Rethinking the roles of families and clients in evidence-based practice

(Photo: Pixabay)

The principles which underpinned our approach to supporting Children and Parenting Support programs to implement evidence-based programs and practice as part of the Children and Families Expert Panel, had a large influence on how I presented evidence-based practice in the workshops we ran.

As mentioned in a previous post about evidence-based practice, evidence-based practice is generally described as a decision-making process that incorporates:

1. The best research evidence
2. The best clinical experience
3. Family and client values. (see Figure 1)

Figure 1: Evidence-based practice (Source: Walsh, Rolls & Williams [1])

When I presented it to the practitioners I made a couple of subtle, but significant changes (see figure 2). The first was fairly minor: “Best clinical experience” became, “Best practitioner wisdom and experience.” This was essentially changing the language to be more relevant to the family services we were working with.

The second change was much more significant. “Consistent with family and client values” become, “Family experience and insights.” This involves quite a different approach to families (or other people we work with). In the second version, families have a much more active role in contributing evidence. Rather than checking that a suggested approach or intervention is consistent with family values, the emphasis is on incorporating the experience and insights of families.

Figure 2: Evidence-based practice (adapted)

Most of my work has been with bottom-up approaches to working with communities. They types of approaches (e.g., asset-based community-driven development) emphasise the importance of being community-led. It is not enough to just ensure our approach is “consistent” with the values of the people we work with, we need to actively involve them in planning and delivery. In suggesting some refinements to Collective Impact, Cabaj and Weaver [2] argue that there needs to be a great emphasis on “inclusive community engagement”.

The idea that those most affected by an issue should participate fully in attempts to address it (aka “Nothing about us without us!”) is a fundamental democratic and moral principle. (p. 5)

Likewise, Barnes and Schmitz [3] suggest that it is important to “view community members as producers of outcomes, not just as recipients of outcomes” (p. 36).

Family centred practice also emphasises valuing the expertise and experience of families. Scope (Victoria) Statewide Specialist Service [4] argue that:

Families are the experts with respect to their child and they can bring a great deal of information to a collaborative relationship with practitioners. It is important for practitioners to recognise this and ensure families have opportunities to share their expertise. (p. 16)

As suggested in the post about evidence-informed practice some approaches to evidence-based practice do place a greater role on the experience and insights of families and clients. For example, Nevo and Slonim-Nevo [5] suggest that:

Research findings should not override, or take precedence over, clinical experience and clients’ wishes, values and knowledge. Rather, empirical evidence is better regarded as one component in the mutual and constantly changing journey of client and practitioner. (p. 1178)

If family and community services are to truly value the experience and expertise of families, we need to update the definitions of evidence-based practice (and its visual representation) to ensure we recognise the important role of families, and their insights and knowledge, in planning and decision-making.

If you liked this post please follow my blog, and you might like to look at:

1. Posts from the expert panel work in evidence-based practice
2. What is evidence-based practice?
3. What is evidence-informed practice?
4. Bottom-up community development
5. What is asset-based community-driven development (ABCD)?
6. What are complex problems?

References

1. Walsh, C., Rolls Reutz, J., & Williams, R. (2015). Selecting and implementing evidence-based practices: A guide for child and family serving systems (2nd ed.). San Diego, CA: California Evidence-Based Clearinghouse for Child Welfare. Available from http://www.cebc4cw.org/files/ImplementationGuide-Apr2015-onlinelinked.pdf
2. Cabaj, M., & Weaver, L. (2016). Collective impact 3.0: An evolving framework for community change: Tamarack Institute. Available from http://cdn2.hubspot.net/hubfs/316071/Events/CCI/2016_CCI_Toronto/CCI_Publications/Collective_Impact_3.0_FINAL_PDF.pdf?t=1472581825369
3. Barnes, M., & Schmitz, P. (2016). cenCommunity Engagement Matters (Now More Than Ever). Stanford Social Innovation Review(Spring), 32-39. Available from https://ssir.org/articles/entry/community_engagement_matters_now_more_than_ever
4. Scope (Victoria) Statewide Specialist Service. (2005). Family-centred practice: an evaluation of an early childhood intervention service. Stronger Families Learning Exchange Bulletin, (7), 15-17. Available from http://content.webarchive.nla.gov.au/gov/wayback/20060820030608/http://aifs.gov.au/sf/pubs/bull7/scope.pdf
5. Nevo, I., & Slonim-Nevo, V. (2011). The Myth of Evidence-Based Practice: Towards Evidence-Informed Practice. British Journal of Social Work, 41(6), 1176-1197. doi: 10.1093/bjsw/bcq149.

7 principles guiding my work

(Photo: Amanda Howard)

When I started facilitating workshops on evidence-based programs and practice as part of the Children and Families Expert Panel, I wanted to ensure that my approach was consistent with my commitment to strengths-based approaches and bottom-up community development. In planning the work I wrote some principles which would underpin our (the Family Action Centre) approach. While specific to the Expert Panel work, they are useful summary of my approach.

What is evidence-informed practice?

Some authors appear to use evidence-based practice and evidence-informed practice interchangeably [e.g., 1] but other authors identify significant difference [2-5]. The main difference is in the approach to evidence. Webber & Carr [4] suggest that, in evidence-informed practice:

Evidence is conceptualised as a more inclusive and non-hierarchical notion than proponents of evidence-based practice understand it. It equally values practice wisdom, tacit knowledge and all forms of knowing. It is thereby viewed as integrative, viewing practice and research less in opposition but more in support of one another. In particular, evidence-informed practice respects the role of practice research. (p. 19)

What are evidence-based programs?

(Created with Wordle)

While evidence-based practice is a decision-making process that incorporates the best research evidence, the best clinical experience and family and client values; evidence-based programs are programs that have been standardised, systematised and rigorously evaluated.

According to Williams-Taylor [1], evidence-based practice is an

Approach, framework, collection of ideas or concepts, adopted principles and strategies supported by research. (p.4)

Evidence-based programs, on the other hand, are:

Programs comprised of a set of coordinated services/activities that demonstrate effectiveness based on research. Criteria for rating as such depend upon organization or agency doing the rankings. [Evidence-based programs] may incorporate a number of evidence-based practices in the delivery of services. [1, p.4]

What is evidence-based practice?

(Created with Wordle)

Although there is no universally accepted definition of evidence-based practice in social work and family work [1, 2], it is generally described as a decision-making process that incorporates:

1. The best research evidence
2. The best clinical experience
3. Family and client values [2-7]. (see Figure 1)

The Fair Share Festival

One of the inspirations for the Tiny House (Photo: Alicia Fox)

The latest Transition Newcastle newsletter received the biggest response we’ve ever had. As part of the Fair Share Festival in November, Jasmine and Larni (both in year 10) are going to construct a tiny house out of second-hand and waste materials. We’ve had so many offers of materials and other support.

In a way, the tiny house exemplifies the focus of this year’s festival: the environmental and social impacts of over-consumption and waste in our society, and how we can make a difference.

Timed to coincide with National Recycling Week, the third Fair Share Festival will be a weekend of inspiration, education, community building, creative actions and entertainment. The festival includes:

6 characteristics of an urban village

Urban design plays a vital role in community building and promoting horizontal community engagement. This video and an associated report, New London Villages: Creating community, (Scanlon, Sagor, Whitehead and Mossa, 2016) explore the concept of villages within the city of London.

In it they identify six characteristics which might define a village within a larger city:

Keeping contact with students in online teaching

I’ve recently started emailing students more frequently in the online elective on community engagement I teach at the University of Newcastle. The students come from a wide variety of disciplines: since it started in 2008 there have been 1389 students from 59 different degrees. Because there is such a range of students, community engagement is not always their main interest or priority.  For some students, community engagement is clearly relevant to their broader degree, but for others, the direct relevance is not always as clear.

In addition, some students select the elective because they are on placement and they appreciate the online nature of the study. All this means that it can be fairly hard to engage some students. For example, I’ve tried some optional online tutes which have only attracted 1 or 2 students out of a possible 80 or more students.

This semester I’ve been much more conscious about trying to build connections with students. In particular I’ve been emailing students to try to combat the impersonal nature of much online study.

Connecting Communities Conference

I’m looking forward to speaking next month at the Connecting Communities Conference organised by the Local Community Services Association (LCSA).

The title of my talk is “Community development in a world of evidence-based practice” and this is what I’ve said in the abstract:

The Targeted Earlier Intervention Program Reform argues there is a need for a service system that is, amongst other things, “Evidence based – grounded in what we know works and building on that knowledge”. What does an increasing emphasis on evidence-based programs and practice mean for community development practitioners? How can we understand evidence-based programs and practice in a way that is consistent with community-led approaches to community development? What skills will we need to flourish (as communities and services) in a world of evidence-based practice?

Seven principles for a strengths-based approach to working with groups

There is surprisingly little literature on strengths-based approaches to group work. Most of the available literature focuses on groups as part of a broader strengths-based approach to a particularly issue or target group, rather than a strengths-based approach to actually working with groups.

The following are seven principles that underpin my strengths-based approach to group work.