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.
2 ‘What works’ as a professional dilemma
The starting point of the professional project in social work was the attempt to lift certain activities out of the general lifeworld context and from unreflected actions based on common sense. From the very beginning professionalization was linked to the claim to an area of specific competence determined by rationality and scientific statement of reasons in order to occupy an area of expertise and to delimit practice from arbitrariness and spontaneous actions. For instance the ‘social diagnostic’ approach developed by Mary Richmond (1917) shows that the presentation of social work as professional practice was made possible by the attempts to establish a scientific foundation for practice in analogy to the medical model and to adopt the rationale and language of modernity. This rationale of modernity and the reliance on the positivist paradigm promoted the respectability of social work in professional and academic terms in the first instance. In this sense the contemporary promotion of evidence based practice – as Gray and McDonald (2006) argue – is the renewed manifestation of a long-standing tradition in the professionalization project, which seeks to constitute social work as a scientifically oriented profession in the project of modernity which promotes rationality and progress (Gray/McDonald 2006). Hence, if today’s proponents of the evidence practice movement highlight the necessity to lift social work out of what is seen as irrationality and arbitrariness, this is not to be seen merely as part of a general return to neo-positivistic positions in the social sciences (in reaction to postmodern positions) or as a trend which renders a political ‘what works agenda’ functional. Although these trends are doubtlessly connected, it is important to recognize that the demand for objective grounds and enforceable criteria of intervention has always been a legitimate part of the professionalization project of social work. At the same time the project of professionalization has always been confronted with the limits of rationality and objectivity. This fundamental dilemma is part of a tension, which is at the heart of social work. As Lorenz (2006) describes it in Habermasian terms, professional social work has always been rooted both in the ‘system’ and in the ‘lifeworld’. According to Lorenz, social work can therefore never be understood either as a total product of the system pushing for rational solutions to social problems, or as merely a ‘private’ lifeworld activity. Rather, social work is rooted in both spheres and remains in continuous tension to be committed to both. This dilemma constitutes part of every front-line social work experience, however small that may be. However, it certainly does not suffice to argue that practice situations are always unique and highly complex and that professional practice is hence too ‘difficult’ to be ‘systematically’ informed and evaluated on the basis of empirical evidence and standardized criteria.
Instead, there is renewed interest in social science models today that offer theoretical approaches which question the notion that narrowly defined positivism is the only way to explain (and to understand) social phenomena. Critics (Gray & McDonald, 2006; Otto & Ziegler, 2006) point out the limits of the positivistic-empirical approach. Firstly, they regard its ontological and epistemological assumptions inadequate and too narrow to engage with different approaches to a broader understanding of social phenomena, such as constructivist bodies of theory and approaches derived from the critical and hermeneutic tradition in the social sciences. Accordingly, they argue further that the positivistic-empirical approach is methodologically inadequate because it can deal at best with those aspects of social phenomena that can be rendered visible and thus measurable. Finally positivistic-empirical approaches neglect completely (or better: they cannot but neglect) the critique of postmodern theorists concerning the intricate relation between knowledge and power, or what Foucault calls the ‘politics of the scientific statement’ (Foucault, 1980: 112). As one can recognize easily, there is a fundamental contraposition in the debate about what might be a valid base for good and accountable practice, mainly between those who promote approaches of evidence based practice and those who criticize them. The argument sustained here in this regard is rather simple, namely that this conflict cannot be resolved or overcome, but that social work has to face it and to deal with it dialectically. To this aim it is important to recognize, that the fundamental ambivalence, which characterizes this debate is neither something new for social work, nor a merely academic debate between different ontological and epistemological views. As was already pointed out, the fundamental ambivalence, which re-emerges from the debate about evidence based practice, is intrinsically linked to the professional project of modern social work and to the attempt to deliver good and accountable practice. Professional social work can never escape from this arena of tension without renouncing its fundamental mandate as a social profession rooted in lifeworld processes and at the same time linked to socio-political objectives. One the one hand it will always have to deal with the necessity to base itself on criteria which are publicly accountable and assumed to be objective, to adopt them for practice development and for purposes of being evaluated on their basis. One the other hand it will always have to face the limits, the incompleteness of those criteria and their immediate (more or less visible) entanglement with interests that have nothing immediately to do with the well-being of people and their personal, subjectively constructed concerns. This is an immanent professional dilemma that re-emerges in different form throughout the history of professionalization and has immediate practice consequences.
3 The common denominator: good practice
The suggestion here is to take one step back in order to go forward and see what the opposing positions have in common or better, to find what could be seen as their common concern. Their common denominator can be identified as their common endeavour for good - though differently framed - accountable practice. On the level of this common effort social work has to deal with the partiality of different epistemological approaches (Fargion, 2009) and more or less explicit and formal sources of knowledge, which derive not only from scientific sources but also from ‘soft’ areas of knowledge such as life experience and cultural wisdom. Furthermore it has to analyze carefully the different interests that attach to the different claims of knowledge and demands for accountability. These interests converge at the level of claims and indeed rights to accountable practice and they can be of different kind, such as power interests, ethical interest, cultural interests and political interests. Subsequently it can be shown how these different interests are connected to the professional dilemma concerning accountable practice and its different sources of knowledge.
4 The power perspective
Knowledge is never exempt from interests of power. Concerning this issue the most revealing contributions come doubtlessly from Foucault’s oeuvre. In his philosophy of science he points out the co-constitutive relationship between power and knowledge, or what he calls the internal regime of power of scientific statements (Foucault, 1980). The important aspect here is Foucault’s originality in deconstructing the question where precisely power enters science by conceptualizing science itself as a field where power is already present. Forms of knowledge emerge from the specific social relations between persons, domains of discourse and institutions. These relations are intelligible as a grid of power, which is neither extrinsic to the forms of knowledge developed, nor do they exhaustively explain them, or eclipse in any way their truth-value (Alcoff, 2005). What Foucault points out are the invasive and insidious mechanisms by which power is interwoven with different forms of knowledge, which at the same time cannot be rejected as ‘not valid’ (Foucault, 1980, Alcoff, 2005). This means it is necessary to abandon an idea of knowledge as a neutral and hence self-legitimating procedure and product, even if it was produced with scientific rigor and if it is needed for systematization and the definition of standards and strategies which fit into the criteria of rationality, predictability and controllability. Social work owes its success to these forms and contents of knowledge which allowed it to adopt a methodological ‘language’ in line with the rationale of modernity: to base progress and the mastery of unpredictable forces on scientific insight and the systematic application of knowledge thus derived. At the same time these bodies of knowledge are also instruments of power and social work has to reflect on how and for what purposes they are used. This means that social work has to question hegemonic assumptions in knowledge production and practice application and the different interests, which lie behind those assumptions. The question here is not merely a theoretical one about social research and the hierarchy of research findings and evidence. Also social work practice processes and applies different bodies of knowledge to develop and to account for practice. This itself has to do with power interests of social work wanting to establish itself as a profession to be taken seriously. A critical, reflexive professional practice has thus to ask itself also what the bases and criteria used to account for practice are: Does social work itself use hegemonic assumptions to gain recognition and status by surrounding itself with symbols of power which have weight in society?
5 The ethical perspective
Of course, ethical interests also play an important role in the debate about what good practice might be and for what and to whom practice should be accountable. Social work is based on fundamental values and professional ethics is at the core of professional practice. The profession incorporates the idea of ethics into practice by articulating its basic values, ethical principles, and ethical standards. This is generally done by the development of specialized codes of ethics designed to inform decision-making processes in practice. But as research suggests, formal codes of ethics do not actually serve as the primary basis for the complex decision making processes in practice. These processes are informed more by practice wisdom, personal values and supervision (Doyle, Miller & Mirza, 2009). Furthermore doubts have been raised about the claim to a universal base of values in the social work profession as this can be seen and perceived as the justification of culturally determined values and hence as a colonizing project. Professional values are generally built on the foundation of mainstream cultural values, but these generally accepted values might exclude certain culture specific views of ethical standards practiced by people, groups and communities from other backgrounds (Gray & McDonald, 2006). And finally one must recognize that a formal code of ethics does neither provide universal concrete practice guidelines nor does it specify a hierarchy of values and ethical standards (Doyle et. al., 2009). Practice situations are often ethically challenging for professional practitioners because of conflicting sets of values and priorities, such as clients’ values, diverging professional values in interdisciplinary teams, discrepancies between legal requirements and professional recommendations, socio-political and other financial and material restrictions or - last, but not least - the personal value systems of practitioners themselves. The professional attempt to practise accountably has thus to confront different interests, value systems and ethical positions and the ethical responsibility of the profession is not only a question of the adherence to a formal code, but it has to emerge from the complex interplay between ethical positions and contextual conditions as differentiated decision making processes in daily micro practices. In this regard social work has to face once again the central dilemma that has always been inherent to professional practice. On the one hand social work in order to be creditable must avoid arbitrariness and has to accord to consistent standards; additionally, for ethical but also for practical-methodological reasons it has to ensure that its modes of intervention guarantee clients the possibility to participate in decision making processes and to enforce and claim their rights. On the other hand professionals have to be capable to go beyond ‘‘one fits all’’ standards and to take decisions that are appropriate in complex situations of diverging and often conflicting interests and multiple cultural contexts.
This dilemma gains renewed actuality in the context of the debate about evidence based practice approaches when both proponents and opponents of evidence based practice use the argument of the ethical responsibility of social work to support their point of view. One of the central arguments of the proponents of evidence based practice is that it has mainly ethical advantages, that social work has to be lifted out of what is seen as the arbitrariness of merely customary practice or the dogmatism of compliance with rules and regulations. Gambrill (2001: 170) argues that practice not informed by evidence is a ‘recipe for bamboozlement’ characterized by well sounding formal but unimplemented ethical codes, the promotion of a relativistic view of knowledge and the reliance on methods that obscure rather than reveal what social workers do and how this produces specific effects. In contrast, the process and philosophy of evidence based practice as Gambrill understands and promotes it should help social workers to integrate concerns of ethics, effectiveness and application. According to this position, evidence informed practice (Gambrill explicitly uses this term) offers a great potential to respect concretely professional values and ethics in practice and research by empowering and involving clients as informed participants in decision-making and by providing evidence as the basis for responding in a true ethical manner to problems of social and economic justice (Gambrill, 2008). This means also to acknowledge rather than to hide uncertainty in decision making processes by considering research findings related to practice decisions and sharing findings with clients within a supportive dialogue. In this sense evidence informed practice is seen as the only way towards transparency and honesty in social work practice by means of providing a clear account of the current state of knowledge and of remaining uncertainties concerning the basis for professional interventions (Gambrill, 2008). By contrast, critics of evidence based approaches are rather sceptical whether evidence can be the appropriate element on which to base social work ethics and which offers appropriate answers in situations of ethical dilemmas (Otto & Ziegler, 2006). Ethical problems in social work are often linked to the fundamental problem of paternalism in social work, this means to the collusive interference in the freedom of action of its clients. Critics argue that this fundamental dilemma cannot be overcome with the argument of evidence based strategies, even less if professional practice is reduced to merely executing a proven ‘people-changing technology’ (Otto & Ziegler 2006: 106) as happens in the case of more narrow approaches of evidence based practice. According to this position the question is rather if ethical aspects such as the self-determination of clients are not going to fall behind in a more instrumental orientation of practice which is focused in the first instance on the measurable effects of interventions. Furthermore it is argued that evidence based approaches mostly prefer approaches and methods that refer to individual attitudes and behaviour and that the evidence based practice agenda puts pragmatic approaches of problem solving at its centre. Being aimed in the first instance at the ‘functionings’ of social work clients, evidence based practice approaches follow an a-political, instrumentalist rationality, which tends to manage social affairs in a ‘scientized’ manner and to reduce social policy as well as social work practice to the exercise of social technology (Otto & Ziegler, 2006; Webb, 2006).
6 The cultural perspective
The debate about what works has to be analyzed also against the cultural background of what Beck, Giddens and Lash (1994) have described as reflexive modernization. In his influential book Beck (1986) characterised the society of late modernity as Risk Society. Placed in the context of society the notion of risk captures the idea that the structure of circumstances and events are ultimately unpredictable and uncertain. For the individuals this means being faced with a confusing variety of choices, courses of action and sources of knowledge and at the same time with an increasing lack of supporting norms, conditions and expectations. Thus, under the conditions of reflexive modernity, individuals are forced to reflect, to judge and to make choices where reflection was previously not required. In fact, risk itself is not a new phenomenon but the reconfiguration of risk has changed significantly with the emergence of reflexive modernity. On the one hand risks become increasingly abstract, globalized and de-personalised, on the other hand individuals see themselves increasingly confronted with the effects of risk society (Beck, 1999; Giddens, 1990). In his illuminating sociological analysis of social work in the risk society, Webb points out the politics of risk society and its consequences to social work practice. The politics of risk society are less concerned with maintaining universal material provision and wealth than with targeted regulation and compliance. This new paradigm of governmentality emerges through ‘the opening up new ways of practicing and thinking, new authorities and mandates, new technologies and conception for regulating and controlling people in risk society’ (Webb 2006: 6). They are generally characterized by individualistic and market oriented rationalities of governance. Individual choice, responsibility and freedom are valorized in all spheres of human action. So-called active citizenship is encouraged with individuals being increasingly held responsible for their own life-planning and for managing and calculating their own risks. These tendencies lead to the division between active citizens capable of managing their own risks and persons who have difficulties in doing so. The latter are being considered for state intervention and hence for social work as those for whom expert intervention is required. Webb analyses how these cultural, social and political conditions for handling risk in risk society shape the knowledge construction as well as the ways of delivering social work. Social work is witnessing a rise of empiricism and the development of evidence based intervention programmes emphasizing effectiveness, time limitation and outcome measures. The new emphasis on positivistic expert knowledge and the shift towards a technical rationality in order to reduce uncertainty and risk legitimize the hardening of what Webb calls an actuarial practice, which transposes the logic of control and regulation into the methodology of life planning. On the one hand these tendencies might be seen as a response to the narrowing of the gap between experts and lay persons and the growing blame culture professional practice is subjected to and, hence, as a way to regain professional credibility and public confidence. On the other hand, social work practice itself is increasingly transposed into a regulatory regime based on actuarial outcomes. In fact, with its preoccupation to rationalize risk social work practice is gradually becoming a technical-rational intervention agency. This means that an interpretative framework of professional practice is vanishing in favour of the administrative execution of narrowly specialized technologies of care. Thus ‘the spaces for professional judgment and autonomy become fewer and reduce the prospects of seeing beyond the enclosing technical framework itself’ (Webb 2006: 169).
7 The political perspective
Lastly the debate about ‘what works’ reveals also traces of political interests. All OECD countries are witnessing fundamental shifts in their welfare arrangements from the late 1970s (Gilbert, 2002). Although these transformation processes differ in their speed of change as well as in their path-dependent development and the extent to which they reframe welfare arrangements, they follow some common general tendencies, such as the territorialisation of the social sphere, the privatization of social services and of parts of the social security systems, the implementation of managerialist strategies in the field of social services and the establishment of activation policies (Kessl, 2009). One of the paradigmatic tendencies in these reform processes is the refocused attention on individual behaviour connected to the emphasis of private and individual responsibility, or as Lorenz (2006: 162) pointed out:
‘Welfare programmes are no longer carriers of the promise of social justice and equality but tools for the re-distribution of opportunities according to principles of justice which are based on the willingness by subjects to adjust to the demands of the new economy for totally flexible workers and indeed for the trouble free exclusion of ‘no-hopers.’
It is not hard to grasp that these paradigmatic shifts are not only a matter for social policy analysts but that they are of direct relevance to social work practice and to the question about ‘what works’ in social work. Additionally, in these emerging ‘post-welfarist’ scenarios the legitimacy of the public welfare role of social work and its interventions are perhaps more sharply put into question than ever before (Kessl, 2009). It is against this background that welfarist conceptions of professionalism are being regarded with suspicion and are being challenged. The notion of reflexive professionalism as the attempt to reconstruct a reflexive type of practice as the characteristic version of professional social work by means of establishing a reflexive interrelation of both academic and practice knowledge and the professional ability to translate knowledge into individualized interventions in specific practice situations (Dewe & Otto, 2005) is no longer seen as an adequate basis for providing effective and accountable services in social work. Instead a politically motivated ‘what works agenda’ and the widespread use of evidence-based approaches demand a more direct knowledge transfer, from positivistic, experimental sources to social work practice. This means that professional reflexivity is going to be substituted more and more by an instrumental technical rationale of intervention reduced to the implementation of standardized programmes to achieve predetermined goals (Kessl, 2009; Webb, 2006). This means that the tasks and the professional scope of social work become increasingly prescribed by a political agenda willing to pay only for results in terms of output-oriented and measurable –so-called SMART – criteria (Otto et. al., 2009). The assumption that the questions of ‘what works’ could be tackled with the adoption of managerial strategies and that good practice might be captured entirely by managerial and quantitative criteria led to a managerial rethinking of social work and changed the assumptions concerning criteria for ‘good practice’ even among social workers. These tendencies might well offer to social work once more the possibility to gain positions of importance and higher status (Lorenz, 2006). But playing this prescribed role requires a fundamental readjustment of the profession’s methodological and political orientation towards largely externally prescribed goals, which are measured by criteria of efficiency and effectiveness within given parameters of an explicitly political nature. These political parameters give new connotations to professional and methodological core principles of social work transforming them increasingly into functional notions of political strategies (Lorenz, 2006, Kessl & Otto, 2002). These attempts to enlist social work into the strategies of the new welfare agendas, impact on social work in an inescapable way. According to Lorenz (2006: 174):
‘Social workers are all too conscious that their very future as a profession might depend on their willingness to deliver on the terms set by the new agendas – the market might otherwise favour different or newly emerging operators which go under titles like care managers or life coaches.’
8 Recapturing ‘what works’ as an issue for democratic professionalism
Pointing out these different interests in the attempt for achieving accountable practice and their enmeshment with the corresponding knowledge basis in social work is the basis for understanding how the debate about ‘what works’ is involving social work with its inherent dilemmas. In the face of these new challenges social work has to brace itself to face these dilemmas anew by understanding them not only as unfortunate (or welcome) external constraints, but by taking them up fundamentally in order to develop cogent responses from the inside of a professional debate.
It has always been the distinctive element of social work as a social profession, that it ‘derives its mandate always from being based and linked in the way in which society, not a group of experts, collectively defines, often in a most contradictory way, criteria of well being, social integration, social solidarity and hence the conditions under which society can only exist’ (Lorenz 2006: 11). In this sense, the ‘social’ in social work is not only part of its title, but it has to be demonstrated as being its core mode of operating (Lorenz, 2006). The dilemmas of ‘what works’ under current circumstances give ground for re-examing what ‘the social’ as its mode of operating practice might mean for social work today and what kind of professionalism is needed for good and accountable practice. As Otto and Ziegler point out professionalism in social work is not to be seen as an end in itself, but it is an important requirement for realising the democratic potential of social work practice and hence for its legitimacy. Specifically with regard to its democratic potential social work needs solid and empirical foundations, but the orientation towards these foundations must not end up replacing professionalism by technical-actuarial practices which refer merely on the ‘functionings’ of clients and service users in an a-political way. Referring to the capability approach, Otto and Ziegler (2006) argue that social work has to be aimed rather at the enhancement of the capabilities of its clients in order to improve their life chances as self-determined individuals in a democratic society.
In fact, latest developments in the discussion about professionalism tend to counter the dominant trend of de-professionalization professionals in the care and welfare services were subjected to over the last decades. Freidson (2001) presented the notion of professionalism as an alternative to consumerism and bureaucracy, as a third logic, according to which professionals are seen as workers with a specialized knowledge and the ability to provide the public with important services without the directives of bureaucratic management or the free market. As Freidson points out this notion of professionalism had been subjected to widespread attacks by both neoclassical economists and populists, which are denigrating the value of credentialism and monopolies. Consequently professional skills and knowledge have been increasingly devalued, disaggregated and decontextualised with demands that they be measurable and evaluated by external criteria. Professional autonomy and control have been lessened and professionals have been more and more distanced from policy and decision making processes. This means that professional knowledge cannot be represented in the professional’s own terms and that job descriptions do not correspond anymore to holistic professional tasks. Rather the discourse is about performance measurement and professional work is cast in fragmented skill or program based terms. (Fook, 2002).
Furthermore the role of clients in social work changed also considerably. The complaint that experts render clients less capable, the criticism that professionals use authoritarian and paternalistic practices and the call for the democratisation of the services to service-user relationship have led to changes in service delivery and to increased attention being given ostensibly to clients’ wishes and demands. But while professionals themselves played an important role in these transformation processes, which resulted in clients being seen in new roles such as citizens and consumers, little attention has been paid to the question what the corresponding new roles of professionals might be (Kremer & Tonkens 2006). Picking up on Freidson’s concept of professionalism, Kremer and Tonkens analyze the unresolved issues concerning the new identities and functions of professionals. They observe that a new logic of professionalism is emerging both in practice and in the literature. This new logic, described as democratic professionalism (Dzur, 2004), can be seen as an adaptation of the traditional concept of professionalism, which links up with the demand for the democratization of service delivery and the criticism of professionalism while still preserving the core characteristic of representing public values. It shares with the established logic of professionalism the idea that public services are different both from bureaucracy and from the market in their commitment to the public good. But according to Kremer and Tonkens there is also a crucial difference to the classical logic of professionalism. In the concept of democratic professionalism knowledge and skills are not owned exclusively by professionals, rather they become the object of a democratic dialogue. Democracy itself becomes a value to be promoted by professionals. This means that the development, the maintenance and the exchange of knowledge remain at the heart of professional activities, but their application has to be the result of processes of democratic exchange in order to enhance the openness and the accountability of professional practice.
‘Professionals are defined by their possession of and willingness to preserve specialized knowledge from their field. By exchanging this knowledge with others collective knowledge is cultivated. But knowledge is not only exchanged among colleagues but also with clients. Professionals explain their views and procedures, acknowledge the specific knowledge that clients posses, and come to a compromise regarding the problems and solutions.’ (Kremer & Tonkens 2006: 132).
This does not mean that the boundaries between expert and lay person are blurred. Referring to Sennett’s work on respect (Sennett, 2003), Kremer and Tonkens argue that clients should acknowledge the superiority of professional knowledge in terms of diagnosis and treatment while professionals should acknowledge the superiority of clients’ knowledge when it comes to defining what competences are required to cope with their living conditions. Fundamentally, this democratic process, established through the skilful use of competences of communication, utilises the democratic potential of communicative processes and values the intrinsic coping skills of clients. In this sense, the concept of democratic professionalism implies a new balance between lay person and expert and frames the establishment of professional relationships differently (Kremer & Tonkens, 2006).
The logic of democratic professionalism is a promising concept for reconstituting the debate about ‘what works’ as a professional and as a political debate to be conducted in micro-contexts and for contrasting the reduction of social work practice to the execution of managerial and actuarial strategies with a broader framework of competent and accountable practice. This means that both in social work research and in social work practice a dialectic analysis is needed concerning the sources of knowledge that inform practice, about their potential to make predictions and about their limitations. Above all, this type of analysis needs to bring to the surface the different interests that lie behind the claims of knowledge and accountability.
9 Democratic professionalism: Dealing with knowledge and interests in a democratic way
Regarding the relationship between knowledge and power interests the notion of democratic professionalism means first and foremost being aware of how power interests are interwoven with different areas and presentations of knowledge in social work. This does not mean to reject a priori some forms of knowledge and to privilege others. On the contrary, it means to examine different sources of knowledge, which can inform practice and to question them as to their potential in specific fields of practice as well as to their limits. The important aspect is not to fall blindly into the traps of hegemonic assumptions that prevail in particular fields of practice and in the respective regimes of social policy and agency policy but to analyze the power interest they might represent and promote. This is not to be done only on a theoretical-conceptual level, but also in the micro practices of research and intervention. At the level of research it means for instance to reassess the potential for better practice and to acknowledge the general heuristic importance of quantitative research methods (Petr & Walter, 2009), something that in some social work circles critical of ‘evidence based practice’ is being frowned upon on principle. This can be undertaken to challenge, but also to complement research strategies informed by the critical hermeneutic tradition in the social sciences. At the level of practice it means to reach a knowledge base which informs good practice by accessing different sites of knowledge production and by negotiating between different sources of knowledge derived from a deliberate change of perspective, such as the clients’ perspective (particularly where different actors hold conflicting views), the research perspective, including that of neighbouring disciplines, and the perspective provided by agency frameworks concerning practice outcomes. In relation to the debate about evidence based practice this means that the aims and the process of intervention cannot be determined by standardized guidelines and rules, but these can nevertheless be taken into consideration as one important source of knowledge. Hence, evidence based approaches have to be combined with more hermeneutic approaches to the challenges presented by a particular practice situation in order to retrace, interpret and reconstruct the problems presented by clients in their actual complexity rather than reducing them to indicators that fit into given professional, administrative or political frameworks. This allows both professionals and clients to gain new insight into and new perspectives on a given problematic situation on the basis of a more dialectic view of the world (Otto et. al., 2009) As a result, more nuanced approaches to what can count as evidence and a more inclusive notion of knowledge based practice can be developed and this will lead to more integrated decisions (Williams & Glasby, 2010).
With regard to the debate about knowledge and ethical interests, democratic professionalism means that social work practice has to be more than the execution of pre-defined ‘people changing technologies’. Of course, findings from empirical research can and must inform practice and their systematic use can enhance transparency and honesty in social work practice by providing accounts of the actual state of knowledge on which professional interventions are based and by making this knowledge available to clients in appropriate forms. But involving clients in such a supportive dialogue has to go beyond merely explaining the scientific, objectified basis of expert interventions. Rather this mode of practicing professionally needs to address ‘what works’ for clients from their point of view and to validate existing coping abilities. In such a perspective the attention should be diverted from improving the ‘functioning’ of clients towards the enhancement of their capabilities and to enable clients to become the subjective authors of their own lives. Applying the concept of ‘subjectivisation’ proposed by Adorno, Matthies (2009) points out the constant dilemma between objectivisation and subjectivisation in social work. According to Matthies restricting knowledge to the concept of objective, evidence based facts that contain the entire truth concerning what is real risks to ignore the contradictions that exist between ‘the real’ and ‘the possible’ and of the resulting interventions will always gravitate towards manipulation instead of ‘subjectivisation’ in the sense of constituting clients as subjects instead of objects of professional attention ‘Subjectivising’ those processes enables social work clients to become subjects of their lives and this is not an idealistic goal but an indispensable precondition for the actual effectiveness of social work. Only under such conditions can professional social work practice have any chance to actually work. Social work interventions at the individual, group and community level can only ‘reach’ clients and be successful on the basis of participatory and subject-directed approaches. This also implies that the knowledge base of social work practice has to be the result of a constant two-way dialogue between theory and practice and between various perspectives of both professionals and citizens in order to open up perspectives for participatory changes, which means opening up ‘the possible’ particularly in those situations which appear to be closed and hopeless (Matthies, 2009).
Concerning the cultural dimensions inherent to the debate about the knowledge base of social work practice it seems also necessary to go beyond and critique the prevailing culture of risk management by actuarial practices. The question is how to regain trust in social work professionals in social conditions where the cultural basis of trust has become uncertain But as Kremer and Tonkens (2006) sustain, trust itself can only be restored not through the reference to facts but trough re-establishing democratic dialogue and thereby a greater openness and accountability of professionals. Trust per se cannot be established as the result of democratic dialogue on specific topics, but it is rather a precondition for such dialogue to become established. A democratic dialogue can only emerge if the involved parties dare to trust each other and when the possession of authority by one side or the other is not a foregone conclusion. This means that both professionals and clients recognize each other’s knowledge (and its limitations) in all its relativity and still come to a joint understanding of the problem and its possible solutions. These preconditions for democratic dialogue can certainly not be to the sole task of social workers and their clients. They form part of a political and normative context which social work needs to be concerned about as a broader political and social project for which coalitions with a wider community of activists is required.
This leads again to the political interests in the debate about ‘what works’ in social work. How can democratic professionalism deal with political interests and how can it inform the highly politicized debate about what works? First of all, it would be important to recognize that what is effective in social work cannot be measured only by managerial and standardized criteria. The aims of social work (and parallel to that also those of social policy) cannot always be expressed immediately in measurable outcomes. The reduction of professional practice to or even their substitution by the implementation of managerial strategies and standardized programmes of intervention in order to achieve predetermined goals has led to an increase in bureaucratization and a creeping de-professionalization processes in social work practice. In addition, the dominant political tenor to pay only for ‘what works’ on the basis of proven measurable evidence (and if there are no cheaper alternatives) might also have a perverting impact on the effectiveness of social policies, thereby increasing the dilemmas faced by social workers. Social work as part of those frontline processes where strategies of social policy meet people’s needs is always faced and has to deal with different interests and different sources of knowledge in the micro-processes of practice. On this frontline, the concept of democratic professionalism holds a great potential not just for more effective forms of practice, but also for shaping the development of social policies from below. As Matthies (2009) finds, social work and other street level professional knowledge has not been used systematically to influence the development of policies. This could be indeed a promising direction in which to develop the expertise of democratic professionalism in social work. Bringing in street level knowledge as the result of a dialectic and democratic dialogue between those who implement social policy strategies and the respective target groups of service users could become an promising strategy to overcome a reductionist, managerial and instrumental ‘what works’ agenda and to develop more effective, more accurate and probably more just social policies.
The debate about what might be the basis for good professional practice in social work has been part of its history of professionalization from the very beginning. In this sense, the dilemmas emerging from the highly dichotomized debate about evidence-based practice are neither something new for social work, nor a merely theoretical academic debate between different ontological and epistemological views. It is rather the awareness of these inherent dilemmas in social work practice, which constitutes the crucial requirement to recapture the debate about ‘what works’ from the insides of the profession. This means that social work practice must be able to deal with different sources of knowledge as well as with their limitations and it needs to bring to the surface the different interests that lie behind the claims of knowledge and accountability. In this regard the notion of democratic professionalism seems to be a promising concept to reconstitute the question about ‘what works’ as a professional and democratic debate to be conducted in practice. Promoting a dialectic and democratic dialogue between the two spheres social work is rooted in and committed to - socio-political objectives on the one hand and lifeworld processes on the other one - social work practice itself generates a valid source of street level knowledge, which should inform the development of social policies from below.
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