HHS 460 Research Methods in Health & Human Services WK3-Outline

1.1 RESEARCH IN THE HUMAN SERVICES

Goals of Research

The word research is applied to many activities: the student who browses in the library for a few hours; the social worker who, while visiting clients about other issues, makes a mental note of some of their social characteristics; the parole officer who routinely inquires about a parolee's family life as part of an intake interview. All these people might claim to be doing research. Yet the term, as it is commonly used in the social and behavioral sciences, has a considerably more precise meaning, according to which none of these activities would be considered as scientific research. This is not to say that these activities are unimportant. They may have a variety of uses. Social research, however, has specific goals that can be achieved only by using proper procedures.

Social research is the systematic examination (or reexamination) of empirical data, collected by someone firsthand, concerning the social or psychological forces operating in a situation. Three major elements characterize this definition. First, social research is systematic—that is, all aspects of the research process are carefully planned in advance, and nothing is done in a casual or haphazard fashion. The systematic nature of research is at the core of the scientific method, which is discussed in detail in Chapter 2. Second, social research involves the collection of empirical data—that is, information or facts about the world that are based on sensory experiences. As such, it should not be confused with philosophizing or speculating, which lack the empirical base of research. Third, social research studies social and psychological factors that affect human behavior. Biological, physiological, nutritional, or other such factors would be a part of social research only to the extent that they affect, or are affected by, social and psychological factors.

Research in the human services generally focuses on one or more of the following goals: description, prediction, explanation, or evaluation. Descriptive research has as its goal description, or the attempt to discover facts or describe reality. Descriptive research, for example, might deal with questions such as these: What are people's attitudes toward welfare? How widespread is child abuse? How many people avail themselves of the services of home health care workers? Some descriptive research efforts are quite extensive. For example, the National Center for Health Statistics (NCHS) and the Centers for Disease Control and Prevention (CDC) collect voluminous amounts of data each year to describe the health status of Americans.

Predictive research focuses on prediction or making projections about what may occur in the future or in other settings. Insurance companies, for example, make use of sophisticated actuarial schemes to predict the risks involved with insuring people or property. Based on past descriptive research concerning deaths and injuries, they can project how long people with certain characteristics are likely to live or the degree of likelihood that they will suffer injuries. Such projections also can be made by the NCHS. For example, the NCHS can project that infants and children with particular social characteristics will have an increased likelihood of being undernourished or suffering from infectious or parasitic diseases. Armed with this information, it is possible to devise preventive health care programs that are targeted at the high-risk groups.

Explanatory research involves explanation or determining why or how something occurred. Explanatory research, for example, would go beyond describing rates of juvenile delinquency or even predicting who will engage in delinquent acts. Explanatory research would focus on why certain people become delinquents. The goal of explanation may appear to be quite similar to that of prediction, but there is a difference: One can make predictions without an accompanying explanation. Insurance companies, for example, make actuarial predictions based on past statistical associations, but often without knowing why those associations occurred.

Evaluation research focuses on evaluation or the use of scientific research methods to plan intervention programs, to monitor the implementation of new programs and the operation of existing ones, and to determine how effectively programs or clinical practices achieve their goals. Evaluation research can also determine whether a program has unintended consequences, desirable or undesirable. In the past few decades, a vast array of social programs has emerged—relating to poverty, child development, crime, alcoholism, delinquency, and the like—that attempts to ameliorate undesirable social conditions. As competition over funds for such programs has increased (especially in the past decade), program directors often must justify and defend their programs in terms of cost-effectiveness. Thus, evaluation research has become an often integral part of human service programs.

Applications of Research

Some social research is called basic research (or pure research) in that its purpose is to advance knowledge about human behavior with little concern for any immediate, practical benefits. Many sociologists and psychologists conduct basic research. Research in the human services, however, is more likely to be applied research—that is, research designed with a practical outcome in mind and with the assumption that some group, or society as a whole, will gain specific benefits from it. Thus, explaining juvenile delinquency to social workers, probation officers, and the police is important because it can lead to programs intended to alleviate delinquency in a community. Although we distinguish between basic and applied research, it is important to recognize that the line between the two is vague and, in fact, that pure research can have applications in the human service field just as applied research can advance our knowledge of human behavior.

So the focus of this book is primarily on applied social research and, especially, on the linkage of social research with the human services. Human service fields such as social work or criminal justice focus on two important issues—practice and policy—and research can be utilized in each of these areas to produce more effective outcomes. Human service practice involves the direct provision of services to clients, such as individuals, families, or other groups, to assist them in dealing with some difficulties. Human service policy involves working through the political, governmental, and legal systems to establish programs, laws, administrative procedures, and other interventions that will deliver desired outcomes to individuals or groups. While not every human service activity falls into one of these two categories, practice and policy constitute the bulk of human service work.

To make these distinctions between basic and applied research and between human service practice and policy more concrete, it is useful to identify five focal areas or applications where research is used in the human services: understanding human functioning in social environments, policy planning and development, assessment of client functioning, program evaluation, and practice effectiveness evaluation. We do not claim that this is the only way to divide the human service field or that our list of areas of application is exhaustive. These five categories, however, are a helpful aid as we analyze the links between research and practice. Here, we review each area briefly. Then, each Research in Practice insert in this and subsequent chapters will emphasize one of these focal areas.

Behavior and Social Environments. Human service providers do many things: link people to resources they can use, enhance people's coping abilities, improve the operation of social systems, and participate in the development of social policy, to name only a few. All these activities rest on an understanding of the behavior of the people to whom services are provided and on a comprehension of the social environment in which they function. Social research can provide much of this knowledge. For example, an agency providing services to teenagers can turn to research on adolescents in American society for a better understanding of the problems facing their clients. Although this research may be conducted without any particular practice or policy goals in mind, it can still be applied in both realms.

Policy Planning and Development. Human service professionals gain direction from policies that are intended to advance the well-being of individuals, families, and society as a whole. Human service policy involves working through the political, governmental, and legal systems to establish programs, laws, administrative procedures, and other interventions that will deliver desired outcomes to individuals or groups. Policies can be thought of as a set of rules that govern what types of resources will be available to people to assist them in achieving goals, maximizing potential, and alleviating distress (Herrick, 2008). So, for example, a few years back, most states changed their laws to make welfare a temporary, time-limited support for people. One could receive payments for, say, a lifetime maximum of five years. So research can be conducted to discover the positive and negative consequences of such a policy. This research can help policymakers in the original development of the policy as well as in deciding whether to change or eliminate the policy after it has been in operation for some time. In this way, social research can be used to help develop, evaluate, and, if necessary, change policies.

Assessment of Client Functioning. In the provision of human services, assessing the level of functioning of clients is often necessary. What kind of communication problems exist in a family? How capable is a teenage parent in dealing with the stresses of motherhood or fatherhood? How skilled is a person in negotiating a job interview? Practitioners often make such assessments, but the danger is that they will be made unsystematically. The past 20 years have seen extensive development of systematic and, in some cases, quantitative assessment tools that can be used for both research and practice tasks. The results of these assessment tools can be compared at different times to see if any change or improvement has occurred. Examples of such client assessment tools can be found in Sheafor and Horejsi (2012).

Program Evaluation. The term policy refers to broad directions or goals whereas the term program refers to the organized delivery of services to people or groups. Programs represent the implementation of a policy or policies whereas policies determine what programs will exist and what they will look like. In the past few decades, many large, ambitious, and expensive programs intended to cope with social problems and provide services to individuals have been developed. Along with the growth of these programs has emerged an increasing concern over their results: Do they achieve their intended goals? These programs are costly, and some evaluation is needed to assess whether resources are, indeed, being used effectively. Equally important, a program that fails to achieve its goals leaves a problem unsolved or an effective service undelivered. Program evaluation is the use of scientific research techniques to assess the results of a program and evaluate whether the program, as currently designed, achieves its stated goals (Rossi, Lipsey, & Freeman, 2004). It is crucial that human service providers understand when program evaluation is called for and when it is possible to conduct an effective evaluation. In addition, many practitioners likely will find themselves participating in programs that include evaluation as one of their goals. (Given the close link between policy and program, there is much overlap between the two: Program evaluation is often a part of a policy evaluation.)

Practice Effectiveness Evaluation. Whereas program evaluation focuses on the assessment of entire programs or policies, the concern of human service professionals often is considerably more specific—namely, “Is what I am doing right now with this particular client working?” For this reason, practitioners are often disenchanted with the utility of evaluation research as a direct aid to helping clients. In recent years, however, major advances have occurred in the ability of research to answer professionals' questions about the efficacy of intervention efforts on specific clients. One such advance is a form of research called single-system design, in which practitioners devise a way to repeatedly measure the occurrence of a problem and monitor the behavior of a single client, group, family, or larger system for a period of time. Intervention then begins, and the behavior is again monitored. Comparison between the baseline and intervention periods permits the practitioner to make more accurate assessments of progress than the informal assessment on which human service professionals traditionally have relied. Through such careful monitoring of behavior and measuring of intervention effects, human service workers not only can enhance their own effectiveness, but also can contribute to the development of an intervention technology that others can successfully apply.

Obvious similarities exist between program evaluation and practice effectiveness research. For example, both are concerned with the effectiveness of certain practices. The difference, however, is in the scope of the efforts. Program evaluation focuses on complete programs, whereas practice effectiveness emphasizes the assessment of some particular aspect of a practice situation in a way that will not necessarily affect the entire program.

Evidence-Based Practice

A theme that underlies many recent developments in the human services, and shows great promise for linking practice and research, is encapsulated by the term evidence-based practice: “the conscientious, explicit, and judicious use” of the best evidence in making decisions about human service assessment and intervention (Sackett, et al., 1997, p. 2). According to this approach, the “best evidence” is knowledge that has been gained via the scientific research process. Research in Practice 1.1 discusses some of the issues involved in the development of evidence-based practice in the human services. As the insert shows, this approach has been called a number of different things over the years by different practitioners, although “evidence-based practice” seems to have emerged as the most widely used designation. The evidence-based approach is inherently critical, which means that it is always questioning whether particular practices or policies are effective. Just because a practice method has been routinely used in the past does not mean it is necessarily effective. Just because a practice method has worked with clients with certain characteristics (e.g., based on age, race, or gender) does not mean it will work on other clients. The evidence-based practitioner constantly questions the efficacy of methods, and the primary yardstick used in resolving these questions is the evidence provided by scientific research (Mullen, Bledsoe, & Bellamy, 2008).

This approach has emerged, in part, because there is now a growing body of research evidence—some of it basic and some of it applied—that can provide guidance to human service practitioners and policy makers. In the past century, researchers in the social sciences and human services have developed more sophisticated research techniques and have used them to produce a large and complex body of knowledge about human social and psychological behavior. This body of knowledge now provides human service practitioners and policy makers with scientifically grounded evidence about what works and what doesn't. So it is much more feasible today—than it was, say, 50 years ago—to base practice and policy on scientific evidence.

Another reason for the emergence of the evidence-based approach is that some startling criticisms of human service practice surfaced a few decades ago that concluded that such practice is not very effective at achieving its goals—or at least that we don't have much proof that it is effective, other than the claims of the practitioners themselves. In response, in the intervening decades, human service researchers and practitioners focused their attention on producing research that would provide such proof. The resulting collaboration of researchers and practitioners has produced a body of research that provides us with evidence about what is effective in practice and what isn't.

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RESEARCH IN PRACTICE 1.1 Practice Effectiveness: “Scientific Practice” as a Challenge to the Human Services

Four decades ago, the Health Research Group, one of Ralph Nader's public citizen organizations, aimed a challenge in the direction of the human services (Adams and Orgel, 1975). The group suggested that people seeking help from human service professionals should demand a written contract at the outset of the relationship specifying the conditions of the therapy, the goals of the intervention, and even the site at which the therapy would take place. The group also suggested that the contract specify the character of the practitioner-client relationship, especially regarding the empirical evidence showing what kind of relationship would enhance the achievement of the client's goals. Underlying these recommendations was a demand for a high degree of accountability on the part of the helping professions. In the intervening decades, these demands for accountability have become louder and broader in scope, as illustrated by a number of developments (Cournoyer & Powers, 2002):

[image] The emergence of managed care systems that drive much human service practice and reward use of interventions shown to be effective by research.

[image] The empowerment of consumer groups, such as Nader's Health Research Group, and a proposed interprofessional Clients' Bill of Rights that includes the right to “be informed about the options available for treatment interventions and the effectiveness of the recommended treatment” (Joint Initiative of Mental Health Professional Organizations, 2003).

[image] The establishment of accreditation standards by such organizations as the Council on Social Work Education that require schools to prepare social workers to “use practice experience to inform research, employ evidence-based interventions, evaluate their own practice, and use research findings to improve practice, policy, and social service delivery” (Council on Social Work Education, 2008, p. 5).

These demands for accountability have motivated human service professionals in such fields as psychology, social work, criminal justice, and nursing to begin defining the human services as scientific disciplines (Goldfried & Wolfe, 1996; Rosen, 1996; Turnbull & Dietz-Uhler, 1995). These professionals now use terms such as “scientific practice,” “scientist practitioner,” and “evidence-based practice.” In the field of community mental health, Abraham Jeger and Robert Slotnick (1982) developed what they called a behavioral–ecological approach to the delivery of mental health services. In presenting this approach, they argued that research should be viewed as an integral part of treatment. Over the ensuing decades, this idea has continued to receive support. For example, integrating research with practice served as the organizing theme of an entire special issue of the journal Education and Treatment of Children. In one of the articles, Alisa Bahl and colleagues (1999) discussed treating behavioral problems in children using what they called a data-driven approach. They advocated collecting data not only before and after treatment, but also throughout the course of treatment itself. To illustrate this point, they discussed how they employed Parent–Child Interaction Therapy to treat a 6-year-old boy with oppositional defiant disorder. They employed parent and teacher reports, observation during clinic sessions, and parental monitoring during each daily home practice session. The case illustrates the importance of using research procedures not only for the advancement of knowledge, but also as an enhancement of service delivery.

On a similar note, the National Association of Social Workers (NASW) Code of Ethics (2008) emphasizes the responsibility of professionals to employ empirical knowledge in practice and to contribute to the advancement of professional knowledge through research. The section on evaluation and research in the NASW Code of Ethics includes the following points:

[image] Social workers should monitor and evaluate policies, implementation of programs, and practice interventions.

[image] Social workers should promote and facilitate evaluation and research to contribute to the development of knowledge.

[image] Social workers should critically examine and keep current with emerging knowledge relevant to social work and fully use evaluation and research evidence in their professional practice.

[image] Social workers should educate themselves, their students, and their colleagues about responsible research practices.

In each chapter, we will set aside separate space entitled “Research in Practice” where we will discuss particular instances in which research and practice have been linked. In this fashion, students in the human services can gain a deeper understanding of the many ways in which this linkage might be achieved.

Evidence comes in many different forms, of course. The observations that a practitioner makes of a single client in her office is “evidence,” as is the complex statistical analysis done on the observations of thousands of people in a highly controlled experimental study. So a central part of the evidence-based approach is to critically evaluate research studies to determine how much confidence we have in their conclusions, and thus whether we want to use them as evidence in particular practice or policy settings. The purpose of this text is to provide students in the human services with an introduction to research methods so that they are in a better position to understand and participate in this critical evaluation. Although an understanding of research methods in general certainly contributes to becoming a more effective human service practitioner, we will link research methods specifically with evidence-based practice in a number of chapters where the linkage is especially relevant. In addition, we have enhanced the focus on this critical perspective by including a brief section toward the end of each chapter titled “Critical Thinking.” There we suggest some ways in which the material in a particular chapter can be a guide for critical thinking and analysis in practice and policy realms, as well as in one's everyday life.

Diversity and Research: The Impact of Diversity and Difference on Research

Human service professionals recognize that diversity and difference—whether they arise from variations in race, ethnicity, gender, or something else—are powerful influences on people and social life. Diversity and difference can lead some groups to suffer disproportionately from the problems that human service workers attempt to alleviate, such as poverty, inequality, or discrimination. So human service practice devotes special attention to diversity and difference. Issues of diversity and difference also need to be addressed when conducting research in the human services. Because of the position of minorities in society, conducting research that produces accurate and complete data on them can be a challenge. In fact, in some circumstances, the standard research methods used in human service research result in misleading and, in some cases, outright false conclusions regarding a minority. In those circumstances the research methods need to be modified.

This problem is sufficiently important to human service research that we devote special attention to it throughout the book. In each chapter, where relevant, we point out particular ways in which problems or biases in research on minorities can occur and provide strategies for overcoming them. The goal is to create a sensitivity to the fact that research methods can have built-in biases when focused on particular minority groups, and that care must be exercised to detect and avoid this.

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