Isabella Pistone, Allan Lidström, Ingemar Bohlin, Thomas Schneider, Teun Zuiderent-Jerak and Morten Sager
This blog post is based on the Evidence & Policy article, ‘Evidence-based practice and management-by-knowledge of disability care: Rigid constraint or fluid support?’.
Evidence-based practice in social work is often critiqued for constraining practices by emphasising rigid methods and standardised interventions that exclude professional and clients’ experiences. Our research within disability care found rather it catalysed a dynamic interplay between local and external knowledge, as explained in our recently published Evidence & Policy article.
Evidence-based practice (EBP) has become an accepted means to improve social care as well as a cherished goal for both actors in the public sphere and practitioners. In Sweden, EBP has been a prioritised goal for government agencies in the area of social work since the late 1990s, often under the umbrella of ‘management-by-knowledge’. The purpose of this infrastructure is to synthesise, recommend and disseminate evidence for social care practices. But, what does this mean for social care of persons with disabilities?
Evidence can mean many things. In one almost trivial definition, EBP simply means using the best available knowledge. Few would disagree about the usefulness of knowledge. While professional expertise and clients’ values were already cornerstones of social care practices, the new focus that EBP has brought is to take empirical evidence from controlled studies as the starting point for knowledge integration.
However, the usefulness and appropriateness of such evidence in social care practice has been vigorously debated, and viewpoints are sometimes sharply polarised. Proponents of EBP argue that those seeking social care services have a right to receive empirically evaluated treatment, and that not doing so is unethical. While many support this idea, others have objected that EBP’s preoccupation with Randomised Control Trials (RCTs) is not appropriate for the complex problems with which social workers grapple. Those critics often describe EBP as an overly positivistic approach that relies on formal techniques and methods that are too rigid to encompass the complexity, uniqueness and unpredictability experienced within the context of social work. Social work is understood as not primarily relying on specific methods and manuals but on practitioners’ ability to establish trusting relationships with their clients.
According to this critique, EBP can become oppressive, creating a power imbalance which values RCT evidence higher than professionals’ own experience and knowledge.
Further, the critique of Swedish management-by-knowledge is that these power imbalances become systematised in those infrastructures. Against the backdrop of criticism regarding the potentially oppressive dimensions of EBP, we use the framework of epistemic injustice to examine the dynamics of epistemic interactions at different levels of management-by-knowledge in a case of disability care in Sweden, examining the interplay between knowledge from evidence, professionals and clients in the synthesising, recommendation, dissemination and social care practices.
Our conclusions in short:
- Firstly, aspects of management-by-knowledge in disability care did not support the dire warnings from social work scholars, and their methodologies in the case studied, did not seem to impose epistemic injustice either on social workers or on clients. On the contrary, there are several elements in the chain of management-by-knowledge that seemed to prevent epistemic injustice. Among them were: a diversity of approaches within social care, a set of broad methodologies to evaluate different care approaches, and an emphasis on participation. These observations challenge a widespread image of management-by-knowledge and national EBP infrastructures. Various national agencies, the social care provider and practitioners are nudging each other, without hard sanctions or demands.
- Secondly, just as management-by-knowledge is not a linear process, power is not always distributed according to a neat chain of command. Against the backdrop of claims about the constraints on social workers’ knowledge and practice, observations of the relative autonomy of social workers in this case put these claims in perspective.
In sum, we find that management-by-knowledge does not necessarily imply a choking constraint. Instead, it can be realised through a greater focus on organisational structures that support the coexistence of social workers’ and clients’ knowledge and various kinds of evidence. Our conclusion, then, based on this empirical case, is that the modus operandi of management-by-knowledge can be more like a fluid support than a straitjacket.
You can read the original research in Evidence & Policy:
Pistone, I. Lidström, A. Bohlin, I. Schneider, T. Zuiderent-Jerak, T. and Sager, M. (2022) Evidence-based practice and management-by-knowledge of disability care: Rigid constraint or fluid support?. Evidence & Policy, DOI: 10.1332/174426421X16390538025881.
Image credit: Wikimedia.
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