EBP Exchange – UMB School of Social Work

I just read a very impressive paper on preventing abusive head trauma (AHT: aka, shaken baby syndrome) that uses a quasi-experimental method to show that a brief orientation, 11 minute video, and request to sign a commitment letter reduced the number of cases of AHT in western NY by half over the rate of AHT that had occurred in the prior 6 years in that part of NY and the rate that continued to occur in adjacent Pennsylvania counties.  Among the 22 cases that did occur about half occurred in households that had not been engaged in the program.  Given the magnitude of the impact on a child, family, and health and educational systems of even one case of AHT, the apparent reduction in cost is striking.  This seems like an intervention that could also be tailored for child welfare work–the cause is too great and the intervention too basic to think that it should be left to OB/GYN units; why not have kiosks with the video in other places where parents of young children could watch it.  Interestingly enough, this paper has not been cited, even once, since publication. It may never be cited, but it can still have an impact because it describes a very practical form of parent training that is largely overlooked.

Dias, M. S., Smith, K., deGuehery, K., Mazur, P., Li, V. T., & Shaffer, M. L. (2005). Preventing abusive head trauma among infants and young children: A hospital-based, parent education program. Pediatrics, 115(4), e470.

This newly released material from CDC describes 14 evidence supported interventions (ESIs).  These were chosen from a larger group of studies identified by Rand in their met-analysis because they met the criteria of including community-dweling adults 65 or older, mesureing falls as a primary outcomes, and using a classic randomized clinical trial (RCT) with significant results.  They come from all over the world–well, from the G8 countries, at least). The interventions are grouped by the type of approach (exercise, home modification, and multi-faceted). (A previous volume included community-based prevention programs). 

The exercise interventions were often delivered by physical therapists although most seem like they could be delivered by social workers. Only one of the two home modification interventions (Nikolaous et al, clearly had a social worker involved (Nikolaus, et al., 2003). Among the multi-faceted studies there were most often PTs and OTs and there were many functions that a social worker could fulfill.

This is an interesting model for presenting results so that the interventions are quite clear and the likelihood that the interventions would be helpful is high.  You will find it at:

www.cdc.gov/ncipc/preventingfalls/CDCCompendium_030508.pdf

In Bruce Thyer’s recent article, “The Quest for Evidence Based PRatice? We Are All Positivist–as part of a EPB focused July 2008 special issue of Research on Social Work Practice –he argues that the social work profession has a long and strong history of positivism and that some of the early writings (e.g., by Edith Abbott) call for a more rigorous experimental science than we now espouse in many schools of social work. Thyer has a number of suggestions about how to implement positivism in a more vigorous way in the future of social work.  Among the least compelling, from my view, is the call for more attention to systematic reviews (as in his discussions of the Oxford MS program or the collaboration between social work organizations and the Campbell and Cochran Collaboratives) because, in my view, we are decades away from having a meaningful enough body of studies to be able to review them in an informative way. I have read many reviews in my primary area–children’s services–and most have been very disappointing.  The primary benefit of this work is, at this point, to remind us of what good science and thorough reporting of methods and results offers but we do not have a history of funding or implementation of such science making many of the reviews relatively vapid.  On the other side, Thyer reprises an earlier and still important argument that we not be concerned with specific social work research methods or knowledge base. Social work operates at the juncture between certain kinds of social and behavioral problems and psychosocially focused interventions but the overlap with other professions is quite profound and they are also claimants for important roles on problems that we once thought to be social work’s domain, like child abuse and neglect, domestic violence services, discharge planning, and the like. Thyer is wise in arguing that we should proactively collaborate with other professions to develo interdicipliinary practice guidelines. Indeed, it’s time for us to recognize that our field has grown substantially from the contributions of political scientists, sociologists, psychologists, and epidemiologists and that just because we now have enough social work PhDs to staff our faculty needs this is not a reason to abandon the fruitful interdicisplinary character that many of our Schools have had but are in danger of losing.  This article is a good summer read as are several others in this special issue.