Competency in Generalist Practice: A Guide to Theory and Evidence-Based Decision Making

382 Pages·2006·2.03 MB·English

by  Elizabeth Moore Plionis

Competency in
Generalist Practice:
A Guide to Theory and
Evidence-Based
Decision Making
ELIZABETH MOORE PLIONIS

OXFORD UNIVERSITY PRESS
COMPETENCY IN
GENERALIST PRACTICE
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COMPETENCY IN
GENERALIST
PRACTICE
A GUIDE TO THEORY AND
EVIDENCE-BASED
DECISION MAKING
Elizabeth Moore Plionis

1
2007
1
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Library ofCongress Cataloging-in-Publication Data
Plionis,Elizabeth Moore.
Competency in generalist practice :a guide to theory and
evidence-based decision making / Elizabeth Moore Plionis.— 1st ed.
p. cm.
Includes bibliographical references and index.
ISBN-13 978-0-19-517799-2
ISBN 0-19-517799-1
1. Social service—Decision making. 2. Evidence-based social work.
3. Core competencies. 4. Social work education. I. Title.
HV41.P56 2007
361.3—dc22 2006007094

1 3 5 7 9 8 6 4 2
Printed in the United States ofAmerica
on acid-free paper
I dedicate this book to my husband, Dimitri, and my children, Alex, Dean, Nick,
and Elena; and to my mother, Bessie, my father, James, and my brothers, Jim and
Terry. I thank you for your constant emotional, intellectual, and creative support.
You have sustained and enriched my life beyond belief. I also dedicate this book to
Mrs. McCree.
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Preface
As an educator with more than 25 years ofexperience,I have observed two devel-
opments that have had a dramatic impact on teaching students how to make
competent practice decisions.The first development is generalist practice.Gener-
alist practice requires students to engage in the open assessment ofthe different-
sized systems found in direct and indirect practice.Students must consider multiple
theories prior to reaching a decision in a specific case or situation.
The second development is evidence-based practice.Evidence-based practice
requires students to additionally evaluate a vast empirical literature when de-
termining which intervention is better than another.Presented with an array of
evidence and method and theory choices,students report having considerable
difficulty in deciding which intervention is the best under the circumstances ofa
specific case or situation.Until now,tools for teaching students how to make such
a decision did not exist.Students have traditionally been taught to apply a domi-
nant theory (for exampl e,psychodynamic theory) to one system size (for exam-
ple,the individual).
This process does not lend itself to complex case data requiring the use of
more than one method and more than one theory when targeting more than one
system size in the same case.For instance,advocacy may be needed to change an
organizational policy to ensure that a specific client receives needed treatment.
As a consequence, many clients (subpopulation) will benefit from the policy
change.
I have written this book to assist teachers,supervisors,and students in navi-
gating existing knowledge and a vast empirical literature when making case-
specific decisions in accord with the standard of best practices. Best practice
is defined as the conscientious, explicit, and judicious selection of an effective
(evidence-based) and appropriate intervention strategy for a specific client or sit-
uation (Sackett, Richardson, Rosenberg, & Haynes, 1997). If one is to consider
viii Preface
systems in direct and indirect practice in the same case,students need a text that
teaches such content side by side. The skills associated with direct and indirect
practice are different and cannot be merged or interchanged one for the other.
Thus the book presents different skill sets needed for direct and indirect practice
in alternating chapters.The framework is integrative without being reductionist.
Several factors have prompted me to write this book.First,I have been influ-
enced by students who observe that there are too many theories and no mecha-
nism to help them know which theory is better than another in a specific case and
bythose who feel a disconnect between what is being taught in the classroom and
what they experience in their field placements.Similarly,students express a dis-
connect (and polarization) between direct and indirect courses in the curriculum.
Students in policy, advocacy, management, and community practice frequently
observe that they are being taught content relevant to clinical students at the cost
ofnot getting content they need for their practice area.Clinical students similarly
perceive that their policy courses have little relevance to their clinical practice.
Generally,students express frustration with first-year descriptive survey courses
that rarely lead to reasonable prescriptive interventions for the cases they en-
counter in the field.
Second, I have been motivated by the dismay instructors and students feel
when faced with the large number ofrequired and supplemental texts needed for
a course.Books tend either to be specialized or too general.To compensate,in-
structors prepare reading packets or place readings on electronic reserve. Stu-
dents complain about difficulties in accessing such materials and the cost of
purchasing more than one text per course.They observe that much of what is in
their required text either needs to be supplemented or goes unused. This book
significantly reduces the number of course-required and supplemental texts and
the need for instructor-prepared packets ofreadings.
Third,I have been influenced by the need for teaching tools.This text com-
bines classic teaching tools with new teaching tools.The decision tree that is a key
feature ofthis book is a teaching innovation that helps instructors,field supervi-
sors,and students manage the multiple variables identified in open assessment.It
rank orders the obtained information to create a hierarchy where decisions are
prioritized.For instance,the decision tree begins by assigning priority to those
facts of the case that have life-threatening and survival relevance. It goes on to
consider crisis intervention,urgent concrete services,advocacy,and clinical inter-
ventions with individuals,families,and groups.The user applies overarching cul-
tural and ethical principles at the outset and during each step ofusing the decision
tree.Process recordings (beginning,ethnographic,and advanced theory-driven)
illustrate work with individuals,families,groups,and agency management,while
cases and treatment matrices correspond step by step to the decision hierarchy.
Finally,decision schemas summarize the content of each chapter and guide stu-
dents in using chapter-specific information and evidence to arrive at a competent
decision for that step.
Preface ix
Fourth,I have been influenced by the need to differentiate theories appropri-
ate for clinical practice (borrowed from biology,psychology,and social psychol-
ogy) from those appropriate for nonclinical practice.Students in policy,advocacy,
management,and community practice observe that they are taught the skills they
need but not the theories from which the skills are derived. These theories are
borrowed from sociology (conflict and order, common good versus individual
rights), political science, economics, and administration. All students, whether
they develop,implement,administer,or offer direct face-to-face services,must be
aware that the policies and programs with which they are associated are norma-
tive in their end goals.Therefore,all students need to be taught the comparative
theories ofsocial justice found in moral philosophy.
The overarching theme laced throughout the book is that of competency.
Competency in social work practice requires that students
acquire and value skill sets for both direct and indirect practice,
critically assess the available empirical evidence when making decisions,
realistically appraise a variety oftheories,and
master the art and science ofrelationship building in direct and indirect
practice.
It is my hope that this text presents complex material and a range ofskill sets
in a substantive and practical way to help students to become competent social
workers.