Social Work Students’ Use of Knowledge in Direct Practice – Reasons, Strategies and Effects

This article describes a study of Swedish social work students’ use of knowledge during their field practice. Data was collected by using short written narratives, where the students reflect on situations from practice, situations they experienced as critical or problematic. The narratives were analysed with a method inspired by the interpretation theory of Paul Ricoeur.

The article starts with a discussion adhering to the present trend of evidence-based social work practice. This is followed by a study of 144 narratives from social work students containing critical or problematic events. A quantitative description of the material as well as qualitative model of two type-strategies, that social work students use, is presented.

The results show, among other things, that students use several forms of knowledge, where facts/evidence is one of several. The study also shows that there is a strong adaptation to varying critical situations. A conclusion is that it is difficult to a priori define the types and proportions of knowledge to use in social work practice.

What kind of knowledge do social workers use? And maybe more importantly, what kind of knowledge should social workers use? Both of these questions are major issues within the field of social work, and dictate a vast array of research that deals with the production of knowledge in social work. We have come to deal with these queries by studying Swedish social work students’ use of knowledge during practice. This article presents an empirical study, based on social work students’ narrative accounts of sources of knowledge, use of knowledge, and its effects.

A present trend in several countries in Western Europe and the USA is that social work practice should be evidence-based (Gambrill 2006; Gilgun 2005; Morago 2006; Roberts and Yeager 2006; Rosen 2003). In principle, it means that work-modes and methods should be based on well-founded knowledge about the effects of certain interventions, preferably client-effects. This is partly based on a normative intra-professional standpoint expressed by social workers, for example through the standards of International Federation of Social Workers (http://www.ifsw.org). This development is also a reaction to a striking lack of knowledge regarding the content of the working-process and the possibilities to describe the result of interventions. It is a problem for the public finances that publicly administered social work, cost taxpayers billions of dollars in many countries, and possesses poor knowledge of efficiency. Another, maybe more serious, problem is that clients cannot, with any greater certainty, beforehand know what kind of help society can offer, or which results different kind of interventions can lead to (Morén and Blom 2003).

In several places in the world, measures have been taken to handle this lack of knowledge. On the international arena, the foundation of Campbell Collaboration can be noted as a present and important example. Campbell Collaboration is an international network with the goal to produce, update, and disseminate systematic reviews of studies of effectiveness of social and behavioural interventions. The object is to produce reviews that are useful to policymakers, practitioners, and the public. The Campbell systematic reviews will be published electronically as well as in printed reports. The systematic reviews of research, will summarize empirical evidence of different interventions, primarily based on randomized controlled trials and, secondly, on quasi-experimental designs. The raw-model is Cochrane Collaboration, the global network for evidence-based medicine (http://www.campbellcollaboration.org). In Sweden (Socialstyrelsen 2001) and Norway (Angel 2003), this development within the field has been launched in terms of “knowledge-based social services”.

The concentration on evidence-based social work practice will probably bring the development forward, at least when it comes to knowledge about effects of interventions and programs. However, it is unlikely that this kind of knowledge explains, in a deeper sense, how and why effects emerge from a certain intervention. Moreover, randomized controlled trials do not take contexts into consideration (focus is primarily interventions and results). This means that such studies cannot tell us in what way the context conditions social workers practice and the client effects (cp. Kazi 2003; Mark et al.2000; Morén and Blom 2003; Pawson and Tilley 1997;).

Nevertheless, this concentration rests upon the assumption that by supporting social workers and others with systematic reviews of “what works”, intervention in social work practice will become more effective. It is also, implicitly, assumed that social workers will act according to this rationale, by searching for and utilize evidence-based knowledge.

This idea presupposes that social workers think and act in a certain way, and work under certain conditions. But is it really this way? Do social workers think and act according to the rationality underpinning the idea of evidence-based social work practice?

Those who are critical and question the current development towards evidence-based social work practice, argue that the view of reality is mechanistic and the view of knowledge is empiricist (Angel 2003; Månsson 2003, Webb 2001).

We, the authors of this article, do not oppose the ambition to improve social work practice, but we argue that it is essential to ask whether it is possible to work according to the rationale of evidence-based social work practice? Moreover, as a more open question, it is legitimate to ask whether this corresponds to the way social workers think and act in practice?

Empirical studies of social work students’ use of knowledge in direct practice are quite rare (cp. Evans 1990), though a recent example is Papadaki and Nygren (2006). However, there are a number of workbooks and guides dealing with what students should do to apply different sorts of knowledge in practice (see for example, Horejsi and Gartwait 1999; Rosen and Proctor 2003; Rothman 2000; Royse et al.1999; Weinbach and Grinnel 1996). When it comes to social workers’ use of knowledge in practice the situation is different. On the international arena there are a number of empirical studies concerning social workers: rationales for practice decisions, use of research, skills, knowledge use et cetera (see for example, Calvin 1993; Papadaki/Papadaki, 2006; Rosen 2003; Rosen et al. 1995; Sheppard et al. 2000; Zeira and Rosen 1999).

Moreover, there are a great number of texts discussing what social work is and what it should be, which indirectly touch upon the question of social workers’ use of knowledge (see for example, Dominelli 1997; Goldstein 1990; Howe 1979; Payne 1997; Reamer 1994; Vass 1996).

On Swedish ground, relatively little is thus far known about social work students and social workers’ levels of, and attitudes towards, knowledge. However, there is a growing interest for knowledge development in social work, as it is manifested in practice and education (Bergmark and Lundström 2000; Dellgran and Höjer 2000; Khoo 2004; Nordlander, 2006; Nygren and Blom 2001; Nygren and Soydan 1997; Westin Hellertz 1999).

In the study presented in this article, we have applied a narrative method of analysis to search for the knowledge content in critical and problematic events occurring during the field studies of social work students. The starting-point for narrative analysis is that when we narrate (tell) something, we convey a message about the meaning or understanding our experiences gives us. A fundamental assumption within this research genre is that story telling serve the purpose of creating meaning from one’s lived experiences (Atkinson 1997; Bruner 1990; Czarniawska 2004). The narrative method has a specific strength in studies of fields of activities where humans work with humans on a social, and thus abstract level, because the mutual understanding becomes an important part of the result (e.g. Salander 2002).

Since we are interested of the meaning that critical situations during field-studies has for social work students, an analysis of the stories that the students create about these situations seems to be a relevant point of departure. Concerning social work, such a starting-point is not original, and there are both research in social work with a narrative approach (Riessman/ Quinney 2005) and practice methods, which are based on narration (Milner et al. 2002).

Swedish social work students in the last semester of their education (which is preceded by a whole semester of field studies including training to work directly with clients) were asked to write a story with the following instructions: Write down a “narrative”, a compressed story, where you describe a situation from your practical training in which you can describe the presence of knowledge/“un-knowing” in relation with client/s.  [1]

What kind of knowledge was it?

From what source did it come (supervisor, colleagues, earlier theoretical studies, earlier experiences et cetera)?

In what way did that knowledge work in the situation described?

The 144 stories were used as a pedagogical tool, as a basis for verbal presentation and discussion in the classroom, but we collected the written narratives for research purposes. They were analysed with a method of analysis that we have developed previously (Nygren/ Blom 2001). The method is based on the French philosopher Paul Ricoeur’s interpretation theory (Ricoeur 1976; 1981; 1984; 1985; 1988), and inspired by a method for research on lived experiences developed within nursing research (Lindseth/Norberg 2004).

The narratives were read with Ricoeur’s interpretation theory in mind. In the first step, all 144 narratives were naively read. This reading resulted in development of the categories in Nygren and Blom (2001), as well as in identification of some new ones. Altogether we identified nine categories concerning how the students formulated the knowledge content in the situations they had described.

These categories were labelled and memorized through simple codes, for example “type of story”, “type of co-actors”, “mentions explicit source for working knowledge”, “useless narrative?” et cetera, but also codes like “apparently influenced by the preceding lesson on theory of knowledge” and “effects of reflection”. These codes led to columns in a matrix where the rows consisted of the information from each narrative. A quantitative description of the most central categories is presented in tables 1 to 6 below.

The purpose of the naive reading is to “get a sense of the text as a whole” (Ricoeur 1976). The procedure was to, after each naive reading, formulate an open and preliminary answer to the question: What meanings are expressed by these stories? The answers, generated from the 144 narratives, were ordered according to the following frame of reference:

The naive reading was followed by a careful structural analysis of a purposive sample of 20 narratives. Those 20 narratives were not chosen randomly to be representative. Instead they were selected subjectively for their high significance and richness of information, and thus their heuristic value (Patton 1987). Those narratives were in different ways special and extra informative and thus possible to learn much from.

The structural analysis sometimes needed several steps, sometimes not. In the structural analysis the aim was to identify meaning units in the text, and these units varied in size from one word to whole paragraphs. The textual elements isolated in the coding procedure were in the process of the structural analysis placed together with other elements (segmentation that generated horizontal relations between elements). Furthermore, connections between elements and the naively understood whole were searched for, where different elements were ordered hierarchically “within” this whole (and that often modified this whole) (Ricoeur 1976, 84). What appeared, in Ricoeur’s terminology, was a dechronologisation of the narrative that rendered an opportunity to uncover the narrative logic, underlying the narrative time. “To explain a narrative is to get hold of its symphonic structure of segmental actions” (Ricoeur 1976, 85).

Generally speaking, the structural analysis aims at generating a matrix that is much more detailed and logical than what results from the naive reading. The matrix is given a schematic form, describing, at least ideally, a hierarchy of actions correlated with a hierarchy of actors (Ricoeur 1976, 85).

Finally, the naive whole generated in the first reading of the narrative, was brought together with the themes from the structural analysis in order to “ground” an interpreted whole. The process can, with the terminology of Ricoeur, be described as a way to go from the guessing mode of the naive reading, to the explaining (but not interpreting) mode of the structural analysis, and then to an in-depth interpretation. The whole is reformulated in narrative form in order to present for the reader of the analysis a readable version of this in-depth interpretation.

Already in the way of framing the result of the naive reading, a strategic choice is made–the option exists to go through the procedure case-by-case from a naive reading, to structural analysis, over to an interpreted whole, and then adding the “wholes” of all individuals, making a general naive whole. Instead the choice here was to consider the results of the naive reading of all 144 narratives in a common frame of reference, and then let the various themes generated from all cases in the case-by-case structural analysis merge into that frame for the creation of a new interpreted whole. In other words the social work students are considered as a collective, or as carriers of the discourse that is studied. The aim was not to research why student A reflects one way while student B reflects another.

The structure of the results section is the following. First we present an example of a narrative; one students’ story. Then we present a quantitative descriptive analysis of six main variables in the material. In the final part, the result is presented as two type strategies (the fact- and the skill-based) either one, which social work students choose to follow. The empirical study is more fully presented in Nyman and Scheid (2004).

Sven – an example

In this part we have chosen to present Sven’s (false name) narrative, as an illustrative example.

“One of the patients I regularly have contact with comes to a day-activity centre where we have decided to meet. He is in a miserable shape; hollow-eyed, cold sweating and filled with anguish. I immediately take him from this place and instead find a “conversation room” that is not occupied, where we sit down. He tells me of a, for him very important, beginning of school the night before, that according to him ended up in a catastrophe. The man is heartbroken, words and tears are flowing out of him, and during a few moments he loses his connection to reality. During the first part of the conversation I am almost completely quiet, only asking some brief questions. After he has ended his story, I take a more active part, where the purpose is, to some extent try, to tone down the un-controlled negative thoughts that govern him. Maybe his failure could be relativized. The timeframe the man and I have set up during other meetings doesn’t count this time. One hour becomes three. When we finish this conversation, I regard him as calm and collected, but also very tired.

This situation is described much summarised, because most of the content of the conversation does not fit into this short narrative. When it comes to types of knowledge that I used, it is difficult to exclude any of the forms that the teacher of this course talked about. To say that facts to a great extent governed my acting feels, in a way, rather futile. Nevertheless, there is always a “bank of knowledge”, containing facts, which you (irrespective of one’s idealistic dream) often have to start from. In this case, information from countless, more or less obscure, books on psychology and psychiatry, concerning symptoms and other things, surely was part of the picture. Moving towards a micro level, one might say that my knowledge of where the “conversation rooms” are situated at the clinic partly forms the situation. My understanding is, to some extent, formed by my facts. The situation with a human in a state of breakdown, I would probably regard as frightening, if I were not to have any idea about why the person would be in that state. Here I believe that understanding (identification) and my ambition to understand is present in, for example, my questions, during the conversation.

Skill can in this case be about the choices I make during the situation, the forms and the techniques around and in the conversation. For example, to choose a secluded place, not to govern the conversation, not to finish after an hour, and not to moralize and simplify. At the same time I do not recall anything that might be conceived as craftsmanship.

Familiarity might be a part of the picture, in spite of the student’s (my) insignificant experience. The examples almost touch upon the category of skill, but might be the feeling for when to finish a conversation or when a certain kind of question is appropriate. To choose to take the patient’s hand and hold it is maybe also to fall back on a personal familiarity.

The sources of knowledge are awkwardly hard to find. Maybe earlier experiences from meetings with persons in crisis, is such a source of knowledge. The social work education, especially the relational approach it conveyed, in combination with Christian values, could be another source. The psychodynamic frame of interpretation that I’ve been dragging on during my practice term, and that probably influenced my way of conceiving (often negatively, could be a hindrance for un-knowing), is naturally from the literature (education, other courses, own reading) but also from influences from the supervisors and colleagues I’ve been in contact with. This question is also almost impossible to answer. – – – Well, the story has a rather happy ending. The state of total inner chaos, in principle, comes to an end. Summing up, one can say that this is the effect my knowledge, partly, contributes to. The man gets someone to express his desperation to and this someone seems to cope with this. It doesn’t have to be more difficult than this. At least if one “freezes” the situation just described.

Below we present a quantitative descriptive analysis of the six main variables in the material. Our mode of procedure, working with the 144 narratives, enables us to classify situations, forms of knowledge, as well as consequences of knowledge. Superficially this had been possible to achieve with a “simple” questionnaire. The point is that we can base our classifications in down-to-earth descriptions of situations, and that we not only can label them, but say something about the relations between situations, use of knowledge, and consequences and the attributed meaning. Thus, we can both give a “thick” descriptive aspect and a well-founded interpretation of the importance that these situations, use of knowledge, and the consequences have in the stories.

The method of analysis offers, in addition to the hermeneutical-phenomenological approach, a possibility to conduct a quantitative analysis. The number of narratives (144) gives a possibility to quantify in several steps. On the one hand, the meaning units, stemming from the structural analysis could have an interest as such (Söderberg and Norberg 1993), and on the other hand it is possible to situate the result of the qualitative analysis (type-stories) in a quantitative relation to these meaning units.

As a result of the limited space, we have chosen to illustrate with a number of tables from the quantitative analysis. The presented quantitative analysis should not be regarded as a completed approach. We want to show that the decomposition of the material that this analysis offers, contributes to further explanations. If the choice is to view this instrumentally or manipulative, it is possible to suggest changes in, for instance, the social work education. The results can thus be valued in relation to norms of what is desirable in the education (goals, curricula et cetera). It is possible, for example, to ask if the result in the tables reflects the ambition to educate reflective students.

Table 1: Type of narrative

Table 2: Knowledge according to students

Table 3: Knowledge sources

Table 4: Effects of knowledge

Table 5: When reflection occurred

Table 6: The effects of reflection on students

In general, the narratives deal with meetings between a student and a specific client (in some cases with a group of clients or that one writes about client meetings in general). This is probably not a coincidence, having in mind the instructions the students were given (cp. above). But it could also be that it is in meetings with individuals that the students experience the problems most strongly, and that these situations attach to the memory more obviously, compared to situations where the students acted together with others in relation to families, groups et cetera.

We have chosen to classify the students’ specification of type of knowledge, by the use of concepts that we know was familiar to the students before they wrote their narratives. Here the lecture that preceded the data collection came to structure the way of writing. For example in Sven’s narrative above, it is obvious that he reflected on different types of knowledge according to the concepts (fact, understanding, skill, familiarity and un-knowing) that we introduced beforehand. Thus this specific theme has more the character of a questionnaire, than the subsequent tables, that was generated via the structural analysis. One might say that we combined the possibility to work with the Ricoeurian hermeneutic-phenomenological method with a deductively structured description. However, not completely – the students have sometimes expressed themselves in terms of “blanking oneself” or that they have “tried to disregard previous knowledge”, something that we classified as un-knowing as role-behaviour (Blom 1999, Morén 1992).

Reported sources of knowledge have been classified according to categories that were identified in the narratives: social work education, personal experiences, different written sources and persons connected to the practice placement. Sven’s narrative clearly illustrates that knowledge used in a specific situation can derive from different sources. In his case, for example academic courses, books on psychology, his earlier experiences and tutoring from supervisors. In some cases, the students have stated directly what the active knowledge stems from, in other cases we have inferred it from the narratives. The sources of knowledge that we identified that were not reported by the students do not always seem to be known by the students. Even though the writing of the narratives was about reflecting, it does not mean that everything that was written down was reflected upon.

When it comes to the question of the effects of the knowledge, our classifications are “inductively” generated, based on what the students reported. In the instructions to the students, no example of possible effects was given. According to the students, the knowledge had mainly positive effects, especially for the understanding of the processes during the meeting with the clients. It is interesting to note that knowledge in some cases was regarded as an obstacle, leading to a temporary blockage of the students’ understanding and action.

The students’ reflection on the problematic situation was in a third of the narratives reported to have occurred during the actual situation. In the rest of the narratives we estimate that the students reflected during the writing of the narrative.

In some of the narratives it was specified what the reflection, the actual writing, meant for the student. We have chosen to classify that in terms of insights about knowledge and about preconceived ideas. In the majority of the narratives, effects of the reflection were not stated, neither was it possible to make any interpretation based from the texts. It would probably have been possible if the students had requested to reflect on that as well. However, it can be assumed that the effects of the reflection in most cases were an increased understanding of the critical/problematic situation.

According to the Ricoeur-inspired analysis we used, the naively read and structure-analysed narratives, was in a third step given a new form. The material was compiled to type stories, which are ideal typical summaries of the 144 narratives. At this stage the interpretation process has generated, what Ricoeur (1976) denominates in-depth interpretation. Due to limitations regarding the length of the article, the type-stories are not presented here. Instead, we have come to draw the analysis a bit further, and below we present the results of this extended analysis.

Based on the type-stories, we have been able to crystallize two type-strategies regarding social work students’ use of knowledge. These strategies are presented in the figure below. The aim to discern these type-strategies is to show how different ways of handling critical situations by using knowledge – ideal typical – can be manifested in practice. The strategies are called the: 1) Fact-based type-strategy, and 2) Skill-based type-strategy.

Figure 1: Social work students’ use of knowledge in critical situations – two type-strategies

The fact-based type-strategy shows an uncertainty among these students regarding which type of knowledge that is needed to handle the situation. One can also notice that the situation the students face, brings about a feeling of anxiety, hesitance and torment. In order to feel more secure and confident, they obtain knowledge and information from many different sources before the meeting with the client. This illustrates an ambition to establish a “good” meeting. Students using the fact-based strategy prefer routines to follow. Routines can be a way of creating a feeling of safety and calmness for the students, which is necessary in order to develop a professional approach.

The skill-based type-strategy illustrates that these students are, what might be phrased as “impressionistically” active; they have an experimenting and questioning approach. Students using this strategy reconsider their own actions and use to a greater extent their own intuition during the meeting with the client. By way of example, Sven’s narrative demonstrates an approach with many of the characteristics of the skill-based strategy. It is apparent that Sven, despite quite extensive book-knowledge about psychology and psychiatry, does not begin from a theoretical stance. Instead he utilizes his theoretical knowledge as a more general frame of reference that helps him understand and cope with specific events in the situation described. Facts in the form of theories were thus important for Sven, but nevertheless subordinated in relation to his more intuitive and skill-based way of encountering the patient.

According to Schön (1983), people usually reflects on their work, when there is something puzzling, annoying or interesting, they want to understand better or get along with. This process is significant when students, during their field-placements, sometimes handle situations that are characterized by uncertainty, instability, and value-conflicts. With the fact-based strategy reflection, occurs temporarily after the situation, what Schön (1983) calls reflection-on-action. With the skill-based strategy, reflection is made during the event, a so called reflection-in-action (Schön 1983). However, both strategies are used to understand and ascribe meaning to, some problematic aspect in a specific situation.

It is obvious that the students view the client meeting as important in social work practice, and that they are keen on establishing a relationship with the client. The client meeting seems to be the most important “learning-event”. However, students do not derive much knowledge from the client as a person. We believe that the students want to ascribe themselves a large and important part of the knowledge process. It is during the field-placements, in meetings with clients, that students have the opportunity to connect theories and previous knowledge.

According to our study, almost half of the knowledge (such as personal experiences and theories) that social work students used in a critical knowledge was acquired before the practice term. This implies that more than half of the knowledge is acquired during the field-placement. We regard this as an indication of how important the field studies are for the students. They utilize different kinds of knowledge during the field studies, depending on where in the work process they are. Approximately half of the students change strategy during the process, for example, from a knowing to an un-knowing approach.

We regard reflection as an important way to treat different questions. The study shows that less than half of the students (42%) had reflected during, or in connection to, the critical event. This implies that the majority of the students in our study were offered an opportunity to reflect upon the critical event by writing the short narrative.

The results show that students use previous and personal knowledge during the field placements. Reflection on events leads to new maps to navigate after. We argue that the field studies offer the students a possibility to form personal ambitions to handle future work tasks and the creating a professional identity.

The conclusions of our study are not self-evident. For example, which are the implications for the social work education and practice, that students’ use of facts is 25%? Is the degree of facts in use sufficient or should it be higher or maybe lower? Given the idea of evidence-based social work, the degree of facts usage should probably be higher. But that is a normative idea that is not based on evidence showing that social work practice is better if more facts/evidence is used. Our study shows that facts partly have been a hindrance for some students when encountering clients.

Another question concerning the results is the question of, what it means that the social work education is the stated source of knowledge in less than a fourth of the cases (23%), and that the students’ own similar experiences are stated as the source of knowledge in a fourth (25%) of the cases? Is this a failure for social work education or an achievement that we have succeeded to teach the students to not solely rely on academic knowledge? We argue that the relatively high number of students (17%) claiming they used un-knowing as a conscious role-behaviour (and as such tried to “put” their knowledge aside for a moment) indicates that students act rather deliberately in relation to knowledge and its use. Viewed this way, the results indicate success.

The quantitative analysis of the narratives shows that the effects of knowledge in 6% of the cases were blockage and partial paralysis of action. But in almost all the narratives the students regard the meeting with the client falling out well. This indicates that the students, on the whole, acted adapted to the situation and utilized knowledge that they experienced as relevant in the specific case. The students’ adaptation to the situation also explains why the knowledge sources as well as the effects vary relatively much in the 144 cases.

Some argue that the present demand for evidence-based practice in social work is determined by and judged upon the use of the medical model (Angel 2003; Månsson 2003), or based upon narrow mechanistic ends-means rationality (Webb 2001). This would indicate a particular type of thinking concerning knowledge, and the use of knowledge in practice. The idea, in brief, is that facts (evidence) should be used to intervene more informed, deliberately and consequently more effectively (cp. Campbell Collaboration home page). This is a sort of fact-based strategy, to use our words. However, the results of our study seem to challenge this idea. A majority of the students did not go into the client meeting loaded with a bunch of facts, but rather with their own similar experiences or with a deliberate un-knowing. The use of facts, according to the narratives, mostly occurs when students use the fact-based strategy initially. In spite of its name, the fact-based strategy does not imply an instrumental application of facts. The material shows that even fact-based students gradually came to revaluate and face the situation more open-minded.

Anew, we want to stress that we are not opponents of the use of facts/evidence in social work practice. Our ambition with this study has been to learn more about social work students’ use of knowledge, but as a result we have come to problematize some of the assumptions that seem to underpin the current idea of evidence-based social work. At present, no one can with scientific certainty claim what kind of knowledge that is superior to use in social work practice. From our point of view, different kinds of knowledge (where facts/evidence is one of several) are needed, but the types and proportions of knowledge are difficult to define a priori. The social work students’ strong and flexible adaptation to specific situations, in our study, is empirical evidence for this conclusion.

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Author´s Address:
Ass Prof Björn Blom / PhD Prof Lennart Nygren / Cia Nyman / Carina Scheid
Umeå University
Department of Social Welfare
SE-901 87 Umeå
Sweden
Tel: ++46 90 786 50 00
Email: Bjorn.Blom@socw.umu.se / Lennart.Nygren@socw.umu.se / Cia.Nyman@socw.umu.se / Carina.Scheid@socw.umu.se