment. During this time disabilityservices also took effect. The student expected a drop in anxiety scoresand an increase in self-esteem scores. Using the principle of “produce itas you go along, use it as you go along,” the student applied visual in-spections to the graph (Figure 1, scores 5-7 & Figure 4, scores 5-7) gen-erated by SINGWIN and was surprised. The findings from SINGWINcontradicted the observation notes of the student. The mood of Ms. B.appeared uplifted. She displayed more buoyancy. But the scores pre-sented no noticeable change on both scales. If it were not for the mea-sures and CAT (SINGWIN), the likelihood of making a false caseconclusion based on simple observation was greater.

Prompted by the visual inspection of the graph, the student probed fur-ther. With a new home came new sources of anxiety, specifically: (1) ad-justments to the new responsibilities of the home and (2) adherence to thenew standards of the residential facility. These changes challenged Ms.


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40

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Intervention

FIGURE 1. Baseline Scores for Anxiety Scale (Range 0-50), (N = 1)

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FIGURE 2. The AB Design: Anxiety Scale (Range 0-50), (N = 1)

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FIGURE 3. The ABC Design: Anxiety Scale (N = 1)Dow

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30

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FIGURE 4. Baseline Scores for the Self-Esteem Scale (Range 0-50), (N = 1)

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FIGURE 5. AB Design for the Self-Esteem Scale (Range 0-50), (N = 1)

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FIGURE 6. ABC Design for the Self-Esteem Scale (N = 1)

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B.’s levels of self-esteem. A critical underlying concern also surfacedabout the distance she walked to keep her children in their former school.The additional walking exacerbated her pain.

Given the discovery of the new information and additional data, thestudent provided another service package for Ms. B. This changed theresearch design from AB to ABC. Ms. B. did access community link-ages, sought school rides and an after-school tutorial program. Visualinspection of the graphs (Figure 1 and Figure 6) showed some move-ment toward desired zones (scores 8-12) but was this change largeenough to believe that treatment goals were achieved? In order to ex-plore this, statistical analyses were applied to both data sets.

First for each phase, for each scale, data was tested for serial inde-pendency and auto-correlation (rF2) was applied (Bloom, Fischer &Orme, 2003, p. 533). Data was not auto-correlated. Then the data wastested for normal distribution and it was ascertained that mean, modeand median values were about the same (Bloom, Fischer & Orme, 2003,p. 610). Once these assumptions were met, a T-test was applied. Since Thandles unequal n’s well, scores were divided into two groups, Baselinescores, 1-4 and Intervention scores, 5-12. Here the T-test showed signif-icance (Table 1 and Table 2). This meant that the size of the differencebetween two phases was large enough for us to believe that treatmentgoals were achieved. The higher intervention mean on the self-esteemscale (29.25) as compared with (25.00) and the lower intervention meanon the anxiety scale (35.88) as compared with (38.5) signified thatmovement was also in the desired direction.

Readers may note that in cases where auto-correlation is significantand/or the data is not normally distributed, other statistical tests areavailable (Bloom, Fischer & Orme, 2003).

PROCESS OF LIFE-LONG LEARNING

The following model (Figure 7) shows a process by which evidence-based practice and CAT merge to enhance life-long learning. A socialwork practitioner (SWP) brings his/her expertise and wisdom to a help-ing situation. One of the prerequisites for the lifelong learner is to havean ability to learn to ask the right questions. In turn, this leads to an un-derstanding of clients’ needs and evolves into treatment goals.

Given this, a practitioner searches for the so-called “Best Evidence” andextracts the “Best Evidence” to carefully select interventions and measuresto inform their practice. The social work practitioner may use CAT to ob-


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tain immediate feedback and in turn use the evidence for benefit of the cli-ent. Initially, this feedback is used to change, modify or reinforce inter-vention. At the end of the process, it is hoped that the client will benefit andso will the practitioner. This process enables a practitioner to function at anethical, more informed level.

The process of life-long learning is well established in the social work pro-fession, but it is now understood as a driving force in some developing nations.

the triumph of pragmatism and professional expertise over ideology isnow an accepted wisdom in the realm of education. A lifelong and neces-sary experience, education is, by common consensus, a powerful drivingforce in any strategy for national development. (Aga Khan, 2004)

CONCLUSION

This article showed how Computer Assisted Technology (CAT) canbe a valuable asset for students in learning how technology can assist


FIGURE 7. A Model for a Process of Life-Long Learning

Practitioners Expertise, Education and WisdomPrerequisite: Ability to ask right questions

⇓Client’s Needs and Treatment Goals are identified

⇓An Objective Search for Current Best Evidence

⇓Extract Best Practice based on Evidence

⇓Plan to Produce Your Own Evidence of Best Practice

⇓Link Treatment Goals, Outcome Measures and CAT

⇓Use Outcome Measures along with CAT to

Obtain Evidence of your Practice⇓

Use Feedback to Change, Modify or Continue Practice⇓

Integrate Evidence, Outcome Measures and CAT in evidence-basedsocial work practice

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their practice. Along with traditional observation, [as indicated herein],its use can prevent a false case conclusion. It can also provide evidenceof practice effectiveness or ineffectiveness and can be used to benefitclients. Social work educators must systematically use CAT to teach ev-idence-based social work practice. CAT cannot stand alone and, there-fore, must be integrated throughout the curriculum. Social work prac-titioners must use CAT to produce their very own evidence of practiceeffectiveness and use it as they go along practicing in partnership withtheir clients.


TABLE 1. Anxiety Scale Scores (N = 1)

Statistics

Autocorrelation; Baseline scores, 1-4 RF2 = �1.33, TF2 = 1.42, M = 38.50,DF = 9, p = 01.42

Autocorrelation; Intervention scores, 5-7 RF2 = 0.87, TF2 = 0.88, M = 36.44, DF = 8,p = 0.42

Autocorrelation; Intervention scores, 8-12 RF2 = 0.01, TF2 = 0.08, M = 36.60,DF = 10, p = 0.30

T test

Equal Variances, T value = 3.206Unequal Variances T value = 4.232

DF = 10 p = 0.009 SignificantDF = 9.4 p = 0.002 Significant

TABLE 2. Self-Esteem Scale Scores (N = 1)

Statistics

Autocorrelation; Baseline scores, 1-4 RF2 = 0.00, TF2 = 0.83, M = 25, DF = 9,P = 0.42

Autocorrelation; Intervention scores, 5-7 RF2 = 1.75, TF2 = 0.59, M = 26.67, DF = 8,P = 0.56

Autocorrelation; Intervention scores, 8-12 RF2 = 1.71, TF2 = 0.18, M = 30.80,DF = 10, P = 0.85

T test

Equal Variances T value = �2.894 DF = 10 p = .016 SignificantUnequal Variances T value = �3.743 DF = 9.7 p = 0.004 Significant

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REFERENCES

Abell, M.L., & Galinsky, M.J. (2002). Introducing students to computer-based groupwork practice. Journal of Social Work Education, 38(1), 39-54.

Bloom, M., Fischer, J., & Orme, J.G. (2003). Evaluating Practice. Guidelines for theAccountable Professional (4th Ed.). New York, NY: Allyn & Bacon/Pearson Edu-cation Inc.

Council on Social Work Education (2003). Handbook of Accreditation Standards andProcedures (5th Ed.). Alexandria, VA: author.

Gibbs, L.E. (2003). Evidence-Based Practice for the Helping Profession. A PracticalGuide with Integrated Multimedia. Stamford, CT: Thomson/Brooks-Cole.

Gripton, J., & Licker, P. (1986). Applying computers to clinical social work. Journal ofSociology and Social Welfare, 13(1), 27-55.

Khan, A. (2004). Speech at the Foundation Ceremony of the Aga Khan Academy,Maputo. Matola, Mozambique. Retrieved December 2, 2004 from http://www.iis.ac.uk/learning/speeches_ak4/2004c.htm

Lohmann, R.A., & Wolvovsky, J. (1979). Native language processing and computeruse in social work. Administration in Social Work, 3(4), 409-422.

National Association of Social Workers (1998). Focus on electronic data sharpens.NASW News. Washington, DC: NASW Press.

doi:10.1300/J394v03n03_09


Practitioner/Provider Questions

1. Do you want to produce your own evidence, so that you can use it as you goalong?

2. Do you believe in Computer Assisted Technology? If yes, you are set on tothe path of becoming life-long learner.

3. Do you believe higher education has a responsibility to produce life-longlearners?

Consumer/Client Questions

1. Would you like to view technology generated graphs showing us your ownscores?

2. How has your practitioner/provider asked questions of practical importance toguide you through this helping process?

3. Has your practitioner told you that she/he is using evidence in guiding you to-ward your counseling goals?

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Documents

Producing Your Own Evidence for Evidence-Based Practice