Evidence Based Practice in Contemporary Social Work Practice

Candidate number: 164107

Student number: 09212536

Using an example, or examples, with which you are particularly familiar, critically discuss the following: Social work is now catching up with its EBP but some still disagree about its value in social work practice- Arthur Gwagwa In critically discussing the above hypothesis, this essay evaluates cross-cultural and cross disciplinary literature with a particular emphasis on social work, whilst specific examples are drawn from statutory adult mental health. In the course of the discussion, the emergence of EBP in medicine from North America and its tentative reception into social work in the late nineties is critically discussed. Its subsequent watersheds are evaluated and chronicled. Particular emphasis is paid to its cross-jurisdictional uneven and asymmetrical growth as well as its adoption and adaptation to local cultural conditions. The sceptism, methodological tensions, conceptual issues, barriers and promoters that have been on its route are critically examined. Attention is also given to the extent to which it has diffused into both cross cultural social work policy and practice. Through a critical evaluation of reviewed literature, this essay aims both to establish a consensual academic baseline, and examine the points of and reasons for dissension whilst at the same time heralding tentative cross-cultural future trends. To that end much reliance is put on the leading works in this area as fully set out in the appended annotated bibliography. The essay concludes that although reviewed literature advance different views of EBP, taken together, they all provide a balanced baseline that EBP is currently in inception stage in social work practice. Whilst the social work task force report (DOH, 2009) provides a political and policy contextual framework within which EBP could sit and take strength, it is too early to express optimism. However, the fact that EBP has been adopted at policy level will fundamentally affect practice (Gray et al, 2009). It should be debated further rather than prematurely dismissed because its potential benefits outweigh objections to it (Gibbs & Gambrill, 2002).

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Candidate number: 164107

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From reviewed literature it is apparent that EBP is currently being used to shape policies mainly by western governments especially in light of the current competitive economic climate (Gray et al, 2009). For example, Stanhope & Solomon (2008) highlight how scientific approaches have been driving the benchmarking and modernisation of public services in the UK and the Mental Health reform in the USA. Despite some misgivings about it, EBP is part of a wider movement to generate uniformity and quality control by streamlining processes in major world economies and appears to be sitting well with the current UK welfare to workfare agenda (Webber, 2008). EBP was coined in North America as a methodological program with epistemological roots in medicine in the early nineties as a way of ensuring that the medical profession explicitly, judiciously and conscientiously apply the best evidence in treatment decisions (Sackett et al, 1997). It began to permeate the social work arena at the turn of the century although it is still in its infancy in practice where it is still a contested concept and methodology with regards to its content and parameters. Therefore it still needs a greater degree of clarity and coherence for its probative value in social work to be fully evaluated (Gray et al, 2009; Rubin & Parish, 2007). Its proponents currently hold divergent views both at epistemological and methodological levels. For example, Gray, Plath & Webb in Gray et al (2009) take a broader view of it that involves the mobilisation of a broader international research infrastructure, wider than Sackett’s original EBM definition and Rubin’s intervention perspective. However they also point out to Gambrill’s liberal approach as well as Thyer, Sheldon and Lipsey’s positivist approach. Plath (2006) seeks to reconcile the seemingly irreconcilable EBP and critical reflection methodologies by advocating for a combination of the positivist and interpretive paradigms, a view which she appears to defend

with much verve in her

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Candidate number: 164107

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subsequent work with Gray and Webb (Gray et al 2009). On the other hand, Gibbs (2001) advocates for an approach to EBP in social work that is socially constructed and value- laden. It could be argued that these divergent conceptualisations are mirrored at a micro-level in mental health social work where according to Roberts & Wolfson (2004) EBP has traditionally taken the positivist EBM approach especially in the USA where the Bush administration embraced scientific research (Fresse, 2001) and equally by the Obama administration through an investment of $650m in evidence-based projects under the Recovery and Reinvestment Act, 2009 (Recovery.Gov, 2009). The positivistic scientific approach is being challenged by social workers who are increasingly advocating for recovery-based principles which most psychiatrists are sceptical of. The stance of equating EBP with EBM in these settings has mainly been caused by the equation by others of empiricism as the only way of knowing (Gray et al, 2009; Van de Luitgaarden, 2009). This is more so in these medically-managed teams where social work exists at the behest of medicine (Wilson, 2008). This heuristic empiricism is struggling to lend itself properly in social work due to a competing interpretive paradigm in understanding human social life that is more amenable to ethnographic research designs and naturalistic critical reflection in social work decision-making (Gould, 2006; Van de Luitgaarden, 2009). In response to the narrow scientific conceptualisation, there are now more competing methodologies and theoretical standpoints informing evidence based social work, viz, the pragmatic, political and the post-modern approaches (Gray et al, 2009).

However, whilst

these are laudable, social workers are still struggling to articulate what EBP is. Further, Gray et al (2009) points out that this shift from the purist positivist EBP is being criticised by some as a cowardly retreat from critical approach and an erosion of evidentiary standards that would give rise to authoritative and managerialism-driven practice. However Gray, Plath and 3

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Webb quickly allay this concern by stating that evidence from randomised controlled trials (RCTs) can also be manipulated to support preferred practices whilst on other hand it can also be used in an ethical and critically reflective way. A close examination of latest academic developments reveals a significant body of literature, even within medical psychiatry calling for caution in over relying on RCTs, meta-analysis and systematic reviews. In social work, RCTs, for example, do not capture the views of those with lived experiences of mental distress thereby clashing with the social work value of service user participation (Gould, 2006). Further, Lynch et al (2010) questions the reliability of most systematic reviews in CBT on the basis of bias since they lacked ‘blinding’ therefore it is argued that Sheldon and Macdonald’s (2009) fidelity to empiricism is out of sync with the emerging critical realism . This departure from the positivist empirical paradigm which was articulated by Plath (2006) in social work generally has resonance in mental health social work as demonstrated in the works of Stanhope and Solomon (2008) and Gould (2006). However, it is apparent that their views are just but a portrait of what they would like to see in social work rather than the obtaining reality in practice. Although, it could be argued that the increasing reliance on the bio psychosocial model in mental health teams is heralding an ideological and methodological compromise, most academics, for example, Bellamy (2006), are calling for a clear migration from the current theoretical and ideological debates to effective research dissemination to all relevant stakeholders and full inclusion of EBP in social work qualifying courses. However, it might be argued that a compromise at epistemological level is a conditio sin qua non for a methodological compromise. For example, the empiricists might need to acknowledge the pathoplastic effects of socio-cultutal factors in mental illness (Jilek, 2001).

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This compromise with this social constructivistic approach is essential to strike a ‘critical realism’ middle ground (Rogers & Lewis, 2007) However, despite the murky and contested course it has taken so far, EBP’s influence has been increasing in social work in the past few years in response to an increased call for social work to articulate its evidence base. Although it’s a new phenomenon to social work, the use of research is as old as the profession itself (Gibbons, 2001; Corcoran, 2007). There has been an increased pressure by policy-makers who require practitioners and researchers to identify and demonstrate evidence-based strategies even in spite of the complexity associated with identifying best evidence (Gray, 2009). A further complication in its full inception into social work is that currently there isn’t enough research evidence in social work to prove conclusively that social work would effectively benefit from the implementation of EBP (Thyer & Kazi, 2004). In addition, in the UK, the requirement to rely on EBP does not sit well with others who see the EBP movement as emanating from government efforts to standardize and bureaucratise social services by reducing complicated human processes to routinised technical functions (Webb, 2001:74). The academic base line from evaluated literature, e.g., Gray (2009) Gambrill (2003); Mullen & Streiner, (2004) Van de Luitgaarden (2009) Rubin & Parish (2007) is that EBP sceptics view it as detrimental to social work core methodologies and values thus contributing to the ambivalence towards its uptake. Mullen & Streiner’s (2004) pilot study found out that EBP sceptics disagree that it has any value in social work and raise different basis to rationalise their views which include; suspicion of researchers & EBP, basic distrust for evidence, objections related to political, ethical, or control issues, that it is politically motivated, is guided by efficiency, researcher preferences, or simply a cost-cutting tool (something other than client’s best interest), devalues the practitioner’s professional 5

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judgment or clients preferences, it’s just a latest fad, more about research reputations, and malleable evidence. These views are confirmed by Gibbs & Gambrill (2002) whilst Dulcan (2005) cited in Rubin & Parrish (2007) points out that the reluctance to use EBP is due its unfeasibility and time-consumption. Whilst some are not sceptical about EBP per se, they are sceptical about the genre of EBP that is being propagated. For example, Webb (2006), in an apparent attack to positivists such as Sheldon, warns that due its risky and varied nature, social work is not amenable to figures, statistics and narrow scientific conceptualisation which is making it a closed rather than an open system. However, Sheldon and Macdonald (2009) find Webb’s ideas unnecessarily distractive to their positivistic quest and in the process, are very clear about their opposition to a social work evidence-base being shaped by sociology. Webb and Sheldon’s diametrically opposed ideologies potentially hinder EBP’s co-option into social work although it could be argued that if constructively harnessed, such differences may be beneficial to EBP in the long run. Further, the slow progress in the realisation of EBP in social work has also partly been caused by social workers’ low enthusiasm in research and in the delay in disseminating and implementing research findings (Gray et al, 2009; Bellamy et al, 2006). Since EBP in social work can best be seen as an emerging actor network which is resource –intensive, this can give a misleading impression that EBP has a wider reach on social work practice than it actually has (Gray et al, 2009). Based on reviewed literature, additional barriers to the implementation of EBP into social work chiefly include: lack of knowledge & skills, lack of knowledge fit to agency practice, suspicion of researchers & EBP, limited resources (Mullen et al, 2004). Despite these barriers, Mullen et al (2004) and Mullen et al (2008) and Rosen & Proctor (2008) reported the following implementation strategies although the extent of their 6

Candidate number: 164107

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usage is not certain; teaching professionals to be evidence-based, tool kits/application kits/manuals/guidelines/combining evidence & consensus, combine focus on practitioner training & organizational development, interactive staff training, outcomes & objectives orientation, objectives-focused multilevel strategy and Roberts-DeGennaro (2010) suggests encouraging students to be life-time leaners by inquiry. Despite these strategies, there is still a conundrum regarding how to define EBP and whether a top-down or a bottom-up approach should be adopted in its implementation (Rubin & Parrish, 2007). To the extent that it’s viewed unfavourably by some, existing efforts to promote it may be insufficient, and new strategies to change those views may need to be developed (Rubin & Parrish, 2007). The current government’s eschewal of real debate on EBP is equally very concerning (Sheldon & Macdonald, 2009). The literature from health care suggests that disseminating information alone is insufficient since interventions that have been designed to improve practitioners’ adherence to EBP guidelines are differentially effective. To date, no intervention has demonstrated powerful effects. Gira, Kessler & Poertner (2004) speculate that multiple strategies are needed rather than relying on any single intervention. As a way forward, Huxley (2002) proposes a reduction in dissemination of low-quality research and incentivizing good-quality research which meets agreed kite mark standards whilst Bellamy (2006); Corcoran (2007) Sheldon (2006) suggest introducing it in qualifying courses and improvement in infrastructure through increased funding. As identified by Manuel (2009) and Frese (2001), whilst EBP barriers and promoters tend fall into broad human and institutional, organisational and governmental cross-cultural typologies, it is argued that a close examination demonstrates cultural variations that will be examined now. For example, in the USA, the federal government’s integration of recovery 7

Candidate number: 164107

Student number: 09212536

into mental health service reform is seen as a potential promoting factor in broadening the concept of EBP in mental health social work. There is a call for researchers to respond to this new mandate for providers by identifying the human processes within services that create these recovery-oriented relationships in order to effectively reconcile EBP with recovery. Despite having at least six identified evidence-based mental health interventions, their positivist scientific roots may not sit well with value –laden principles and human processes that underpin the recovery model that can best be captured through qualitative methods of evidence-gathering (Stanhope &Solomon, 2008). In contrast to an exclusive reliance on positivism, Canada has since adopted Upshur’s (2003) non-hierarchical model of evidence for health care services since they believe all models contribute equally to an understanding of health care. In adopting this stance, the Canadians realised the need for mental health social work to draw knowledge from a wider epistemological terrain including epidemiology in setting up its own evidence base (Gould, 2006). Whilst reviewed literature, particularly Gray et al (2009) concludes that EBP has become institutionalized throughout the USA social services, as ever stronger infrastructure is developed to support it, it remains weak in social work practice and that could be the reason why Pomeroy (2010) in apparent reference to EBP and Recovery suggests that the passage of the Health Care Bill should encourage the American research community to work closely with practitioners in coming up with projects that can be shown to benefit clients. Gray et al (2009) examined diffusion of EBP into social work in the UK and concluded that it could best be understood as a network of actors whereby systems and networks legitimate the research programme. Rather than following a sequential order, it is rather situational and the way it shapes is partly determined locally which shows that EBP in social work requires more than practitioners using evidence but must be backed up by an infrastructural system

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Candidate number: 164107

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and human actors who network, negotiate compromise and account to each other. The process of adoption consequently leads to adaptation. (Appendix,20). The practitioner’s decision at the ‘coalface’ is the net effect of the articulation of evidence-based networks. In the same work, Gray and her colleagues aver that despite SCIE and others actors’ efforts, it is evident from social work systematic reviews that they tend to reach uncertain conclusions without specific guidance on effective interventions. Further, only a few outcome evaluations in social work have been carried out. More so, as a methodology, a systematic review does not appropriately capture all the complex social problems and the technology is mainly interested in standardizing practices. There are also significant problems with search criteria and definitional issues, which lead to flawed knowledge review conclusions. To obtain a full picture on how social work is catching up with its EBP, a number of research studies were carried out internationally and locally and although these had a number of methodological difficulties, interviewees unremittingly embraced EBP. Chivers in 2000 and Sheldon 2005 cited in Sheldon and Macdonald (2009) reported on a study carried out in the South West of England and their findings are a clear testament of social workers’ enthusiasm about evidence-based social work, although there are concerns about the lack of understanding of research and how to appraise it. The New York Best pilot study (Manuel et al, 2009) gave invaluable lessons on the need for a multilevel approach to EBP implementation, but was limited on the basis of a small and non -representative sample. The RURU project in Scotland has shed light on the need for a cross-sector analysis of EBP, but raises concerns about the slow progress of EBP uptake (Nutley, 2009). In addition, Rubin & Parrish’s (2007) survey on attitude towards EBP in the MSC programme showed a favourable response but had instrumental methodological limitations. The issue of methodological limitations is not unique to social work but also affects psychology mainly in

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Candidate number: 164107

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the form a failure to moderate reviews through blinding and utilisation of control intervention (Lynch et al, 2010). Since EBP becomes evidence based social work at the point that it materialises, is performed and made durable in a more or less fixed set of locations within social work (Gray et al, 2009), looking at how it has specifically affected mental health social work might be illustrative of how far EBP has diffused in to social work practice. At policy level, community mental health social workers typically work in multi-disciplinary teams alongside healthcare professionals in statutory services borne out of evidence-based mental health policy (Thorncroft, 2000; Webber, 2008). Whilst all the other services are based on empirical research within a scientific paradigm, social work practice is mainly founded on a theoretical schema (Wilson, 2008). Webber (2008) posits that most social workers are still yet to understand the evidence on which the health services are founded as well as articulate their own evidence based. Gray et al (2009) suggests that social workers who are moving into such settings need to investigate and establish the current status quo of EBP in these settings and come up with an informed decision on the way forward in a bid to move beyond the government’s ‘what works’ agenda and locate best evidence for best practice. This investigative approach is imperative for mental health social workers for a number of reasons. Firstly, Webber (2008) is critical of the Bandolier-based hierarchical approach and its positivistic scientific bias which makes it methodologically inadequate for social work. For example, it doesn’t capture such aspects as improved social functioning and service user satisfaction. The caution not to rely on medical methodologies is confirmed in CBT metaanalysis carried out by Laws of University of Hertfordshire and his colleagues (Lynch et al, 2010) who observed that CBT may never be able to precisely use the same methodology as that used to establish the efficacy of drug treatments, namely the double blind and placebo10

Candidate number: 164107

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controlled trials. Secondly, the evidence that informed the NSF is deemed to have been inadequate and tampered with for political expediency. In addition to this Dalrymple (2010) also points out that the transmission of EBM from research to practice also remains low and uneven. Even assuming that the evidence base of Mental Health teams was beyond doubt, Webber (2008) places a caveat that working in an evidence-based service does not make social workers evidence-based practitioners until they show that they are conscientiously, explicitly and judiciously applying the best evidence in making decisions at the coalface within the broader evidence-based contextual framework. However, as pointed above, mental health social workers need to define what EBP means to them and how they want to advance it according to their own defined parameters (Gray et al, 2009). Currently, the evidence base of social interventions in mental health is patchy, incomplete and anecdotal, a few example of which are; the relationship between social work interventions in reducing suicidal ideation and social work’s contribution to multidisciplinary assessments in mental health teams (Mitchell & Patience, 2002). However, there are also additional cross-discipline RCTs and systematic reviews applicable to social work, viz, 9 RCTs on the effect of psycho-social interventions in mood disorders, CBT metaanalysis (Lynch et al, 2010), aetiology and epidemiology of mental illness (Sheldon & McDonald (2009). However some of these findings were not specifically carried out for social work and in any event the availability or even the production of evidence doesn’t exactly amount to evidence-based social work if it is not systematically applied in practice as pointed out by Gray et al (2009). Webber (2008) and Pritchard (2006) also point out that politicians have also been impeding the natural course EBP in mental health social work since evidence from empirical research can be abused or ignored by policy makers especially if it is uncomfortable to read. For 11

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example, closure of day care centres to encourage patients to use hospitals (Standard 7 NSF), the replacement of the ASW by the AMPH (MHA, 2007) and compulsory community treatment were all not squarely based on clear evidence but political expediency. Despite these frustrations, EBP proponents such as Webber (2008), Mullen et al (2008), Gambrill (2006b) and Mullen & Bacon (2004) are urging practitioners to update their knowledge and base interventions on latest research findings to close the yawning gap between what research considers to be effective and the reality in practice. Using research evidence could benefit social work in a number of ways, particularly to secure its own future at a time when its probity is highly questionable and is struggling to define itself in mental health settings ( Pritchard, 2006). In light of the above painted picture, the question that needs to be asked is the direction and shape EBP is taking in 2010 and beyond and where it sits in the ever changing terrain of social work in the political economy of welfare in Britain and on the international landscape? Whilst there appears to be consensus on the need for a debate by EBP proponents such as Sheldon & Macdonald (2009) and Gray et al (2009), there also appears to be a dissension on the nature of this debate since Gray, Plath and Webb are of the view that EBP should not just be uncritically transferred from medicine whilst applied science adherents such as Sheldon and Macdonald are unremittingly positivistic. The government could help to bridge the blue waters between these two camps but unfortunately it has lately been prevaricating through a reliance on prudent common sense rather than evidence in decision-making. For example Webber (2008) cites the House of Commons Select Committee on Science’s statement to the effect that EBP can be misleading if adhered to in decision-making. This position is confirmed in the government‘s current trend of ignoring the ACMD’s advice, for example, on mephedrone as reported by BBC (12/04/ 2010). The government may rationalise this

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approach on the basis that some lobbyists may misuse evidence to advance their own parochial agendas which might not sit well with their electorate (Gray et al, 2009: 173). For example, the University of East Anglia’s climate change data manipulation has driven a wedge between the government and some academics in the science community (Guardian, 20//11/2009). However, the government’s views of considering scientifically generated evidence only as part of the broad evidence that should form the basis of a decision can also be viewed positively since it sits well with progressive views of Plath (2007), Stanhope & Solomon (2009, Luitgaarden (2009) and (Upshur, 2003). For example, both Plath and Luitgaarden advocate for a middle ground approach that reconciles both the positivist on the one hand and the critical reflective, rational & interpretive paradigms on the other hand, in social work decision-making. This view is further confirmed by Gray et al (2009) who draw similarities between a government making a decision at macro level and a social worker making a decision at micro level since both may be compelled to put professional judgement above scientifically-generated evidence. Webber (2008) also points out that the government’s recent social work and social sciences initiatives such as the National Skills Academy (2008) and the National Social Care research Ethics Committee, SCIE and ESC have been helping to harden the institutional infrastructure for EBP in UK Social Sciences. In addition, although the Social Work Taskforce report (2009) does not explicitly mention EBP, it proposes a social work college and the need for social workers to draw from sound understanding of social work, which could all enhance social work’s professional probity (DOH & DCSF, 2010). However, it could be argued that its proposal to license social workers might be sceptically viewed by some as a measure to control the profession and EBP might be used as a Trojan horse in pursuit of this quest. Such 13

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an assumption is not too far-fetched since EBP has already been used to standardise and streamline social services (Stanhope and Solomon, 2009). However, this might not discourage the EBP incursion into social work since past regulatory tendencies such as the Platt review (2007) did not discourage SCIE’s ambitions to clearly define social work’s evidence base, which would distinguish it from other disciplines (Webber, 2008).

In conclusion, it is apparent that there is substantial evidence to conclude that EBP is currently being used as a government policy benchmarking and streamlining tool both in the UK and USA that it largely shaped the NSF policy within which statutory adult mental health social work currently sits and informs both medical and psychological treatments in those teams. This conclusion is subject to the caveats covered elsewhere in this paper regarding the evidentiary probity, e.g. Lynch et al’s (2010) and Dalrymple (2010). However there has been ambivalence towards EBP’s uptake in social work practice despite the fact that it’s shaping policies. Although reviewed literature advance different views of EBP and the reasons behind its slow uptake into social work practice, taken together, they all provide a balanced baseline that it is currently in inception stage in practice and needs to be progressed. Whilst the Social Work Task Force Report (DOH, 2009) provides a political, professional and policy contextual framework within which the EBP could sit and take strength, it is too early to express much optimism. However, the fact that EBP has been adopted at policy level will fundamentally affect practice (Gray et al, 2009). It should be debated further rather than prematurely dismissed because its potential benefits outweigh objections to it (Gibbs & Gambrill, 2002).

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Bibliography /References 1. BBC (12/04/2010), Mephedrone reclassified: http://news.bbc.co.uk/1/hi/uk/8616758.stm. Accessed 12/04/2010 at 23:00 hours 2. Building a safe and confident future policy document (DOH and DCSF, 2010) 3. Bellamy, J. et al.(2006), The current state of EBP in social work: a Review of the literature and Qualitative analysis of Expert Interviews, Journal of Evidence-Based Social work V.3 (1), pp:23-48 4. Corcoran, K. (2007), From the Scientific Revolution to Evidence –Based Practice: Teaching the Short History with a Long Past, Research on Social Work Practice, V. 17 (5), pp:548-552 5. Dalrymple, P. (2010), Applying Evidence in Practice: What We Can Learn from Healthcare Evidence Based Library and Information Practice, Vol 5, No 1, pp:43-47 6.

Edmond, T. (2006) Integrating evidence-based practice and social work field education, Journal of Social Work Education, Spring-Summer, 2006

7. Enola, K. et al. (2007) Implementation of Evidence-Based Practice in Community Behavioural Health: Agency Director Perspectives, Administration & Policy in mental health service research, Volume 34, Number 5 8. Gambrill, E. (2006b), Evidence-Based Practice and Policy: Choices Ahead Research on Social Work Practice, 16(3): pp: 338 - 357. 9. Gibbons, J. (2001). Effective practice: Social work’s long history of concern about outcomes, Australian Journal of Social Work, 54(3), pp: 3-13. 10. Gibbs, L. and Gambrill, E., (2002) Evidence based practice: counterarguments to objections, Research on social work practice, 12(3), pp: 452-476 11. Gira, E. et al. (2004), Influencing Social Workers to Use Research Evidence in Practice: Lessons from Medicine and the Allied Health Professions, Research on Social Work Practice, Vol. 14, No. 2, pp: 68-79 12. Gould, N. (2006) ‘An Inclusive Approach to Knowledge for Mental Health Social work Practice and Policy’, British Journal of Social Work Practice, 36, pp:109-125 13. Gray, M. et al., (2009), Evidence Based social work: A critical stance, (1st edition), Routledge, London & New York.

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14. Guardian online (20/11/2009) Climate skeptics claim leaked emails are evidence of collusion among scientists, http://www.guardian.co.uk/environment/2009/nov/20/climatesceptics-hackers-leaked-emails. Accessed 3 April 2010 at 14:53 hours 15. Huxley, P., (2002) Evidence in social care: the policy context. In Priebe, S. And Slade, M. (Eds) Evidence in mental health care. Hove, Brunner-Routledge, pp.193-203 16. Jilek, W.G. (2001). Cultural Factors in Psychiatric Disorders. Paper presented at the 26th Congress of the World Federation for Mental Health. Vancouver: Piscaway 17. Lynch, D. Et al (2010), Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials, Psychological medicine journal, 40, pp: 9-24 18. Manuel et al., (2009), Preparing Social Work Practitioners to Use Evidence Based Practice: A Comparison of Experiences from an Implementation Project, Research on Social Work Practice. 19, 5, pp: 613-627 19. McNeece, C.A. and Thyer, B. (2004) Evidence-Based Practice and Social Work Journal of Evidence - Based Social Work, Volume 1, pp 7 – 25 20. Mitchell, F. & Patience, D. (2002), Conjoint multi-disciplinary assessment in a community mental health team: the impact on the social care role. Social work in Health care, 35, pp:605-13 21. Mullen, J. and Streiner, D. L. (2004) Implementing Evidence-based Practice (EBP) in Social Work: A Pilot Study Mental Health Services Research #5 T32 MH14623-24/25 Columbia University Musher centre 22. Mullen, E. et al., (2008) Implementing evidence-based social work practice. Research on Social Work Practice, 18(10, pp: 325-338 23. Mullen, E.J. and Bacon, W.F. (2003). Practitioner adoption and implementation of practice guidelines and evidence based treatments. In Roberts, AR. And Yeager, K. (eds). Evidence based practice manual: research and outcome measures in health and human services, New York, NY: Oxford University press.pp 210-218 24. Nathan, J. (2002) The Advanced practitioner: beyond reflective practice. Journal of Practice Teaching, 4,pp: 59-84 25. National Service Framework (DOH, 199b) 16

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26. Nutley, S et al., (2009) Promoting Evidence-based Practice Models and Mechanisms from Cross Sector Review, Research on Social Work Practice, 19, 5, pp:552-559 27. Pilgrim, D. & Rogers, A. (2005). The Troubled relationship between Psychiatry and Sociology, International Journal of Social Psychiatry Volume. 15, No.3, pp: 228-241.

28. Pomeroy, E. (2010), The beginning of a New decade 2010, Social work journal, National Association of social workers, Gale, USA. 29. Pritchard, C. (2006) Mental Health Social Work: Evidence Based Practice, Abington: Routledge 30. Recovery and Reinvestment Act, USA, 2009 (www.recovery.gov) 31. Rogers A., Lewis L., and Woodward L (2007) Re-locating the sociology of mental health and illness, Journal of Mental Health, vol.16 no.3 pp.287-289. 32. Roberts, G. & Wolfson, P. (2004.) The rediscovery of recovery: open to all, Advances in Psychiatric Treatment, vol.10, pp: 37-49 33. Roberts-DeGennaro,M. (2010) Using an Evidence-Based Program Planning Model In a Macro Practice Course, Journal of Teaching in Social Work, V. 30, PP: 46 - 63 34. Rosen, A. and Proctor, E., (2008). Developing practice guidelines for social work intervention. New York Columbia university press 35. Rubin, A. and Parrish, D. (2007). Views of Evidence-Based Practice Among Faculty in Master of Social work Programs: A National Survey, Research on Social Work Practice, V.17, No. 1, pp: 110-122 36. Ryan, M. et al., (2004), Belief, optimism and caring: findings from a cross sectional study of expertise in mental health social work. Qualitative Social Work, 3, pp:411-29 37. Sackett, D.L. et al. (1996) Evidence based medicine: what it is and what it isn't. BMJ 312 (7023), 13 January, 71-72), http://cebm.jr2.ox.ac.uk/ebmisisnt.html. Accessed 20/03/2010 at 12: 30 pm 38. Scientists quit government drugs body over David Nutt sacking Times online (2009): http://www.timesonline.co.uk/tol/news/politics/article6898456.ece. accessed 1/03/2010 at 14:00 hours 39. Sheldon, B. & Macdonald, G. (2009), A Textbook of Social Work, (1st Edition), Routledge, London and New York. 17

Candidate number: 164107

Student number: 09212536

40. Sheldon, B. (2006) Evidence based social services: prospects and problems, Social work research magazine 41. Stanhope, V. and Solomon, P. (2008) ‘Getting to the Heart of Recovery: Methods for Studying Recovery and their Implications for Evidence-Based Practice’, British Journal of Social Work, 38, pp. 885-899. 42. Steinberg, E. and Luce, B., (2005), Evidence Based? Caveat Emptor!, Heath Affairs, 24, 1, pp:80-92 43. Thyer, B.A. and Kazi, M.A.F. eds. (2004). International perspectives on evidence-based practice in social work. Birmingham, UK: Venture Press 44. Thorncroft, G., (2000) National Service Framework for Mental Health. Psychiatric Bulletin, 24, pp: 203-206 45. Upshur, R. E. G, (2003), Are all evidence-based practices alike? Problems in the ranking of evidence, CMAJ, V 169, No. 7 46. Van de Luitgaarden G.M.J. (2009) Evidence –Based Practice in Social Work: Lessons from Judgement and Decision-Making Theory, British Journal of Social work, 39, pp:243-260 47. Warner, S. (2006), Review of the literature on the Care Programme Approach, Sainsbury Centre for Mental Health, London 48. Webb, S. (2001), Some considerations on the validity of evidence-based practice in social work, British Journal of Social Work pp: 57-79 49. Webb, S.A., (2006) Social Work in a risky society: social and political perspectives: London: Palgrave Macmillan. 50. Webber, M. (2008), Evidence-based Policy and Practice in Mental Health Social Work, (1st edition), Learning matters, London 51. Wheaton, B. 2001. “The Role of Sociology in the Study of Mental Health...and the Role of Mental Health in the Study of Sociology.” Journal of Health and Social Behaviour 42: pp: 221-34. 52. Wilson, K et al, (2008) Social Work an introduction to contemporary practice (1st edition) England, Pearson edition limited.

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Candidate number: 164107

Student number: 09212536

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