Beyond the Pro and Contra of Evidence-Based Practice: Reflections on a Recurring Dilemma at the Core of Social Work

Currently, social work is witnessing a quite polarized debate about what should be the basis for good practice. Simply stated, the different attempts to define the required basis for effective and accountable interventions in social work practice can be grouped in two paradigmatic positions, which seem to be in strong opposition to each other. On the one hand the highly influential evidence based practice movement highlights the necessity to base practice interventions on proven effectiveness from empirical research. Despite some variations, such as between narrow conceptions of evidence based practice (see e.g. McNeece/Thyer, 2004) and broader approaches to it (see e.g. Gambrill, 1999, 2001, 2008), the evidence based practice movement embodies a positivist orientation and more explicitly scientific aspirations of social work by using positivistic empirical strategies. Critics of the evidence based practice movement argue that its narrow epistemological assumptions are not appropriate for the understanding of social phenomena and that evidence based guidelines to practice are insufficient to deal with the extremely complex activities social work practice requires in different and always somewhat unique practice situations (Webb, 2001; Gray & Mc Donald, 2006; Otto, Polutta &Ziegler, 2009). Furthermore critics of evidence based practice argue that it privileges an uncritical and a-political positivism which seems highly problematic in the current climate of welfare state reforms, in which the question ‘what works’ is highly politicized and the legitimacy of professional social work practice is being challenged maybe more than ever before (Kessl, 2009). Both opponents and proponents of evidence based practice argue on the epistemological, the methodological and the ethical level to sustain their point of view and raise fundamental questions about the real nature of social work practice, so that one could get the impression that social work is really at the crossroads between two very different conceptions of social work practice and its further professional development (Stepney, 2009). However, this article is not going to merely rehearse the pro and contra of different positions that are being invoked in the debate about evidence based practice. Instead it aims to go further by identifying the dilemmas underlying these positions which - so it is argued – re-emerge in the debate about evidence based practice, but which are older than this debate. They concern the fundamental ambivalence modern professionalization processes in social work were subjected to from their very beginnings.

What is Practice Research in Social Work - Definitions, Barriers and Possibilities

Practice is subject to increasing pressure to demonstrate its ability to achieve outcomes required by public policy makers. As part of this process social work practice has to engage with issues around advancing knowledge-based learning processes in a close collaboration with education and research based perspectives. This has given rise to approaches seeking to combine research methodology, field research and practical experience. Practice research is connected to both “the science of the concrete” – a field of research oriented towards subjects more than objects and “mode 2 knowledge production” – an application-oriented research where frameworks and findings are discussed by a number of partners. Practice research is defined into two approaches: practice research – collaboration between practice and research – and practitioner research – processes controlled and accomplished by practitioners. The basic stakeholders in practice research are social workers, service users, administrators, management, organisations, politicians and researchers. Accordingly, practice research is necessarily collaborative, involving a meeting point for different views, interests and needs, where complexity and dilemmas are inherent. Instead of attempting to balance or reconcile these differences, it is important to respect the differences if collaboration is to be established. The strength of both practice and research in practice research is to address these difficult challenges. The danger for both fields is to avoid and reject them.

Dementia with lewy bodies--diagnosis and treatment

Dementia with Lewy bodies (DLB) accounts for 15-20% of all autopsy confirmed dementias in old age. Characteristic histopathological changes are intracellular Lewy bodies and Lewy neurites, with abundant senile plaques but sparse neurofibrillary tangles. Core clinical features are fluctuating cognitive impairment, persistent visual hallucinations and extrapyramidal motor symptoms (parkinsonism). One of these core features has to be present for a diagnosis of possible DLB, and two for probable DLB. Supportive features are repeated falls, syncope, transient loss of consciousness, neuroleptic sensitivity, delusions and hallucinations in other modalities. DLB is clinically under-diagnosed and frequently misclassified as systemic delirium or dementia due to Alzheimer's disease or cerebrovascular disease. Therapeutic approaches to DLB can pose difficult dilemmas in pharmacological management. Neuroleptic medication is relatively contraindicated because some patients show severe neuroleptic sensitivity, which is associated with increased morbidity and mortality. Antiparkinsonian medication has the potential to exacerbate psychotic symptoms and may be relatively ineffective at relieving extrapyramidal motor symptoms. Recently there is converging evidence that treatment with cholinesterase inhibitors can offer a safe alternative for the symptomatic treatment of cognitive and neuropsychiatric features in DLB. This review will focus on the clinical characteristics of DLB, its differential diagnosis and on possible management strategies.

Toward the Development of Ethical Guidelines for Family Preservation

Family preservation workers need a standard set of ethical guidelines to assist them in providing their service in a proper manner. This paper describes how ethical codes have been developed for the "traditional" mental health care disciplines and why such codes are not sufficient for the type of work done in family preservation. The paper further provides examples of the types of ethical dilemmas family preservation workers encounter as well as suggestions for workers, supervisors, and agencies in dealing with such dilemmas.

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

BACKGROUND: Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence.Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression. DESIGN: A therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions). METHOD: Participants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used. DISCUSSION: We expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression. TRIAL REGISTRATION: ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Rezension zu: Irini Katsirea, Public Broadcasting and European Law

Public broadcasting has always been a regulatory field somewhat zealously guarded within the nation states' sphere and kept willingly untouched by regional or international rules. Values inherent to the role of public broadcasting, such as cultural and national identity, social cohesion, pluralism and a sustained public sphere, were thought too critical and too historically connected with the particular society to allow any "outside" influence. Different regulatory models have emerged to reflect these specificities within the national boundaries of European countries. Yet, as media evolved technologically and economically, the constraints of state borders were rendered obsolete and the inner tension between culture and commerce of the television medium became more pronounced. This tension was only intensified with the formulation of a European Community (EC) layer of regulation, which had as its primary objective the creation of a single market for audiovisual services (or as the EC Directive beautifully put it, a "Television without Frontiers"), while also including some provisions catering for cultural concerns, such as the infamous quota system for European and independent productions. Against this backdrop, public broadcasting makes a particularly intriguing subject for a study of regulatory dilemmas of national versus supranational, integration versus intergovernmentalism, culture versus commerce, intervention versus liberalisation, and all this in the dynamic setting of contemporary media. The present paper reviews Irini Katsirea's book PUBLIC BROADCASTING AND EUROPEAN LAW and seeks to identify whether all elements of the complex governance puzzle of European public service broadcasting rules are analytically well fitted together.

Inference in Ecology: The Sea Urchin Phenomenon in the Northwestern Atlantic

We have reviewed the considerable body of research into the sea urchin phenomenon responsible for the alternation between macroalgal beds and coralline barrens in the northwestern Atlantic. In doing so, we have identified problems with both the scientific approach and the interpretation of results. Over a period of approximately 20 years, explanations for the phenomenon invoked four separate scenarios, which changed mainly as a consequence of extraneous events rather than experimental testing. Our specific concerns are that results contrary to the keystone-predator paradigm for the American lobster were circumvented, system components of the various scenarios became accepted without testing, and modifications of some components appeared arbitrary. Our review illustrates dilemmas that, we suggest, have hindered ecological progress in general. We argue for a more rigorous experimental approach, based on sound natural-history observations and strong inference. Moreover, we believe that the scientific community needs to be cautious about allowing paradigms to become established without adequate scrutiny.

A model of factors determining levels of public support for health care policy in the United States

Public preferences for policy are formed in a little-understood process that is not adequately described by traditional economic theory of choice. In this paper I suggest that U.S. aggregate support for health reform can be modeled as tradeoffs among a small number of behavioral values and the stage of policy development. The theory underlying the model is based on Samuelson, et al.'s (1986) work and Wilke's (1991) elaboration of it as the Greed/Efficiency/Fairness (GEF) hypothesis of motivation in the management of resource dilemmas, and behavioral economics informed by Kahneman and Thaler's prospect theory. ^ The model developed in this paper employs ordered probit econometric techniques applied to data derived from U.S. polls taken from 1990 to mid-2003 that measured support for health reform proposals. Outcome data are four-tiered Likert counts; independent variables are dummies representing the presence or absence of operationalizations of each behavioral variable, along with an integer representing policy process stage. Marginal effects of each independent variable predict how support levels change on triggering that variable. Model estimation results indicate a vanishingly small likelihood that all coefficients are zero and all variables have signs expected from model theory. ^ Three hypotheses were tested: support will drain from health reform policy as it becomes increasingly well-articulated and approaches enactment; reforms appealing to fairness through universal health coverage will enjoy a higher degree of support than those targeted more narrowly; health reforms calling for government operation of the health finance system will achieve lower support than those that do not. Model results support the first and last hypotheses. Contrary to expectations, universal health care proposals did not provide incremental support beyond those targeted to “deserving” populations—children, elderly, working families. In addition, loss of autonomy (e.g. restrictions on choice of care giver) is found to be the “third rail” of health reform with significantly-reduced support. When applied to a hypothetical health reform in which an employer-mandated Medical Savings Account policy is the centerpiece, the model predicts support that may be insufficient to enactment. These results indicate that the method developed in the paper may prove valuable to health policy designers. ^

Iverna Codina en su novela

Con La luna ha muerto, Iverna Codina escritora chileno-argentina inicia un camino de búsqueda del sentido de su obra y de su responsabilidad social como novelista. Parte del axioma de que la literatura es expresión de la vida humana, una vida que siempre es lucha y agonía. En una estructura ramificada de trama y cotramas, los personajes - Claudio, Valentina, Ariel, Marcelo, Felipe y otros, todos artistas- se cuestionan permanentemente acerca de su destino personal, pero también sobre las distintas formas de encarar la literatura y el arte. En estos dilemas es evidente la influencia de La gaviota de Chejov. Las indagaciones existenciales de los personajes -diversas según la personalidad de cada uno- se manifiestan por medio de las peripecias narrativas, del diálogo entre personajes y de los símbolos de la luna y del ascenso al Aconcagua. Por su parte, la novelista, en su propia búsqueda,toma la decisión de ser una escritora comprometida con el ser humano sufriente, como su personaje Valentina.

Unamuno entre nosotros : visiones cruzadas de la modernidad

Aquellos dilemas que interpretábamos como inherentes a la historia de nuestras nacionalidades hispanoamericanas comprenden inexcusablemente a España –y por tanto también a Europa– ya que su presencia pone en evidencia algunos de nuestros posibles orígenes sea por contraste, asimilación o directamente por diferenciación; lo mismo vale en la dirección contraria, aunque los frutos hayan sido a veces tan desiguales. Esta perspectiva intentará brindar algún aporte al debate sobre la Modernidad iberoamericana.

Economia solidária e trabalho coletivo : Um olhar sobre a Cooperativa do Riachão no Norte de Minas Gerais - Brasil

It is intended to discuss the prospect of collective work in solidarity economy, from experiences with those of the Cooperative Riachao workers, located in a rural community in the municipality of Montes Claros, Minas Gerais / Brazil, this approximately 240 farming families extractive are benefited with the generation of jobs and income through initiatives grounded in associations, cooperatives and collectives. Among the 80 to 90 years, appeared inBrazil experiences of solidarity, resulting economy of the labor market crisis and rising unemployment, and an important response to the workers in relation to changes in the world of work. It is grounded in the organization of groups of workers, by way of solidarity, community, cooperation, and self-management reactions. In this sense, we intend to present the achievements, challenges and dilemmas of workers COOPERIACHAO, around a project that aims at empowerment of social actors and social transformation of the subject

Crisis de representación política en Argentina a fines de los '90 : Algunas vías de análisis

La crisis de representación política en Argentina a fines de los noventa es abordada en esta tesina desde diversas vías de análisis. Se presentan las contradicciones propias de la democracia en un sistema representativo que limita la posibilidad del llamado "gobierno del pueblo", así como los dilemas de la relación entre representante y representado. Los cambios políticos, la crisis del Estado de Bienestar y las transformaciones de los partidos ofrecen el marco general para el análisis de las distintas interpretaciones sobre el problema de la crisis en Argentina. Las teorías utilizadas en este estudio ofrecen una amplia mirada sobre el tema, desde las que consideran que se trata de un problema de representatividad de los partidos hasta las que tratan otras dimensiones tales como el Estado, el régimen político, los políticos, la ciudadanía, los liderazgos, entre otros. Los niveles de análisis abordados permiten configurar el estado de situación del problema de la crisis de representación, se incluyen cuestiones de la democracia per se y se relacionan los problemas políticos generales que han afectado a varios países con aquellos específicos de la crisis de representación en Argentina.

Barroco, Modernismo, Neobarroco

Rubén Darío es el primer escritor en lengua castellana que reivindica sin matices y de manera plena la obra de Luis de Góngora. Su propuesta se encuentra plasmada en Cantos de vida y esperanza a través del tríptico de sonetos "Trébol" y el poema que abre el poemario ("Yo soy aquel que ayer no más decía"), en el cual confiesa que dos de sus grandes influencias son Góngora y Paul Verlaine. A partir de este diálogo inicial que establece Darío, la crítica ha insistido desde muy temprano sobre las afinidades que se encuentran entre el Modernismo y el Barroco. Pero debajo de las afinidades existen desde luego diferencias cruciales, que en este trabajo desarrollo a partir de tres ejes comparativos: la política, la religión y el lenguaje. Tras esta comparación, sostengo que el Modernismo, a través de Darío, arranca el Barroco de su suelo histórico y lo coloca en los dilemas y las contradicciones modernas del artista con la sociedad. Con esto, sienta las bases de lo que más tarde será el Neobarroco.