The ‘New Social Work’ is Performance-Based Practice | Brown School at Washington University in St. Louis
Evidence-Based Research in Social Work
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The ‘New Social Work’ is Performance-Based Practice

Social Work; Research; Faculty

Rather than social work practice being based solely on a therapist’s intuition and assumptions, social workers should consider a system of evaluation and measurement based on hard data, suggests a professor of social work at Washington University in St. Louis.

“Not only do current professional social work therapists not know their past performance stats, they also are not able to provide any performance measures regarding their active patient caseload,” said David Patterson Silver Wolf, associate professor at the Brown School and author of the piece “The New Social Work,” published Sept. 13 in the Journal of Evidence-Informed Social Work.

Portrait of David Patterson

David Patterson Silver Wolf

“For instance, what could a therapist produce to answer questions such as: How many patients have decreased illness symptoms on your current caseload? What is the rate of patients meeting at least two health objectives documented on their treatment plan? What measure is used to monitor patients’ overall health improvement and the percentage of caseload under that threshold?”

Instead, Patterson Silver Wolf contends, social work should perhaps take a page from sports.

“Imagine Major League Baseball without any past or ongoing player performance statistics,” he said. “During hiring decisions, without performance data, how could they know which players have high, professional-level performance? Further, after a player was hired and put into the game, unless the organization hired a mental savant, how could the organization know, over time, whether the player was performing at a professional level?

“This is our current social work industry. Social work therapists practice without any performance measures. While the profession boasts about using practices based in evidence, what good is this proposition without real-time data showing their outcomes?”

In the absence of actual performance data on both patients and professionals, the entire social work practice industry is sustained by intuition and gut feelings, Patterson Silver Wolf argues.

“Additionally, social work’s therapeutic foundation is supported by the antiquated assumption that every patient entering a therapist’s office, regardless of that therapist’s demographic profile, has an equal chance of reaching the gold standard of ‘completed treatment with staff approval,’ ” he said. “This assumption must be called into question.”

Patterson Silver Wolf presents data that show therapist-patient race and gender matching have significant implications: “Our data show that patient-therapist matching matters. For instance, when a white female patient is matched with a white male therapist, her treatment success is about 50 percent. When a white female patient is matched with a white female therapist, her success drops to about 23 percent, and when matched with a non-white female therapist, it further drops to a 3-percent success rate.

“These data reveal a serious flaw throughout our industry’s practices and at a minimum should raise questions about the assumption that patients have an equal chance at completing treatment with staff approval regardless of their therapist’s demographic profile,” Patterson Silver Wolf said.

While professional therapists welcome the idea to regularly measure the performance of their patients, the thought of having their own services measured and monitored is threatening, he said.

His new start-up, Takoda, has developed technology tools to assist front-line therapists monitor and address their performance. Patterson Silver Wolf has worked with several substance use disorder programs throughout the St Louis region to implement these tools into routine practice.

“Most of the pushback has been rooted in the idea that therapists, like patients, have autonomy and should not be measured on their patients’ performance,” Patterson Silver Wolf said. “Our social work industry has had a good run, from the time of Freud until now, using intuition and good intentions as the main performance measures.”

The future of social work, or what Patterson Silver Wolf refers to as the “New Social Work,” is not an industry where patients enter community facilities sitting in waiting rooms and interacting with a therapist for one hour a few times weekly.

“Social service building will transform into technology centers where therapists use tools to measure and intervene with patients in real-time,” he said. “The ‘new social work’ will finally understand that people do not recover or learn how to recover in therapist’s offices — but in their own communities — with assistance from high performance professional therapists interacting in the moment.”

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