Method: Employing grounded theory methodology, a sample of 31 clinical social work practitioners from 6 states (CA, CO, MA, NY, VT, NC) was interviewed in depth using a structured interview protocol. Purposive sampling allowed variation by length of time in practice, gender and involvement with managed care. ATLAS.ti software was used to manage the data set and insure complete coding.
Results: These theoretically eclectic practitioners reported that problem formulation is a complex process, not simply and completely done in a few sessions nor invariant over time. They integrated psychological and social factors, and attended to diversity issues. Economic influences on practice, particularly managed care, and other agency policy factors were also shaping influences on their evaluation practices. Monitoring and summative evaluation were not viewed as separate by these practitioners. Methods for collecting data and testing its validity are common in their descriptions.
Implications: These findings can help social work researchers understand how in-vivo practice evaluation is done and orient development of "practice-friendly" approaches to evaluation. Implications for future research and for training are offered.
Methods: This was an ethnographic, sociolinguistic study of three interdisciplinary teams at "Riverview Children’s Center," where children with possible developmental disabilities were referred for comprehensive team evaluations. The authors used multiple methods of data collection, including participant observation, interviewing, and a review of case records. They videotaped the teams’ processes of pre-assessment, disciplinary assessments, post-assessment team meetings, and team-parent conferences in the evaluations of 15 children.
Results: Interdisciplinary constructions of problems and diagnoses were negotiated between parents and professionals and among professionals through a complex series of context-specific social interactions. The parents’ prior experiences interacting with other professionals about their child provided additional contexts that were outside the awareness of the teams. Parents and diverse professionals contributed to both medical and social diagnoses. When professionals offered recommendations, they placed parents in the role of passive recipients.
Implications: Because parents’ prior knowledge and experience enter into the ways in which they participate in the evaluative process, social workers could assess these areas in advance and, if needed, assist parents in formulating their questions and obtaining answers. Teams would benefit from increasing their awareness of the extent to which parents and non-medical professionals contribute to the social construction of medical diagnoses and non-social workers contribute to social diagnoses. Suggested questions for team reflection on their own processes will be offered.
Methods: I used ethnographic methods to examine the service and evaluation experiences of case managers and clients in Jobs Initiatives in four U.S. cities. MIS data and auxiliary interviews and observations with program and Foundation principals, agency staff, and training providers augmented the service data and produced triangulation of source, investigator, and perspective. The data set includes over 200 contacts relevant to the 20 practitioner-client dyads. NVivo qualitative software was used for data management and code-based case construction.
Results: Performance-based funding both contributed to and detracted from service delivery processes and program evaluation. At the organization level, mandatory establishment of management information systems increased agencies’ ability to collect and use data for evidence-based program development. The technical requirements of MIS, however, strained agency capacity and increased pressure to meet outcome goals, which contributed to applicant creaming or uneven provision of agency resources. At the practice level, performance-based funding encouraged practitioner/client collaboration, practitioner self-assessment, and service advocacy, but also contributed to practitioner role strain and client dissatisfaction with services.
Implications for Practice and Research: Challenges experienced under performance-based funding in the Jobs Initiative may be similar to those encountered by practitioners working under other third-party funding directives such as managed care or welfare-to-work. Program design and evaluation can be improved and service delivery enriched by including the "voices" of practitioners and clients in setting service and research parameters under performance-based funding.
Methods: A review of the literature on process evaluation in social work and closely allied fields raises issues about its definition, its importance and its role in both practice and research efforts. Publications addressing process factors have declined as emphasis on outcomes has increased. However, the practice literature shows continued attention to process issues in "traditional" as well as managed care settings. This literature continues to include ongoing attention to the evaluation of process and clinical technique.
Findings: Recent emphasis on outcome celebrates results while minimizing attention to how they are achieved. With any practice model, wide variation is encountered due to a multiplicity of variables which include the skill level and personality of the practitioner and the difficulties, personality and environmental supports of the client. Such "practice wisdom" has slowly faded from favor and is absent from the latest Encyclopedia of Social Work. Practice wisdom performs a mediating function between intervention models or programs and the individual clients engaged in the program, addressing process and technique.
Implications: Research examining how master clinicians conceptualize evaluation and the connection of technique to evaluation will complement research on aggregate outcomes. This is a practice-friendly route to bridging the gap between research and practice while expanding the relevance of outcomes.