Knowledge Based Practice in Substance Abuse Interventions

Knowledge Based Practice in Substance Abuse Interventions Knowledge based practice Introduction This paper will look at how research informs practice. I will be looking at young people and substance misuse and older people and how research might inform or affect my practice. Good professional practice is knowledge based practice which often means that it is practice based on what others have done, or research that others have undertaken. Research is an important part of most aspects of the human services. In health, in education, and in social work research is important informs our view of the world and can provide a framework for dealing with a particular subject or case. Research has a prominent place in the social services and it is important to the social worker. When people undertake research into areas of social and health care, then these findings and recommendations are generally used to inform practice. Not only is research important in informing social work practice, it is also important when it comes to Government policy. Like most social workers I have found some research an invaluable asset when dealing with disaffected and vulnerable groups such as young children and socially excluded young people. Some research may have been undertaken some time in the past but its findings still prove to be useful today. Willis’ (1977 in Giddens 2001) used group interviews (what are sometimes called focus group interviews) in his study of working class boyS and the ways in which the education system attempts to prepares them for the labour market. Both individual and group interviews were used in collecting this data, and while the work has been criticised it provided, and continues to provide useful information about how working class boys communicate and interact. This type of research is a source of invaluable knowledge to someone working with young people. It provides some insights into why youngsters react against authority and why they might act the way they do. Research can be a two edged sword, on the one hand it informs, and on the other it can produce lasting impressions that can lead to oppressive policy making. While Government papers on young people set a framework for soc ial workers, this kind of early research is useful when dealing with them in a practice context. Yet another valuable, yet some might say, problematic, source of information is Bowlby’s (1946) work on why young people commit crime or get involved in substance abuse. While Bowlby’s work, (which points to maternal deprivation as a cause of problematic behaviour in young people )has been deeply criticised within academic circles his ideas still have a significant impact on current Government discourses on youth. Certainly many social workers find themselves dealing with youngsters who have substance abuse problems and may feel themselves in an ethical dilemma when confronted with some of the policies in this area. One of the worst influences that work such as this has had is the growing tendency to treat anyone who does not conform to society’s norms as sick and deviant. Government initiatives on drugs, more often than not, appear to be targeted at poor and working class communities. Further there is a tendency for these initiatives to link poverty and drugs in the minds of other people. If an adolescent comes from the poorer part of town and is perhaps unemployed then this can lead to people in authority thinking that he/she is more likely to be seen as a drugs user even if they are not. Eley (2002) maintains that this leads to the association of drugs and crime with those who are already underprivileged in society. For social workers this is can be an extremely problematic situation. Do I as a social worker automatically assume something about a young person who is in trouble, and label them as sick and deviant, or do I adhere to what I believe to be the case, that everyone is of equal worth and therefore deserves an equal chance. If I am to abide, in my professional capacity by the 1998 Human Rights Act, then ethically, I could be duty bound to ignore Government guidelines in this area. Moore (1996) says that Government overstates the case on drug misuse when it refers to drug users as addicts because, he argues, most of the drug use that takes place in Britain is recreational This implies that those who use them are in control of the situation with regard to when they take drugs e.g. weekends, and how much they spend. Theorists are divided on why adolescents take drugs therefore it might be argued that the reason adolescents use drugs are quite complex and differ from person to person. This means that a social worker should act in accordance with the Human Rights Act when dealing with the problems of young people because that also implies treating each case on its individual merits Becker (1963) has argued that young people are often viewed as delinquent because of the way society viewed certain acts, such as drug taking. Calling or labelling a young person as deviant is problematic because it can become a self-fulfilling prophecy. Those in authority often take the view that young people, and particularly underprivileged young people are deviant and if the label is applied often enough, and by those with the power to apply it, then that is how the adolescent may come to view themselves. Taylor, Walton and Young (1973) however, say that no theory is sufficient unless there is also an analysis of the power relationships that exist in society. Hall (1978) maintains that the way in which adolescents are represented in the media has a huge effect on the way in which they are viewed by others. This can then have a further effect on their actions. In my own professional practice I have to be aware of such theories and how they inform public perception and Government policy. I also have to be aware of them in my practice and this might involve questioning the assumptions and methods behind certain research findings i.e. I am questioning their theories. Theories aid us in making sense of the world, one explanation of theory is an observation of observed regularities for example that women do more housework than men. Many things are not self-evident but need an explanation, thus Abbott and Wallace (1997) maintain that all of us are theorists because of the need to analyse and interpret our ordinary everyday experiences in order to make sense of them In sociological theory, some theories are extremely abstract, for example critical theory. Merton (1967 in Giddens, 2001) has called these theories ‘grand theories’ because they operate at a general and abstract level, theories such as those of Willis and Bowlby are middle range theory, because they are looking at an aspect of social life. Usually Merton (1967in Giddens 2001) maintains it is the middle range theories that are more likely to guide research. Labelling theory and Becker’s work, for example is a middle range approach to research that was developed out of the sociology of deviance. The problem is that while I as a social worker dealing with a young person with substance abuse issues might prefer to treat that person as an individual, and ethically I am bound to do so, Government discourses take a quite different view. Drug abuse and crime as mentioned earlier are closely associated in public discourses with poverty and this is evident in recent policy making. When evaluating research and research findings social workers need to find some sort of framework within which to evaluate the work this might be the 12 step approach advocated by Locke or it might be something as simple as using a content analysis approach to evaluate what the researcher has done and decide how effective that research may be. The Government’s report, No More Excuses (The Causes of Youth Crime) states that deprivation and poverty are usually a contributing factor in youth crime.[1] Government research suggests that while young people who offend may not do it very often, there are a few persistent offenders who are responsible for the greater part of youth crime new Youth Justice reforms will concentrate on preventing crime and on early intervention where children and young people are at risk of becoming involved in crime.[2] Leitner et al (1993) maintain that the British public is concerned about drug use, drug dealing, and the crime that is associated with this. Pudney (2003) maintains that if young people take soft drugs such as cannabis then they are more likely to progress to hard drugs and to criminal activity. He also argues that such behaviour is strongly associated with unobservable personal characteristics and New Labour have consistently targeted drugs initiatives at underprivileged commun ities. Working with young people means that I have to take into account Government reports as well as other research findings. At the same time I, like many other social workers, have as Moore (2002) points out, entered social work because of a commitment to social justice, or at the very least a desire to help others and to see improvement and positive change in people’s lives. Some critics maintain that the way in which social services often operates is self-serving rather than serving the needs of the clients, yet social workers do police themselves and their profession. The way in which they do this is to think critically about what they are doing, why they are doing it, and what moral implications this may have. Certainly social work ethics should not lead anyone to believe that the social work profession should serve itself, rather the needs of the client should be most important. One of the ways this is achieved is by establishing clear relationship boundaries early on and thi s is vital when working with young people who have issues around substance misuse. The BASW has to say about social work ethics and values. The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work (BASW,2001). [3] Social work practice, in order to be ethical practice must be centred on the needs of service users Social workers of necessity intervene in people’s lives and have an influence on situations, ethical decision making is therefore a vital component of social work practice (Osmo and Landau, 2001). Yet another area where social work practice can be a minefield is in working with older people. When working with older people a social worker has a duty to abide by the 1990 NHS and community care act. Working with older people can be difficult on the one hand there is what you want to achieve as a social worker and on the other there are guidelines that may prevent you from doing your best for a client. There are an increasing number of legal and policy requirements that the social worker dealing with an older person must adhere to. It is difficult for the social worker to negotiate the needs and wishes of the client while remaining within the legislative framework. Working together is not always straightforward. The more recent Health and Social Care Bill of 2001 gives Government powers to require health bodies and local authorities whose services are failing to pool their resources. Parrott (2002) undertook research into the care management process and how it affects social worke rs and service users. He points out that there is often no common guidelines on which services should be provided, or the standard of care to expect. The social worker may find that he/she has to perform most of the assessment and to discover whether an older person’s family would be prepared to help so that he/she could remain in their own home. Whatever the decision the social worker would also need to ensure that the client could, at some level, participate in the decision making process. Thus the process is fraught with problems, for example a social worker might assess a person as needing a certain level of care but this has to be agreed with the social worker’s supervisor and with care management. So the person may not receive the care that the social worker deems appropriate. Thus the social worker has a dilemma. While knowledge does inform practice it is not the only thing that the social worker has to deal with, management decisions also affect the process as Parrott’s research shows. One thing that has become apparent to me is while research can inform practice, it should not be allowed to determine it, if and when it does this can result in oppressive practice and a complete disregard of the rights of the service user and this is against ethical practice as outlined by the BASW. Conclusion This paper has looked at knowledge based practice and how research informs what a social worker does. When dealing with research one is not looking at it in isolation but also having to deal with policies that emerge as a result of that research. Many of the funding restrictions that social workers have to deal with are a result of the 1988 Griffiths report which found that getting organizations to work together, and using a market based approach to social care would save the Government money. 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