social work research strategy

Social Work Research Methods That Drive the Practice

Social workers advocate for the well-being of individuals, families and communities. But how do social workers know what interventions are needed to help an individual? How do they assess whether a treatment plan is working? What do social workers use to write evidence-based policy?

Social work involves research-informed practice and practice-informed research. At every level, social workers need to know objective facts about the populations they serve, the efficacy of their interventions and the likelihood that their policies will improve lives. A variety of social work research methods make that possible.

Data-Driven Work

Data is a collection of facts used for reference and analysis. In a field as broad as social work, data comes in many forms.

Quantitative vs. Qualitative

As with any research, social work research involves both quantitative and qualitative studies.

Quantitative Research

Answers to questions like these can help social workers know about the populations they serve — or hope to serve in the future.

• How many students currently receive reduced-price school lunches in the local school district?
• How many hours per week does a specific individual consume digital media?
• How frequently did community members access a specific medical service last year?

Quantitative data — facts that can be measured and expressed numerically — are crucial for social work.

Quantitative research has advantages for social scientists. Such research can be more generalizable to large populations, as it uses specific sampling methods and lends itself to large datasets. It can provide important descriptive statistics about a specific population. Furthermore, by operationalizing variables, it can help social workers easily compare similar datasets with one another.

Qualitative Research

Qualitative data — facts that cannot be measured or expressed in terms of mere numbers or counts — offer rich insights into individuals, groups and societies. It can be collected via interviews and observations.

• What attitudes do students have toward the reduced-price school lunch program?
• What strategies do individuals use to moderate their weekly digital media consumption?
• What factors made community members more or less likely to access a specific medical service last year?

Qualitative research can thereby provide a textured view of social contexts and systems that may not have been possible with quantitative methods. Plus, it may even suggest new lines of inquiry for social work research.

Mixed Methods Research

Combining quantitative and qualitative methods into a single study is known as mixed methods research. This form of research has gained popularity in the study of social sciences, according to a 2019 report in the academic journal Theory and Society. Since quantitative and qualitative methods answer different questions, merging them into a single study can balance the limitations of each and potentially produce more in-depth findings.

However, mixed methods research is not without its drawbacks. Combining research methods increases the complexity of a study and generally requires a higher level of expertise to collect, analyze and interpret the data. It also requires a greater level of effort, time and often money.

The Importance of Research Design

Data-driven practice plays an essential role in social work. Unlike philanthropists and altruistic volunteers, social workers are obligated to operate from a scientific knowledge base.

To know whether their programs are effective, social workers must conduct research to determine results, aggregate those results into comprehensible data, analyze and interpret their findings, and use evidence to justify next steps.

Employing the proper design ensures that any evidence obtained during research enables social workers to reliably answer their research questions.

Research Methods in Social Work

The various social work research methods have specific benefits and limitations determined by context. Common research methods include surveys, program evaluations, needs assessments, randomized controlled trials, descriptive studies and single-system designs.

Surveys involve a hypothesis and a series of questions in order to test that hypothesis. Social work researchers will send out a survey, receive responses, aggregate the results, analyze the data, and form conclusions based on trends.

Surveys are one of the most common research methods social workers use — and for good reason. They tend to be relatively simple and are usually affordable. However, surveys generally require large participant groups, and self-reports from survey respondents are not always reliable.

Program Evaluations

Social workers ally with all sorts of programs: after-school programs, government initiatives, nonprofit projects and private programs, for example.

Crucially, social workers must evaluate a program’s effectiveness in order to determine whether the program is meeting its goals and what improvements can be made to better serve the program’s target population.

Evidence-based programming helps everyone save money and time, and comparing programs with one another can help social workers make decisions about how to structure new initiatives. Evaluating programs becomes complicated, however, when programs have multiple goal metrics, some of which may be vague or difficult to assess (e.g., “we aim to promote the well-being of our community”).

Needs Assessments

Social workers use needs assessments to identify services and necessities that a population lacks access to.

Common social work populations that researchers may perform needs assessments on include:

• People in a specific income group
• Everyone in a specific geographic region
• A specific ethnic group
• People in a specific age group

In the field, a social worker may use a combination of methods (e.g., surveys and descriptive studies) to learn more about a specific population or program. Social workers look for gaps between the actual context and a population’s or individual’s “wants” or desires.

For example, a social worker could conduct a needs assessment with an individual with cancer trying to navigate the complex medical-industrial system. The social worker may ask the client questions about the number of hours they spend scheduling doctor’s appointments, commuting and managing their many medications. After learning more about the specific client needs, the social worker can identify opportunities for improvements in an updated care plan.

In policy and program development, social workers conduct needs assessments to determine where and how to effect change on a much larger scale. Integral to social work at all levels, needs assessments reveal crucial information about a population’s needs to researchers, policymakers and other stakeholders. Needs assessments may fall short, however, in revealing the root causes of those needs (e.g., structural racism).

Randomized Controlled Trials

Randomized controlled trials are studies in which a randomly selected group is subjected to a variable (e.g., a specific stimulus or treatment) and a control group is not. Social workers then measure and compare the results of the randomized group with the control group in order to glean insights about the effectiveness of a particular intervention or treatment.

Randomized controlled trials are easily reproducible and highly measurable. They’re useful when results are easily quantifiable. However, this method is less helpful when results are not easily quantifiable (i.e., when rich data such as narratives and on-the-ground observations are needed).

Descriptive Studies

Descriptive studies immerse the researcher in another context or culture to study specific participant practices or ways of living. Descriptive studies, including descriptive ethnographic studies, may overlap with and include other research methods:

• Informant interviews
• Census data
• Observation

By using descriptive studies, researchers may glean a richer, deeper understanding of a nuanced culture or group on-site. The main limitations of this research method are that it tends to be time-consuming and expensive.

Single-System Designs

Unlike most medical studies, which involve testing a drug or treatment on two groups — an experimental group that receives the drug/treatment and a control group that does not — single-system designs allow researchers to study just one group (e.g., an individual or family).

Single-system designs typically entail studying a single group over a long period of time and may involve assessing the group’s response to multiple variables.

For example, consider a study on how media consumption affects a person’s mood. One way to test a hypothesis that consuming media correlates with low mood would be to observe two groups: a control group (no media) and an experimental group (two hours of media per day). When employing a single-system design, however, researchers would observe a single participant as they watch two hours of media per day for one week and then four hours per day of media the next week.

These designs allow researchers to test multiple variables over a longer period of time. However, similar to descriptive studies, single-system designs can be fairly time-consuming and costly.

Learn More About Social Work Research Methods

Social workers have the opportunity to improve the social environment by advocating for the vulnerable — including children, older adults and people with disabilities — and facilitating and developing resources and programs.

Learn more about how you can earn your  Master of Social Work online at Virginia Commonwealth University . The highest-ranking school of social work in Virginia, VCU has a wide range of courses online. That means students can earn their degrees with the flexibility of learning at home. Learn more about how you can take your career in social work further with VCU.

From M.S.W. to LCSW: Understanding Your Career Path as a Social Worker

How Palliative Care Social Workers Support Patients With Terminal Illnesses

How to Become a Social Worker in Health Care

Gov.uk, Mixed Methods Study

MVS Open Press, Foundations of Social Work Research

Open Social Work Education, Scientific Inquiry in Social Work

Open Social Work, Graduate Research Methods in Social Work: A Project-Based Approach

Routledge, Research for Social Workers: An Introduction to Methods

SAGE Publications, Research Methods for Social Work: A Problem-Based Approach

Theory and Society, Mixed Methods Research: What It Is and What It Could Be

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The link between social work research and practice

When thinking about social work, some may consider the field to solely focus on clinical interventions with individuals or groups.

There may be a mistaken impression that research is not a part of the social work profession. This is completely false. Rather, the two have been and will continue to need to be intertwined.

This guide covers why social workers should care about research, how both social work practice and social work research influence and guide each other, how to build research skills both as a student and as a professional working in the field, and the benefits of being a social worker with strong research skills. 

A selection of social work research jobs are also discussed.  

• Social workers and research
• Evidence-based practice
• Practice and research
• Research and practice
• Build research skills
• Social worker as researcher
• Benefits of research skills
• Research jobs

Why should social workers care about research?

Sometimes it may seem as though social work practice and social work research are two separate tracks running parallel to each other – they both seek to improve the lives of clients, families and communities, but they don’t interact. This is not the way it is supposed to work.

Research and practice should be intertwined, with each affecting the other and improving processes on both ends, so that it leads to better outcomes for the population we’re serving.

Section 5 of the NASW Social Work Code of Ethics is focused on social workers’ ethical responsibilities to the social work profession. There are two areas in which research is mentioned in upholding our ethical obligations: for the integrity of the profession (section 5.01) and for evaluation and research (section 5.02). 

Some of the specific guidance provided around research and social work include:

• 5.01(b): …Social workers should protect, enhance, and improve the integrity of the profession through appropriate study and research, active discussion, and responsible criticism of the profession.
• 5.01(d): Social workers should contribute to the knowledge base of social work and share with colleagues their knowledge related to practice, research, and ethics…
• 5.02(a) Social workers should monitor and evaluate policies, the implementation of programs, and practice interventions.
• 5.02(b) Social workers should promote and facilitate evaluation and research to contribute to the development of knowledge.
• 5.02(c) 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.
• 5.02(q) Social workers should educate themselves, their students, and their colleagues about responsible research practices.

Evidence-based practice and evidence-based treatment

In order to strengthen the profession and determine that the interventions we are providing are, in fact, effective, we must conduct research. When research and practice are intertwined, this leads practitioners to develop evidence-based practice (EBP) and evidence-based treatment (EBT).

Evidence-based practice is, according to The National Association of Social Workers (NASW) , a process involving creating an answerable question based on a client or organizational need, locating the best available evidence to answer the question, evaluating the quality of the evidence as well as its applicability, applying the evidence, and evaluating the effectiveness and efficiency of the solution. 

Evidence-based treatment is any practice that has been established as effective through scientific research according to a set of explicit criteria (Drake et al., 2001). These are interventions that, when applied consistently, routinely produce improved client outcomes. 

For example, Cognitive Behavioral Therapy (CBT) was one of a variety of interventions for those with anxiety disorders. Researchers wondered if CBT was better than other intervention options in producing positive, consistent results for clients.

So research was conducted comparing multiple types of interventions, and the evidence (research results) demonstrated that CBT was the best intervention.

The anecdotal evidence from practice combined with research evidence determined that CBT should become the standard treatment for those diagnosed with anxiety. Now more social workers are getting trained in CBT methods in order to offer this as a treatment option to their clients.

How does social work practice affect research?

Social work practice provides the context and content for research. For example, agency staff was concerned about the lack of nutritional food in their service area, and heard from clients that it was too hard to get to a grocery store with a variety of foods, because they didn’t have transportation, or public transit took too long. 

So the agency applied for and received a grant to start a farmer’s market in their community, an urban area that was considered a food desert. This program accepted their state’s version of food stamps as a payment option for the items sold at the farmer’s market.

The agency used their passenger van to provide free transportation to and from the farmer’s market for those living more than four blocks from the market location.

The local university also had a booth each week at the market with nursing and medical students checking blood pressure and providing referrals to community agencies that could assist with medical needs. The agency was excited to improve the health of its clients by offering this program.

But how does the granting foundation know if this was a good use of their money? This is where research and evaluation comes in. Research could gather data to answer a number of questions. Here is but a small sample:

• How many community members visited each week and purchased fruits and vegetables? 
• How many took advantage of the transportation provided, and how many walked to the market? 
• How many took advantage of the blood pressure checks? Were improvements seen in those numbers for those having repeat blood pressure readings throughout the market season? 
• How much did the self-reported fruit and vegetable intake increase for customers? 
• What barriers did community members report in visiting and buying food from the market (prices too high? Inconvenient hours?)
• Do community members want the program to continue next year?
• Was the program cost-effective, or did it waste money by paying for a driver and for gasoline to offer free transportation that wasn’t utilized? What are areas where money could be saved without compromising the quality of the program?
• What else needs to be included in this program to help improve the health of community members?

How does research affect social work practice?

Research can guide practice to implement proven strategies. It can also ask the ‘what if’ or ‘how about’ questions that can open doors for new, innovative interventions to be developed (and then research the effectiveness of those interventions).

Engel and Schutt (2017) describe four categories of research used in social work:

• Descriptive research is research in which social phenomena are defined and described. A descriptive research question would be ‘How many homeless women with substance use disorder live in the metro area?’
• Exploratory research seeks to find out how people get along in the setting under question, what meanings they give to their actions, and what issues concern them. An example research question would be ‘What are the barriers to homeless women with substance use disorder receiving treatment services?’
• Explanatory research seeks to identify causes and effects of social phenomena. It can be used to rule out other explanations for findings and show how two events are related to each other.  An explanatory research question would be ‘Why do women with substance use disorder become homeless?’
• Evaluation research describes or identifies the impact of social programs and policies. This type of research question could be ‘How effective was XYZ treatment-first program that combined housing and required drug/alcohol abstinence in keeping women with substance use disorder in stable housing 2 years after the program ended?’

Each of the above types of research can answer important questions about the population, setting or intervention being provided. This can help practitioners determine which option is most effective or cost-efficient or that clients are most likely to adhere to. In turn, this data allows social workers to make informed choices on what to keep in their practice, and what needs changing. 

How to build research skills while in school

There are a number of ways to build research skills while a student.  BSW and MSW programs require a research course, but there are other ways to develop these skills beyond a single class:

• Volunteer to help a professor working in an area of interest. Professors are often excited to share their knowledge and receive extra assistance from students with similar interests.
• Participate in student research projects where you’re the subject. These are most often found in psychology departments. You can learn a lot about the informed consent process and how data is collected by volunteering as a research participant.  Many of these studies also pay a small amount, so it’s an easy way to earn a bit of extra money while you’re on campus. 
• Create an independent study research project as an elective and work with a professor who is an expert in an area you’re interested in.  You’d design a research study, collect the data, analyze it, and write a report or possibly even an article you can submit to an academic journal.
• Some practicum programs will have you complete a small evaluation project or assist with a larger research project as part of your field education hours. 
• In MSW programs, some professors hire students to conduct interviews or enter data on their funded research projects. This could be a good part time job while in school.
• Research assistant positions are more common in MSW programs, and these pay for some or all your tuition in exchange for working a set number of hours per week on a funded research project.

How to build research skills while working as a social worker

Social service agencies are often understaffed, with more projects to complete than there are people to complete them.

Taking the initiative to volunteer to survey clients about what they want and need, conduct an evaluation on a program, or seeing if there is data that has been previously collected but not analyzed and review that data and write up a report can help you stand out from your peers, be appreciated by management and other staff, and may even lead to a raise, a promotion, or even new job opportunities because of the skills you’ve developed.

Benefits of being a social worker with strong research skills

Social workers with strong research skills can have the opportunity to work on various projects, and at higher levels of responsibility. 

Many can be promoted into administration level positions after demonstrating they understand how to conduct, interpret and report research findings and apply those findings to improving the agency and their programs.

There’s also a level of confidence knowing you’re implementing proven strategies with your clients. 

Social work research jobs

There are a number of ways in which you can blend interests in social work and research. A quick search on Glassdoor.com and Indeed.com retrieved the following positions related to social work research:

• Research Coordinator on a clinical trial offering psychosocial supportive interventions and non-addictive pain treatments to minimize opioid use for pain.
• Senior Research Associate leading and overseeing research on a suite of projects offered in housing, mental health and corrections.
• Research Fellow in a school of social work
• Project Policy Analyst for large health organization
• Health Educator/Research Specialist to implement and evaluate cancer prevention and screening programs for a health department
• Research Interventionist providing Cognitive Behavioral Therapy for insomnia patients participating in a clinical trial
• Research Associate for Child Care and Early Education
• Social Services Data Researcher for an organization serving adults with disabilities.
• Director of Community Health Equity Research Programs evaluating health disparities.

No matter your population or area of interest, you’d likely be able to find a position that integrated research and social work. 

Social work practice and research are and should remain intertwined. This is the only way we can know what questions to ask about the programs and services we are providing, and ensure our interventions are effective. 

There are many opportunities to develop research skills while in school and while working in the field, and these skills can lead to some interesting positions that can make a real difference to clients, families and communities. 

Drake, R. E., Goldman, H., Leff, H. S., Lehman, A. F., Dixon, L., Mueser, K. T., et al. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52(2), 179-182. 

Engel, R.J., & Schutt, R.K. (2017). The Practice of Research in Social Work. Sage.

National Association of Social Workers. (n.d). Evidence Based Practice. Retrieved from: https://www.socialworkers.org/News/Research-Data/Social-Work-Policy-Research/Evidence-Based-Practice

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Getting Started with Social Work Research

• Video Tutorials
• Understanding the Libraries "Basic" Search
• The Research Process
• What is a literature review?
• What is a Research Question?
• Turn a topic into a Search Strategy
• Keyword Brainstorming
• Search Tips

The search box on the library homepage provides a basic search across library holdings.  See the guide below for an explanation of how to effectively use the basic search:

• Library Search Help

As you work toward completing your research projects, remember that the research process is NOT linear. It's usually more of a circular process and there may be many times where you jump back and forth between the stages of your research. While not everyone's research process will look exactly the same, the following model can give you a better idea of how the research process often works.

Think of scholarly papers like a conversation. A paper takes a look at what people are saying on a particular topic and then adds something new to the conversation based on their own research. A literature review is how scholars get caught up on the conversation so they will know what to say or ask next.

A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis.

A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates.

• APA Literature Review Template Note: not yet updated for APA 7th edition

A research question is what forms and guides your literature review. It is the question that you want the literature to answer for you. A research question should be specific, focused, and concise.

To develop a research question, start with a general topic of interest to you. You'll want to do some preliminary and background research on this topic to think through what specific questions you might have.

Sample Topic: impact of social media on adolescent physical activity

Sample Research Question: Can social media serve as an effective tool for increasing physical activity among adolescents?

Need more guidance on developing your topic into a research question? Check out  this video  from the library at Northern Kentucky University.

In order to search most effectively for articles that pertain to your research topic, take a little time at the beginning of your project to plan out your search strategy.

1. Break up your topic/research question into it's primary concepts

• i.e. What impact does tobacco use have on the lung health of teenagers?
• Population - teenagers
• Problem - tobacco use
• Outcome - lung health

2. Brainstorm synonyms for your terms (see more in next tab)

• i.e. teenagers, teens, adolescents, youth, young adults, juvenile

3. Add quotation marks around exact phrases and be sure to include both singular and plural

• i.e. "young adults", "young adult"

4. Search one concept at a time using ORs to include all of your synonyms and then combine your searches with AND

• Search 1: teenagers OR teens OR adolescents OR youth OR "young adults" OR "young adult" OR juveniles
• Search 2:  tobacco OR smoking OR vaping OR cigarettes OR nicotine
• Search 3:  lung health OR "respiratory health" OR "respiratory distress" OR dyspnea OR asthma OR "pulmonary disorder" OR "pulmonary disorders" OR "pulmonary disease" OR "pulmonary diseases"

1. Save time, prepare to research!

• Break your research question into key concepts (you'll connect these in your paper to make an original argument)
• For each of these concepts, brainstorm multiple  keywords
• Try this   keyword tool  to brainstorm online and send the results to yourself.

2. Combine keywords using  AND  and  OR :

• Too many  results? Try using quotation marks around an exact phrase. Ex: "students with disabilities"
• Still too many  results? Narrow using  AND . Ex:  "students with disabilities" AND "assistive technology"
• Too few  results? Broaden using  OR . Ex: "students with disabilities" AND (campus OR college OR university OR higher education)
• Put  parentheses  around synonyms.
• The  asterisk  finds multiple endings from a root word. Ex: wom* will bring back women, woman's, wombat, etc.

3. Brush up on the  search tools  available:

• Here are  search tips for Google .
• Databases often include their own search tips. Tip: Look for a help link or a gear symbol.

Interfaces and search options vary across databases, but best practices for searching are relatively consistent across interfaces. No matter which database you choose, remember these important tips...

1) Don't search wth your topic as a single phrase!  Determine the key concepts of your topic. Then place each concept in its own search bar.  For example...

2) Use ORs to string together synonyms or related terms for core concepts...

3) Use truncation, when appropriate. Adding an * to the end of a word will catch all forms of that word. For example, teach* will return teach, teachers, teaching , etc.

4) Use proximity searches to force a relationship between two terms. This isn't always needed, but is sometimes super helpful. Completion is a common word that may come up in many context. The search below means that the word complete or completion must appear within two words of college in the article title and abstracts.

5) Look for the "peer reviewed" limit in each database. You can set this limit on the main search screen (before you search) or narrow your results after you've started your search.

6) Set date limits  as appropriate for your topic..

Writing a Research Paper

• Steps for Writing a Research Paper Step by Step instructions on how to write a research paper by the University Writing Center

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The Pursuit of Quality for Social Work Practice: Three Generations and Counting

Enola proctor.

Shanti K. Khinduka Distinguished Professor and director of the Center for Mental Health Services Research at Washington University in St. Louis

Social work addresses some of the most complex and intractable human and social problems: poverty, mental illness, addiction, homelessness, and child abuse. Our field may be distinct among professions for its efforts to ameliorate the toughest societal problems, experienced by society’s most vulnerable, while working from under-resourced institutions and settings. Members of our profession are underpaid, and most of our agencies lack the data infrastructure required for rigorous assessment and evaluation.

Moreover, social work confronts these challenges as it is ethically bound to deliver high-quality services. Policy and regulatory requirements increasingly demand that social work deliver and document the effectiveness of highest quality interventions and restrict reimbursement to those services that are documented as evidence based. Social work’s future, its very survival, depends on our ability to deliver services with a solid base of evidence and to document their effectiveness. In the words of the American Academy of Social Work and Social Welfare (AASWSW; n.d.) , social work seeks to “champion social progress powered by science.” The research community needs to support practice through innovative and rigorous science that advances the evidence for interventions to address social work’s grand challenges.

My work seeks to improve the quality of social work practice by pursuing answers to three questions:

• What interventions and services are most effective and thus should be delivered in social work practice?
• How do we measure the impact of those interventions and services? (That is, what outcomes do our interventions achieve?)
• How do we implement the highest quality interventions?

This paper describes this work, demonstrates the substantive and methodological progression across the three questions, assesses what we have learned, and forecasts a research agenda for what we still need to learn. Given Aaron Rosen’s role as my PhD mentor and our many years of collaboration, the paper also addresses the role of research mentoring in advancing our profession’s knowledge base.

What Interventions and Services Are Most Effective?

Answering the question “What services are effective?” requires rigorous testing of clearly specified interventions. The first paper I coauthored with Aaron Rosen—“Specifying the Treatment Process: The Basis for Effectiveness Research” ( Rosen & Proctor, 1978 )—provided a framework for evaluating intervention effectiveness. At that time, process and outcomes were jumbled and intertwined concepts. Social work interventions were rarely specified beyond theoretical orientation or level of focus: casework (or direct practice); group work; and macro practice, which included community, agency-level, and policy-focused practice. Moreover, interventions were not named, nor were their components clearly identified. We recognized that gross descriptions of interventions obstruct professional training, preclude fidelity assessment, and prevent accurate tests of effectiveness. Thus, in a series of papers, Rosen and I advocated that social work interventions be specified, clearly labeled, and operationally defined, measured, and tested.

Specifying Interventions

Such specification of interventions is essential to two professional responsibilities: professional education and demonstrating the effectiveness of the field’s interventions. Without specification, interventions cannot be taught. Social work education is all about equipping students with skills to deliver interventions, programs, services, administrative practices, and policies. Teaching interventions requires an ability to name, define, see them in action, measure their presence (or absence), assess the fidelity with which they are delivered, and give feedback to students on how to increase or refine the associated skills.

To advance testing the effectiveness of social work interventions, we drew distinctions between interventions and outcomes and proposed these two constructs as the foci for effectiveness research. We defined interventions as practitioner behaviors that can be volitionally manipulated by practitioners (used or not, varied in intensity and timing), that are defined in detail, can be reliably measured, and can be linked to specific identified outcomes ( Rosen & Proctor, 1978 ; Rosen & Proctor, 1981 ). This definition foreshadowed the development of treatment manuals, lists of specific evidence-based practices, and calls for monitoring intervention fidelity. Recognizing the variety of intervention types, and to advance their more precise definition and measurement, we proposed that interventions be distinguished in terms of their complexity. Interventive responses comprise discrete or single responses, such as affirmation, expression of empathy, or positive reinforcement. Interventive strategies comprise several different actions that are, together, linked to a designated outcome, such as motivational interviewing. Most complex are interventive programs , which are a variety of intervention actions organized and integrated as a total treatment package; collaborative care for depression or community assertive treatment are examples. To strengthen the professional knowledge base, we also called for social work effectiveness research to begin testing the optimal dose and sequencing of intervention components in relation to attainment of desired outcomes.

Advancing Intervention Effectiveness Research

Our “specifying paper” also was motivated by the paucity of literature at that time on actual social work interventions. Our literature review of 13 major social work journals over 5 years of published research revealed that only 15% of published social work research addressed interventions. About a third of studies described social problems, and about half explored factors associated with the problem ( Rosen, Proctor, & Staudt, 2003 ). Most troubling was our finding that only 3% of articles described the intervention or its components in sufficient detail for replication in either research or practice. Later, Fraser (2004) found intervention research to comprise only about one fourth of empirical studies in social work. Fortunately, our situation has improved. Intervention research is more frequent in social work publications, thanks largely to the publication policies of the Journal of the Society for Social Work and Research and Research on Social Work Practice .

Research Priorities

Social work faces important and formidable challenges as it advances research on intervention effectiveness. The practitioner who searches the literature or various intervention lists can find more than 500 practices that are named or that are shown to have evidence from rigorous trials that passes a bar to qualify as evidence-based practices. However, our profession still lacks any organized compendium or taxonomy of interventions that are employed in or found to be effective for social work practice. Existing lists of evidence-based practices, although necessary, are insufficient for social work for several reasons. First, as a 2015 National Academies Institute of Medicine (IOM) report—“Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards” ( IOM, 2015 )—concluded, too few evidence-based practices have been found to be appropriate for low-resource settings or acceptable to minority groups. Second, existing interventions do not adequately reflect the breadth of social work practice. We have too few evidence-based interventions that can inform effective community organization, case management, referral practice, resource development, administrative practice, or policy. Noting that there is far less literature on evidence-based practices relevant to organizational, community, and policy practice, a social work task force responding to the 2015 IOM report recommended that this gap be a target of our educational and research efforts ( National Task Force on Evidence-Based Practice in Social Work, 2016 ). And finally, our field—along with other professions that deliver psychosocial interventions—lacks the kinds of procedure codes that can identify the specific interventions we deliver. Documenting social work activities in agency records is increasingly essential for quality assurance and third-party reimbursement.

Future Directions: Research to Advance Evidence on Interventions

Social work has critically important research needs. Our field needs to advance the evidence base on what interventions work for social work populations, practices, and settings. Responding to the 2015 IOM report, the National Task Force on Evidence-Based Practice in Social Work (2016) identified as a social work priority the development and testing of evidence-based practices relevant to organizational, community, and policy practice. As we advance our intervention effectiveness research, we must respond to the challenge of determining the key mechanisms of change ( National Institute of Mental Health, 2016 ) and identify key modifiable components of packaged interventions ( Rosen & Proctor, 1978 ). We need to explore the optimal dosage, ordering, or adapted bundling of intervention elements and advance robust, feasible ways to measure and increase fidelity ( Jaccard, 2016 ). We also need to conduct research on which interventions are most appropriate, acceptable, and effective with various client groups ( Zayas, 2003 ; Videka, 2003 ).

Documenting the Impact of Interventions: Specifying and Measuring Outcomes

Outcomes are key to documenting the impact of social work interventions. My 1978 “specifying” paper with Rosen emphasized that the effectiveness of social work practice could not be adequately evaluated without clear specification and measurement of various types of outcomes. In that paper, we argued that the profession cannot rely only on an assertion of effectiveness. The field must also calibrate, calculate, and communicate its impact.

The nursing profession’s highly successful campaign, based on outcomes research, positioned that field to claim that “nurses save lives.” Nurse staffing ratios were associated with in-hospital and 30-day mortality, independent of patient characteristics, hospital characteristics, or medical treatment ( Person et al., 2004 ). In contrast, social work has often described—sometimes advertised—itself as the low-cost profession. The claim of “cheapest service” may have some strategic advantage in turf competition with other professions. But social work can do better. Our research base can and should demonstrate the value of our work by naming and quantifying the outcomes—the added value of social work interventions.

As a start to this work—a beginning step in compiling evidence about the impact of social work interventions—our team set out to identify the outcomes associated with social work practice. We felt that identifying and naming outcomes is essential for conveying what social work is about. Moreover, outcomes should serve as the focus for evaluating the effectiveness of social work interventions.

We produced two taxonomies of outcomes reflected in published evaluations of social work interventions ( Proctor, Rosen, & Rhee, 2002 ; Rosen, Proctor, & Staudt, 2003 ). They included such outcomes as change in clients’ social functioning, resource procurement, problem or symptom reduction, and safety. They exemplify the importance of naming and measuring what our profession can contribute to society. Although social work’s growing body of effectiveness research typically reports outcomes of the interventions being tested, the literature has not, in the intervening 20 years, addressed the collective set of outcomes for our field.

Fortunately, the Grand Challenges for Social Work (AASWSW, n.d.) now provide a framework for communicating social work’s goals. They reflect social work’s added value: improving individual and family well-being, strengthening social fabric, and helping to create a more just society. The Grand Challenges for Social Work include ensuring healthy development for all youth, closing the health gap, stopping family violence, advancing long and productive lives, eradicating social isolation, ending homelessness, creating social responses to a changing environment, harnessing technology for social good, promoting smart decarceration, reducing extreme economic inequality, building financial capability for all, and achieving equal opportunity and justice ( AASWSW, n.d. ).

These important goals appropriately reflect much of what we are all about in social work, and our entire field has been galvanized—energized by the power of these grand challenges. However, the grand challenges require setting specific benchmarks—targets that reflect how far our professional actions can expect to take us, or in some areas, how far we have come in meeting the challenge.

For the past decade, care delivery systems and payment reforms have required measures for tracking performance. Quality measures have become critical tools for all service providers and organizations ( IOM, 2015 ). The IOM defines quality of care as “the degree to which … services for individuals and populations increase the likelihood of desired … outcomes and are consistent with current professional knowledge” ( Lohr, 1990 , p. 21). Quality measures are important at multiple levels of service delivery: at the client level, at the practitioner level, at the organization level, and at the policy level. The National Quality Forum has established five criteria for quality measures: They should address (a) the most important, (b) the most scientifically valid, (c) the most feasible or least burdensome, (d) the most usable, and (e) the most harmonious set of measures ( IOM, 2015 .) Quality measures have been advanced by accrediting groups (e.g., the Joint Commission of the National Committee for Quality Assurance), professional societies, and federal agencies, including the U.S. Department of Health and Human Services. However, quality measures are lacking for key areas of social work practice, including mental health and substance-use treatment. And of the 55 nationally endorsed measures related to mental health and substance use, only two address a psychosocial intervention. Measures used for accreditation and certification purposes often reflect structural capabilities of organizations and their resource use, not the infrastructure required to deliver high-quality services ( IOM, 2015 ). I am not aware of any quality measure developed by our own professional societies or agreed upon across our field.

Future Directions: Research on Quality Monitoring and Measure Development

Although social work as a field lacks a strong tradition of measuring and assessing quality ( Megivern et al., 2007 ; McMillen et al., 2005 ; Proctor, Powell, & McMillen, 2012 ), social work’s role in the quality workforce is becoming better understood ( McMillen & Raffol, 2016 ). The small number of established and endorsed quality measures reflects both limitations in the evidence for effective interventions and challenges in obtaining the detailed information necessary to support quality measurement ( IOM, 2015 ). According to the National Task Force on Evidence-Based Practice in Social Work (2016) , developing quality measures to capture use of evidence-based interventions is essential for the survival of social work practice in many settings. The task force recommends that social work organizations develop relevant and viable quality measures and that social workers actively influence the implementation of quality measures in their practice settings.

How to Implement Evidence-Based Care

A third and more recent focus of my work addresses this question: How do we implement evidence-based care in agencies and communities? Despite our progress in developing proven interventions, most clients—whether served by social workers or other providers—do not receive evidence-based care. A growing number of studies are assessing the extent to which clients—in specific settings or communities—receive evidence-based interventions. Kohl, Schurer, and Bellamy (2009) examined quality in a core area of social work: training for parents at risk for child maltreatment. The team examined the parent services and their level of empirical support in community agencies, staffed largely by master’s-level social workers. Of 35 identified treatment programs offered to families, only 11% were “well-established empirically supported interventions,” with another 20% containing some hallmarks of empirically supported interventions ( Kohl et al., 2009 ). This study reveals a sizable implementation gap, with most of the programs delivered lacking scientific validation.

Similar quality gaps are apparent in other settings where social workers deliver services. Studies show that only 19.3% of school mental health professionals and 36.8% of community mental health professionals working in Virginia’s schools and community mental health centers report using any evidence-based substance-abuse prevention programs ( Evans, Koch, Brady, Meszaros, & Sadler, 2013 ). In mental health, where social workers have long delivered the bulk of services, only 40% to 50% of people with mental disorders receive any treatment ( Kessler, Chiu, Demler, Merikangas, & Walters, 2005 ; Merikangas et al., 2011 ), and of those receiving treatment, a fraction receive what could be considered “quality” treatment ( Wang, Demler, & Kessler, 2002 ; Wang et al., 2005 ). These and other studies indicate that, despite progress in developing proven interventions, most clients do not receive evidence-based care. In light of the growth of evidence-based practice, this fact is troubling evidence that testing interventions and publishing the findings is not sufficient to improve quality.

So, how do we get these interventions in place? What is needed to enable social workers to deliver, and clients to receive, high-quality care? In addition to developing and testing evidence-based interventions, what else is needed to improve the quality of social work practice? My work has focused on advancing quality of services through two paths.

Making Effective Interventions Accessible to Providers: Intervention Reviews and Taxonomies

First, we have advocated that research evidence be synthesized and made available to front-line practitioners. In a research-active field where new knowledge is constantly produced, practitioners should not be expected to rely on journal publications alone for information about effective approaches to achieve desired outcomes. Mastering a rapidly expanding professional evidence base has been characterized as a nearly unachievable challenge for practitioners ( Greenfield, 2017 ). Reviews should critique and clarify the intervention’s effectiveness as tested in specific settings, populations, and contexts, answering the question, “What works where, and with whom?” Even more valuable are studies of comparative effectiveness—those that answer, “Which intervention approach works better, where, and when?”

Taxonomies of clearly and consistently labeled interventions will enhance their accessibility and the usefulness of research reports and systematic reviews. A pre-requisite is the consistent naming of interventions. A persistent challenge is the wide variation in names or labels for interventive procedures and programs. Our professional activities are the basis for our societal sanction, and they must be capable of being accurately labeled and documented if we are to describe what our profession “does” to advance social welfare. Increasingly, and in short order, that documentation will be in electronic records that are scrutinized by third parties for purposes of reimbursement and assessment of value toward outcome attainment.

How should intervention research and reviews be organized? Currently, several websites provide lists of evidence-based practices, some with links, citations, or information about dissemination and implementation organizations that provide training and facilitation to adopters. Practitioners and administrators find such lists helpful but often note the challenge in determining which are most appropriate for their needs. In the words of one agency leader, “The drug companies are great at presenting [intervention information] in a very easy form to use. We don’t have people coming and saying, ‘Ah, let me tell you about the best evidence-based practice for cognitive behavioral therapy for depression,’” ( Proctor et al., 2007 , p. 483). We have called for the field to devise decision aids for practitioners to enhance access to the best available empirical knowledge about interventions ( Proctor et al., 2002 ; Proctor & Rosen, 2008 ; Rosen et al., 2003 ). We proposed that intervention taxonomies be organized around outcomes pursued in social work practice, and we developed such a taxonomy based on eight domains of outcomes—those most frequently tested in social work journals. Given the field’s progress in identifying its grand challenges, its associated outcomes could well serve as the organizing focus, with research-tested interventions listed for each challenge. Compiling the interventions, programs, and services that are shown—through research—to help achieve one of the challenges would surely advance our field.

We further urged profession-wide efforts to develop social work practice guidelines from intervention taxonomies ( Rosen et al., 2003 ). Practice guidelines are systematically compiled, critiqued, and organized statements about the effectiveness of interventions that are organized in a way to help practitioners select and use the most effective and appropriate approaches for addressing client problems and pursuing desired outcomes.

At that time, we proposed that our published taxonomy of social work interventions could provide a beginning architecture for social work guidelines ( Rosen et al., 2003 ). In 2000, we organized a conference for thought leaders in social work practice. This talented group wrestled with and formulated recommendations for tackling the professional, research, and training requisites to developing social work practice guidelines to enable researchers to access and apply the best available knowledge about interventions ( Rosen et al., 2003 ). Fifteen years later, however, the need remains for social work to synthesize its intervention research. Psychology and psychiatry, along with most fields of medical practice, have developed practice guidelines. Although their acceptance and adherence is fraught with challenges, guidelines make evidence more accessible and enable quality monitoring. Yet, guidelines still do not exist for social work.

The 2015 IOM report, “Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards,” includes a conclusion that information on the effectiveness of psychosocial interventions is not routinely available to service consumers, providers, and payers, nor is it synthesized. That 2015 IOM report called for systematic reviews to inform clinical guidelines for psychosocial interventions. This report defined psychosocial interventions broadly, encompassing “interpersonal or informational activities, techniques, or strategies that target biological, behavioral, cognitive, emotional, interpersonal, social, or environmental factors with the aim of reducing symptoms and improving functioning or well-being” ( IOM, 2015 , p. 5). These interventions are social work’s domain; they are delivered in the very settings where social workers dominate (behavioral health, schools, criminal justice, child welfare, and immigrant services); and they encompass populations across the entire lifespan within all sociodemographic groups and vulnerable populations. Accordingly, the National Task Force on Evidence Based Practice in Social Work (2016) has recommended the conduct of more systematic reviews of the evidence supporting social work interventions.

If systematic reviews are to lead to guidelines for evidence-based psychosocial interventions, social work needs to be at the table, and social work research must provide the foundation. Whether social work develops its own guidelines or helps lead the development of profession-independent guidelines as recommended by the IOM committee, guidelines need to be detailed enough to guide practice. That is, they need to be accompanied by treatment manuals and informed by research that details the effect of moderator variables and contextual factors reflecting diverse clientele, social determinants of health, and setting resource challenges. The IOM report “Clinical Practice Guidelines We Can Trust” sets criteria for guideline development processes ( IOM, 2011 ). Moreover, social work systematic reviews of research and any associated evidence-based guidelines need to be organized around meaningful taxonomies.

Advancing the Science of Implementation

As a second path to ensuring the delivery of high-quality care, my research has focused on advancing the science of implementation. Implementation research seeks to inform how to deliver evidence-based interventions, programs, and policies into real-world settings so their benefits can be realized and sustained. The ultimate aim of implementation research is building a base of evidence about the most effective processes and strategies for improving service delivery. Implementation research builds upon effectiveness research then seeks to discover how to use specific implementation strategies and move those interventions into specific settings, extending their availability, reach, and benefits to clients and communities. Accordingly, implementation strategies must address the challenges of the service system (e.g., specialty mental health, schools, criminal justice system, health settings) and practice settings (e.g., community agency, national employee assistance programs, office-based practice), and the human capital challenge of staff training and support.

In an approach that echoes themes in an early paper, “Specifying the Treatment Process—The Basis for Effectiveness Research” ( Rosen & Proctor, 1978 ), my work once again tackled the challenge of specifying a heretofore vague process—this time, not the intervention process, but the implementation process. As a first step, our team developed a taxonomy of implementation outcomes ( Proctor et al., 2011 ), which enable a direct test of whether or not a given intervention is adopted and delivered. Although it is overlooked in other types of research, implementation science focuses on this distinct type of outcome. Explicit examination of implementation outcomes is key to an important research distinction. Often, evaluations yield disappointing results about an intervention, showing that the expected and desired outcomes are not attained. This might mean that the intervention was not effective. However, just as likely, it could mean that the intervention was not actually delivered, or it was not delivered with fidelity. Implementation outcomes help identify the roadblocks on the way to intervention adoption and delivery.

Our 2011 taxonomy of implementation outcomes ( Proctor et al., 2011 ), became the framework for two national repositories of measures for implementation research: the Seattle Implementation Research Collaborative ( Lewis et al., 2015 ) and the National Institutes of Health GEM measures database ( Rabin et al., 2012 ). These repositories of implementation outcomes seek to harmonize and increase the rigor of measurement in implementation science.

We also have developed taxonomies of implementation strategies ( Powell et al., 2012 ; Powell et al., 2015 ; Waltz et al., 2014 , 2015) . Implementation strategies are interventions for system change—how organizations, communities, and providers can learn to deliver new and more effective practices ( Powell et al., 2012 ).

A conversation with a key practice leader stimulated my interest in implementation strategies. Shortly after our school endorsed an MSW curriculum emphasizing evidence-based practices, a pioneering CEO of a major social service agency in St. Louis met with me and asked,

Enola Proctor, I get the importance of delivering evidence based practices. My organization delivers over 20 programs and interventions, and I believe only a handful of them are really evidence based. I want to decrease our provision of ineffective care, and increase our delivery of evidence-based practices. But how? What are the evidence-based ways I, as an agency director, can transform my agency so that we can deliver evidence-based practices?

That agency director was asking a question of how . He was asking for evidence-based implementation strategies. Moving effective programs and practices into routine care settings requires the skillful use of implementation strategies, defined as systematic “methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice into routine service” ( Proctor et al., 2013 , p. 2).

This question has shaped my work for the past 15 years, as well as the research priorities of several funding agencies, including the National Institutes of Health, the Agency for Healthcare Research and Quality, the Patient-Centered Outcomes Research Institute, and the World Health Organization. Indeed, a National Institutes of Health program announcement—Dissemination and Implementation Research in Health ( National Institutes of Health, 2016 )—identified the discovery of effective implementation strategies as a primary purpose of implementation science. To date, the implementation science literature cannot yet answer that important question, but we are making progress.

To identify implementation strategies, our teams first turned to the literature—a literature that we found to be scattered across a wide range of journals and disciplines. Most articles were not empirical, and most articles used widely differing terms to characterize implementation strategies. We conducted a structured literature review to generate common nomenclature and a taxonomy of implementation strategies. That review yielded 63 distinct implementation strategies, which fell into six groupings: planning, educating, financing, restructuring, managing quality, and attending to policy context ( Powell et al., 2012 ).

Our team refined that compilation, using Delphi techniques and concept mapping to develop conceptually distinct categories of implementation strategies ( Powell et al., 2015 ; Waltz et al., 2014 ). The refined compilation of 73 discrete implementation strategies was then further organized into nine clusters:

• changing agency infrastructure,
• using financial strategies,
• supporting clinicians,
• providing interactive assistance,
• training and educating stakeholders,
• adapting and tailoring interventions to context,
• developing stakeholder relationships,
• using evaluative and iterative strategies, and
• engaging consumers.

These taxonomies of implementation strategies position the field for more robust research on implementation processes. The language used to describe implementation strategies has not yet “gelled” and has been described as a “Tower of Babel” ( McKibbon et al., 2010 ). Therefore, we also developed guidelines for reporting the components of strategies ( Proctor et al., 2013 ) so researchers and implementers would have more behaviorally specific information about what a strategy is, who does it, when, and for how long. The value of such reporting guidelines is illustrated in the work of Gold and colleagues (2016) .

What have we learned, through our own program of research on implementation strategies—the “how to” of improving practice? First, we have been able to identify from practice-based evidence the implementation strategies used most often. Using novel activity logs to track implementation strategies, Bunger and colleagues (2017) found that strategies such as quality improvement tools, using data experts, providing supervision, and sending clinical reminders were frequently used to facilitate delivery of behavioral health interventions within a child-welfare setting and were perceived by agency leadership as contributing to project success.

Second, reflecting the complexity of quality improvement processes, we have learned that there is no magic bullet ( Powell, Proctor, & Glass, 2013 ). Our study of U.S. Department of Veterans Affairs clinics working to implement evidence-based HIV treatment found that implementers used an average of 25 (plus or minus 14) different implementation strategies ( Rogal, et al., 2017 ). Moreover, the number of implementation strategies used was positively associated with the number of new treatment starts. These findings suggest that implementing new interventions requires considerable effort and resources.

To advance our understanding of the effectiveness of implementation strategies, our teams have conducted a systematic review ( Powell et al., 2013 ), tested specific strategies, and captured practice-based evidence from on-the-ground implementers. Testing the effectiveness of implementation strategies has been identified as a top research priority by the IOM (2009) . In work with Charles Glisson in St. Louis, our 15-agency-based randomized clinical trial found that an organizational-focused intervention—the attachment, regulatory, and competency model—improved agency culture and climate, stimulated more clinicians to enroll in evidence-based-practice training, and boosted clinical effect sizes of various evidence-based practices ( Glisson, Williams, Hemmelgarn, Proctor, & Green, 2016a , 2016b ). And in a hospital critical care unit, the implementation strategies of developing a team, selecting and using champions, provider education sessions, and audit and feedback helped increase team adherence to phlebotomy guidelines ( Steffen et al., in press ).

We are also learning about the value of different strategies. Experts in implementation science and implementation practice identified as most important the strategies of “use evaluate and iterative approaches” and “train and educate stakeholders.” Reported as less helpful were such strategies as “access new funding streams” and “remind clinicians of practices to use” ( Waltz et al., 2015 ). Successful implementers in Veterans Affairs clinics relied more heavily on such strategies as “change physical structures and equipment” and “facilitate relay of clinical data to providers” than did less successful implementers ( Rogal et al., 2017 ).

Many strategies have yet to be investigated empirically, as has the role of dissemination and implementation organizations—organizations that function to promote, provide information about, provide training in, and scale up specific treatments. Most evidence-based practices used in behavioral health, including most listed on the Substance Abuse and Mental Health Services Administration National Registry of Promising and Effective Practices, are disseminated and distributed by dissemination and implementation organizations. Unlike drugs and devices, psychosocial interventions have no Federal Drug Administration-like delivery system. Kreuter and Casey (2012) urge better understanding and use of the intervention “delivery system,” or mechanisms to bring treatment discoveries to the attention of practitioners and into use in practice settings.

Implementation strategies have been shown to boost clinical effectiveness ( Glisson et al., 2010 ), reduce staff turnover ( Aarons, Sommerfield, Hect, Silvosky, & Chaffin, 2009 ) and help reduce disparities in care ( Balicer et al., 2015 ).

Future directions: Research on implementation strategies

My work in implementation science has helped build intellectual capital for the rapidly growing field of dissemination and implementation science, leading teams to distinguish, clearly define, develop taxonomies, and stimulate more systematic work to advance the conceptual, linguistic, and methodological clarity in the field. Yet, we continue to lack understanding of many issues. What strategies are used in usual implementation practice, by whom, for which empirically supported interventions? What strategies are effective in which organizational and policy contexts? Which strategies are effective in attaining which specific implementation outcomes? For example, are the strategies that are effective for initial adoption also effective for scale up, spread, and sustained use of interventions? Social workers have the skill set for roles as implementation facilitators, and refining packages of implementation strategies that are effective in social service and behavioral health settings could boost the visibility, scale, and impact of our work.

The Third Generation and Counting

Social work faces grand, often daunting challenges. We need to develop a more robust base of evidence about the effectiveness of interventions and make that evidence more relevant, accessible, and applicable to social work practitioners, whether they work in communities, agencies, policy arenas, or a host of novel settings. We need to advance measurement-based care so our value as a field is recognized. We need to know how to bring proven interventions to scale for population-level impact. We need to discover ways to build capacity of social service agencies and the communities in which they reside. And we need to learn how to sustain advances in care once we achieve them ( Proctor et al., 2015 ). Our challenges are indeed grand, far outstripping our resources.

So how dare we speak of a quality quest? Does it not seem audacious to seek the highest standards in caring for the most vulnerable, especially in an era when we face a new political climate that threatens vulnerable groups and promises to strip resources from health and social services? Members of our profession are underpaid, and most of our agencies lack the data infrastructure required for assessment and evaluation. Quality may be an audacious goal, but as social workers we can pursue no less. By virtue of our code of ethics, our commitment to equity, and our skills in intervening on multiple levels of systems and communities, social workers are ideally suited for advancing quality.

Who will conduct the needed research? Who will pioneer its translation to improving practice? Social work practice can be only as strong as its research base; the responsibility for developing that base, and hence improve practice, is lodged within social work research.

If my greatest challenge is pursuing this quest, my greatest joy is in mentoring the next generation for this work. My research mentoring has always been guided by the view that the ultimate purpose of research in the helping professions is the production and systemization of knowledge for use by practitioners ( Rosen & Proctor, 1978 ). For 27 years, the National Institute of Mental Health has supported training in mental health services research based in the Center for Mental Health Services Research ( Hasche, Perron, & Proctor, 2009 ; Proctor & McMillen, 2008 ). And, with colleague John Landsverk, we are launching my sixth year leading the Implementation Research Institute, a training program for implementation science supported by the National Institute of Mental Health ( Proctor et al., 2013 ). We have trained more than 50 social work, psychology, anthropology, and physician researchers in implementation science for mental health. With three more cohorts to go, we are working to assess what works in research training for implementation science. Using bibliometric analysis, we have learned that intensive training and mentoring increases research productivity in the form of published papers and grants that address how to implement evidence-based care in mental health and addictions. And, through use of social network analysis, we have learned that every “dose” of mentoring increases scholarly collaboration when measured two years later ( Luke, Baumann, Carothers, Landsverk, & Proctor, 2016 ).

As his student, I was privileged to learn lessons in mentoring from Aaron Rosen. He treated his students as colleagues, he invited them in to work on the most challenging of questions, and he pursued his work with joy. When he treated me as a colleague, I felt empowered. When he invited me to work with him on the field’s most vexing challenges, I felt inspired. And as he worked with joy, I learned that work pursued with joy doesn’t feel like work at all. And now the third, fourth, and fifth generations of social work researchers are pursuing tough challenges and the quality quest for social work practice. May seasoned and junior researchers work collegially and with joy, tackling the profession’s toughest research challenges, including the quest for high-quality social work services.

Acknowledgments

Preparation of this paper was supported by IRI (5R25MH0809160), Washington University ICTS (2UL1 TR000448-08), Center for Mental Health Services Research, Washington University in St. Louis, and the Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis.

This invited article is based on the 2017 Aaron Rosen Lecture presented by Enola Proctor at the Society for Social Work and Research 21st Annual Conference—“Ensure Healthy Development for All Youth”—held January 11–15, 2017, in New Orleans, LA. The annual Aaron Rosen Lecture features distinguished scholars who have accumulated a body of significant and innovative scholarship relevant to practice, the research base for practice, or effective utilization of research in practice.

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Social Work Research and Evaluation Foundations

Studying social work and its effect on societies is essential to understanding and enhancing human and community well-being. By effectively measuring and evaluating social work outcomes, practitioners can employ evidence-based social work practices and evidence-based treatments (EBTs) to provide structured approaches to addressing client needs. For example, in the case of a client with an anxiety disorder, cognitive behavioral therapy (CBT) and behavioral science can be applied as efficient and ethical frameworks to address communication and collaboration problems. 1

Read on to learn more about the essential role of social work research and evaluation.

The Importance of Research and Evaluation in Social Work Practice

By rigorously assessing and evaluating social work studies, researchers can better identify the most effective strategies to achieve their client’s objectives. 2 Instead of trial and error, a data-driven approach ensures researchers make better use of the resources available to them.

Evidence-based interventions result from analyzing past research findings. After choosing a solution, researchers test it to verify replicability in multiple real-world scenarios before it’s deemed successful. 3 New intervention methods are constantly being standardized across the social work field of study, letting practitioners choose from a wider range of tools and techniques suitable for their study. These are usually taught in more advanced research courses in graduate or master's programs.

For example, at Wurzweiler School of Social Work, students participate in individual research projects and learn the basics of conducting social work research . This includes learning how to use measurement instruments; logic of research design, including sampling and design selection; ethical and legal issues; quantitative and qualitative modes of observation; analysis of data; use of computers and computer programs; and research report writing.

Methodologies and Approaches for Conducting Social Work Research

Conducting social work research requires access to large amounts of data supplied by study participants, which can be historical data or up-to-date surveys. 4 Due to social work’s multifaceted nature, researchers must then use their understanding of how psychosocial factors intersect. They need to develop and adhere to strict research methodologies that are evidence-based instead of preconceived notions of a particular social issue. 5

Action Research and Participatory-Action Research (PAR)

By emphasizing the importance of direct collaboration with communities, researchers can hope to identify and address a demographic’s needs. 6

Empowerment Research

Studies, surveys and experiments aim to increase the feelings of empowerment, equality and social justice among people in communities by having them participate directly in the research process. 7

Constructivist Research

Constructivist research begins with the individual and their social contexts instead of the community as a whole. 8 It highlights the importance of perspective and social standing in shaping communities .

Designing Effective Evaluation Frameworks for Social Programs

Data collected from participants in a target demographic is considered raw data that needs to go through several stages of cleaning and refining before any insights can be extracted. 9 That’s why researchers need to be able to develop robust evaluation frameworks that facilitate access to the data.

Logic Models

Logic models are often used to evaluate a single program or intervention. 10 Logic models are designed to offer:

• Development approaches: Using forward logic to develop models starts from activities to predict outcomes, or vice versa in the case of reverse logic
• Framework utility: Frameworks guide the implementation and reporting of the logic model by clarifying its methodology and expected results
• Visual representation: Graphical depictions of data illustrate the connections between a study’s input, activities and outputs, showcasing the anticipated outcomes
• Components: Key elements include the problem statement, outcomes, outputs, resources and strategies

Theories of Change and Program Theory

Merging theories with logic models adds depth to frameworks by outlining the research process, mechanisms and the logic behind the expected outcomes. 11 Furthermore, theories explain the “how” and “why” the desired changes and outcomes are expected to occur in the program’s context, including factors outside the program’s control.

Furthermore, leveraging resources such as The Kellogg Foundation Logic Model Development Guide and the CDC Framework for Program Evaluation in Social Work can offer guidance and tools for constructing and utilizing robust evaluation frameworks. 12,13

Data Collection and Analysis Techniques in Social Work Research

Researchers can collect relevant data in a variety of ways , such as surveys, in-person focus groups, observations and official census reports. They can then select the suitable social work data analysis technique based on the type of data they have and the nature of the insights they’re looking for. 14 These techniques include:

• Thematic analysis: A qualitative approach that identifies, analyzes and reports patterns and anomalies
• Descriptive statistics: Mean, medians, modes and averages of datasets
• Inferential statistics: Predictive models that provide insights based on patterns

Ethical Considerations in Social Work Research and Evaluation

Ethical considerations determine the efficacy of social work research methods and evaluations. 15 Participants in the study must give informed consent to the data being collected on them without attempts to persuade or influence their answers. 16 Similarly, confidentiality and anonymity, especially when handling socially sensitive topics, are needed to ensure candid responses from study participants.

Utilizing Research Findings to Inform Evidence-Based Practice

In order to use results from past studies to inform future practices, researchers need to translate the studies’ outcomes through systematic reviews and guideline development. 17 The outcomes of earlier implementations often require constant monitoring to detect any underlying biases that can be addressed early on.

Challenges and Limitations in Social Work Research and Evaluation

Research in social work often faces numerous challenges that might impact the quality and efficacy of studies. Some of the most common ones include:

• Time constraints
• Hard-to-reach populations
• Inadequate strategies
• Financial constraints

Case Study of Successful Research and Evaluation Initiative

Despite the many complexities, many research studies can be successfully conducted in the field of social studies. One example is the study of developing new treatments for post-traumatic stress disorder (PTSD) patients.

First developed in the 1980s by Francine Shapiro, eye movement desensitization and reprocessing has been successful in treating emotional distress associated with PTSD. The method’s application was then expanded to include a wide range of issues from trauma and anxiety to addiction.

It’s been supported by over 30 controlled outcomes studies and has since been recognized by the World Health Organization and the Department of Veterans Affairs (VA) as an effective therapeutic method. 18

Deepen Your Impact Through Social Work

The intersection between theoretical research and practical evaluation in the field of social work produces solutions that make a profound impact on the quality of life of communities and individuals. 19 This is a testament to the commitment of researchers to advance the field through progressively available means, particularly technology for data collection and mathematical algorithms for Big Data analytics.

Yeshiva University’s online Master of Social Work focuses on cultural responsiveness, social justice, and human transformation. You will gain hands-on experience in the field of social work and obtain CSWE accreditation that qualifies you for the post-graduate state exam. The expert faculty will equip you with the tools to create positive change in the world. Make an appointment to speak with an admissions outreach advisor today.

• Retrieved on April 10, 2024, from hbr.org/podcast/2021/01/using-behavioral-science-to-improve-well-being-for-social-workers
• Retrieved on April 10, 2024, from researchgate.net/publication/323370072_Evaluating_effectiveness_in_social_work_sharing_dilemmas_in_practice
• Retrieved on April 10, 2024, from ncbi.nlm.nih.gov/books/NBK547524/
• Retrieved on April 10, 2024, from researchgate.net/publication/298697140_Big_data_in_social_work_The_development_of_a_critical_perspective_on_social_work’s_latest_electronic_turn
• Retrieved on April 10, 2024, from https://caseworthy.com/articles/why-is-evidence-based-practice-important-in-social-work/
• Retrieved on April 10, 2024, from nature.com/articles/s43586-023-00214-1
• Retrieved on April 10, 2024, from academic.oup.com/bjsw/article/51/4/1482/6202975
• Retrieved on April 10, 2024, from journals.sagepub.com/doi/full/10.1177/16094069231186257
• Retrieved on April 10, 2024, from journals.sagepub.com/doi/10.1177/17456916221137350
• Retrieved on April 10, 2024, from sopact.com/guides/theory-of-change-vs-logic-model
• Retrieved on April 10, 2024, from betterevaluation.org/frameworks-guides/rainbow-framework/define/develop-programme-theory-theory-change
• Retrieved on April 10, 2024, from naccho.org/uploads/downloadable-resources/Programs/Public-Health-Infrastructure/KelloggLogicModelGuide_161122_162808.pdffrom-being-a-breeding-ground-for-threats/
• Retrieved on April 10, 2024, from cdc.gov/evaluation/framework/index.htm
• Retrieved on April 10, 2024, from nesta.org.uk/feature/eight-ways-councils-are-using-data-create-better-services/the-data-driven-social-worker/
• Retrieved on April 10, 2024, from cmsindia.org/sites/myfiles/Guidelines-for-Ethical-Considerations-in-Social-Research-Evaluation-In-India_2020.pdf
• Retrieved on April 10, 2024, from researchsupport.admin.ox.ac.uk/governance/ethics/resources/consent
• Retrieved on April 10, 2024, from health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-00662-1
• Retrieved on April 10, 2024, from ptsd.va.gov/understand_tx/emdr.asp
• Retrieved on April 10, 2024, from researchgate.net/publication/8480043_Future_directions_in_evaluation_research_People_organizational_and_social_issues

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Social Work Research Guide

• Source Selection & Evaluation
• Construct a Research Question

Brainstorming Keywords

Search strategies.

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Research questions guide the research process, but they don't work well in search systems in their sentence form. Instead, we use the main ideas from the research question to formulate keywords for searching.

And sometimes, those keywords need to be adjusted to find more relevant sources. Synonyms, narrower related terms, and broader related terms can all be used to adjust searches. It's often helpful to brainstorm these related words and phrases before beginning your search, so that you immediately have other words to use.

Here's a table that may help you with this brainstorming process.

• Boolean Operators
• Terminology
• Wildcard & Truncation
• Field Terms
• Site Extension Limiters

Boolean operators define the relationship between search terms.

• AND searches for all of the search terms. The AND operator limits the search because the sources in the results must contain both terms.
• OR searches for either of the search terms. The OR operator expands the search because the sources in the results can contain either term.
• NOT excludes the search term immediately after the NOT operator. The NOT operator limits the search because the sources in the results cannot include the term following the word NOT.

Here is a series of Venn diagrams to show you how the Boolean operators limit or expand searches.

AND = searches for sources that contain both words; example: gender AND identity

OR = searches for sources that contain either word (the first, the second, or both words); example: gender OR identity

NOT = searches for sources that contain the word before the NOT, but not the word after the NOT; example: gender NOT identity

Terminology search strategies focus on the words that you use in your searches. These strategies are very precise.

Keyword searching is a form of search strategy that most people know. When you type a word in a search box and click "Search" without adding any additional information, that's a keyword search.

Phrase searching is similar to keyword searching, but instead of searching for one word, you're searching for a phrase. Phrases are surrounded by quotation marks to keep the words of the phrase together. Otherwise, the search interface will usually search for the words anywhere, not necessarily together. For example, searching for "influenza vaccine," including the quotation marks, will search for the phrase together, instead of the word influenza in one location and the word vaccine in a different location.

Proximity searching locates words within a specific distance from each other. The number in the search phrase tells the search interface how many words away from each other the search terms can be. This allows a limited number of other words to be placed between the search terms, providing more possibilities for search retrieval within a limited scope.

• Near operators, usually using the letter N, search for words in any order. For example, a search for influenza N2 vaccine would find both influenza vaccine and vaccine for influenza .
• Within operators, usually using the letter W, search for words in the order you place them. For example: influenza W2 vaccine would find influenza vaccine but not vaccine for influenza .

Here’s the order of terminology search types based on restrictions placed upon the search.

• Keyword searches = no restrictions. The database can search for the terms in any order and at any distance from each other.
• Proximity searches = some restrictions. The database can search for the terms either in any order ( near ) or in a specific order ( within ). The database is restricted to allowing a limited number of other words to appear between the search terms (the number in the proximity operator).
• Phrase searches = restricted. The database must search for the terms in the order provided with no other words being allowed to appear between the search terms that are placed in quotation marks.

Wildcard searching replaces the wildcard character with any other character or characters, or sometimes no characters. Typical wildcard characters include the asterisk (*), pound sign or hashtag (#), or question mark (?). Some databases accept multiple wildcard characters. Others only accept one or two. Be sure to check the database's "Help" page to find out this information.

• For example, a search for wom*n finds woman, women, womyn, etc. However, it can also expand further; for example, col*r results in color and colour, but also collector, etc.

Truncation searching is a specific type of wildcard search that replaces the wildcard character with any other character or series of characters at the end of the word. Truncation characters are almost always asterisks (*).

• For example, a search for manag* finds manage, manager, management, managing, etc.

Note: Google uses the asterisk (*) as a wildcard for an entire word , not just letters. So, this strategy won't work quite the same way in Google. It can be a good option for locating half-remembered quotes, though!

Field terms are words or phrases located in an item's record according to a specific type, or field. To search according to field term, select the field from the drop-down menu next to the search box.

• A keyword search looks for your search terms anywhere in an item's record. They could be in an author's name, a title, an abstract, or somewhere in the technical coding. Keyword searches are automatic in most search systems. If you don't see an option for "Keyword" in the drop-down menu, then the search interface will search by keyword in its default setting.
• An author search looks for your search terms ONLY in the author fields for an item's record. Sources have different types of author fields: main author, translator, editor, etc. This search will look in all of those fields.
• A title search looks for your search terms ONLY in the title fields for an item's record. Sources also have different types of title fields: main title, subtitle, series title, etc. This search will usually look in all of those fields.
• A subject search looks for your search terms ONLY in the subjects for an item's record. This usually means a search in the system's controlled vocabulary. (Controlled vocabularies are like specialized thesauri. Organizations agree to use one word or phrase to describe an idea. From there, indexers will associate the controlled vocabulary with sources. For example, instead of movie, film, video, motion picture, a catalog would only use the phrase motion picture to describe all of those things.) Because subject searches are more precise, they usually return more relevant results.
• An ISSN is an International Standard Serial Number , which is used to identify serial publications, such as journals or magazines.
• An ISBN is an International Standard Book Number , which is used to identify books.
• OCLC stands for Online Computer Library Center . The OCLC number is a specific number used to identify materials cataloged in the OCLC network of libraries. Many, but not all, items will have this number.

These are the main field search limiters that will appear in most search systems. Many databases will have additional field terms, such as geographic locations or other numeric codes. Explore the drop-down menus to find out what’s available.

Site extension limiters limit a search to a specified domain (or domains, if you limit to more than one). Because this search strategy is only limiting the domain result, it can only be used with web searches. There are a couple of different ways to limit to a site extension.

• site:.edu – This syntax looks for the information following site: in the actual domain. It doesn't look anywhere else in the URL. This is a more precise search.
• inurl:.edu – This syntax looks for the information following i nurl: anywhere in the URL. This search is less precise because it will bring up third-party sites that simply locate information about sites.

To apply more than one site extension limiter, add both the connecting Boolean operator OR and the limiter by hand in the search bar.

(policy OR policies) AND (diversity OR inclusion) site:.edu OR site:.gov

The example above searches for policies related to diversity/inclusion from both .edu and .gov sites.

Be sure to use the OR Boolean operator between the site extensions because you want either type of site. (If you get confused about whether to use AND or OR, remember that websites can't have more than one domain. They can't be both .edu and .gov at the same time.)

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Rigor in Qualitative Social Work Research: A Review of Strategies Used in Published Articles

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Amanda Barusch, Christina Gringeri, Molly George, Rigor in Qualitative Social Work Research: A Review of Strategies Used in Published Articles, Social Work Research , Volume 35, Issue 1, March 2011, Pages 11–19, https://doi.org/10.1093/swr/35.1.11

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This study was conducted to describe strategies used by social work researchers to enhance the rigor of their qualitative work. A template was developed and used to review a random sample of 100 articles drawn from social work journals listed in the 2005 Journal Citation Reports: Science and Social Sciences Edition . Results suggest that the most commonly applied strategies were use of a sampling rationale (67%), analyst triangulation (59%), and mention of methodological limitations (56%); the least common were negative or deviant case analysis (8%), external audit (7%), and specification of ontology (6%). Of eight key criteria, researchers used an average of 2.0 ( SD = 1.5); however, the number used increased significantly between 2003 and 2008. The authors suggest that for this trend to continue, social work educators, journal editors, and researchers must reinforce the judicious application of strategies for enhancing the rigor of qualitative work.

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Value-Based Social Work Research

Strategies for connecting research to the mission of social work.

• Patrick Shannon, MSW, Ph.D. Associate Professor, Department of Social Work, University of New Hampshire

Social work practitioners are often ambivalent about the necessity of conducting research. Witkin (1995) suggests that the reason may have little to do with adequate training in research methods and more to do with a lack of an approach to research consistent with the mission of the profession. The purpose of this article is to begin a dialogue that focuses on delineating an approach to social work research that is consistent with the mission and values of the profession. A description of research approaches that share aspects of social work values is provided, followed by a discussion of core elements of each approach that may have implications for social work researchers. The core elements discussed include: (a) research that is shaped, guided, conducted, and even controlled by consumers; (b) research that focuses on communities or local contexts; (c) research that strives for mutual understanding; and (d) research that facilitates social change leading to empowerment, equality, and social justice. Finally, challenges to incorporating these core elements into research practice are discussed.

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11.3 Action research

Learning objectives.

• Define and provide at least one example of action research
• Describe the role of stakeholders in action research

Action research is defined as research that is conducted for the purpose of creating social change. When conducting action research, scholars collaborate with community stakeholders at all stages of the research process with the aim of producing results that will be usable in the community and by scientists. Stakeholders are individuals or groups who have an interest in the outcome of your study. Social workers who engage in action research never just go it alone; instead, they collaborate with the people who are affected by the research at each stage in the process. In action research, stakeholders, particularly those with the least power, are consulted on the purpose of the research project, research questions, design, and reporting of results.

Action research also distinguishes itself from other research in that its purpose is to create change on an individual and community level. Kristin Esterberg (2002) puts it quite eloquently when she says, “At heart, all action researchers are concerned that research not simply contribute to knowledge but also lead to positive changes in people’s lives” (p. 137).  As you might imagine, action research is consistent with the assumptions of the critical paradigm, which focuses on liberating people from oppressive structures. Action research has multiple origins across the globe, including Kurt Lewin’s psychological experiments in the United States and Paulo Friere’s literacy and education programs (Adelman, 1993; Reason, 1994). Over the years, action research has become increasingly popular among scholars who wish for their work to have tangible outcomes that benefit the groups they study.

Action research does not bring any new methodological tricks or terms, but it uses the processes of science in a different way from traditional research. What topics are important to study in a neighborhood or with a target population? A traditional scientist might look at the literature or use their practice wisdom to formulate a research question. An action researcher, on the other hand, would consult with the target population itself to see what they thought were the most pressing issues and best solutions. In this way, action research flips traditional research on its head. Scientists are more like consultants who provide the tools and resources necessary for a target population to achieve their goals and address social problems.

According to Healy (2001), the assumptions of participatory-action research are that (a) oppression is caused by macro-level structures such as patriarchy and capitalism; (b) research should expose and confront the powerful; (c) researcher and participant relationships should be equal, with equitable distribution of research tasks and roles; and (d) research should result in consciousness-raising and collective action. Coherent with social work values, action research supports the self-determination of oppressed groups and privileges their voice and understanding through the conceptualization, design, data collection, data analysis, and dissemination processes of research.

There are many excellent examples of action research. Some of them focus solely on arriving at useful outcomes for the communities upon which and with whom research is conducted. Other action research projects result in some new knowledge that has a practical application and purpose in addition to the creation of knowledge for basic scientific purposes.

One example of action research can be seen in Fred Piercy and colleagues’ (Piercy, Franz, Donaldson, & Richard, 2011) work with farmers in Virginia, Tennessee, and Louisiana. Together with farmers in these states, the researchers conducted focus groups to understand how farmers learn new information about farming. Ultimately, the aim of this study was to “develop more meaningful ways to communicate information to farmers about sustainable agriculture” (p. 820). This improved communication, the researchers and farmers believed, would benefit not just researchers interested in the topic but also farmers and their communities. Farmers and researchers were both involved in all aspects of the research, from designing the project and determining focus group questions to conducting the focus groups and finally to analyzing data and disseminating findings.

Perhaps one of the most unique and rewarding aspects of action research is that it is often interdisciplinary. Action research projects might bring together researchers from any number of disciplines, from the social sciences, such as sociology, political science, and psychology; to an assortment of physical and natural sciences, such as biology and chemistry; to engineering, philosophy, and history (to name just a few).

Anyone interested in social change can benefit from having some understanding of social scientific research methods. The knowledge you’ve gained from your methods course can be put to good use even if you don’t have an interest in pursuing a career in research. As a member of a community, perhaps you will find that the opportunity to engage in action research presents itself to you one day. Your background in research methodology will no doubt assist you in making life better for yourself and those who share your interests, circumstances, or geographic region.

Spotlight on UTA School of Social Work

Dr. maxine davis shares experiences with action research.

There are various types of action research. Although the degree to which stakeholders are involved may vary across different stages of the research and dissemination process, each type is valuable and aims to accomplish shared decision-making, responsibility, and power between the researcher and the researched. I will share with you a few examples of recent research that I have had the pleasure of being involved in.

Case 1 (St. Louis, MO) Community based participatory research (CBPR)

As a community organizer, activist, and Missionary, Ms. Johnson is well connected to her community in North St. Louis city. She has worked in partnership with a number of clergy members throughout St. Louis on improving the overall well-being of African-Americans for a number of years. From education to political engagement, she has her pulse on the many issues of local residents and a wide network of clergy and ministers who trust her. In 2014, I partnered with Ms. Johnson to explore clergy perceptions on religious or spiritual (R/S) related abuse within intimate partner violence (IPV). Ms. Johnson conducted more than half of the interviews (many of which occurred only because of the trust clergy members had with her, not due to my recruitment efforts). We coded the data independently and analyzed it as a team. As a result, Ms. Johnson gained the skills to conduct basic qualitative data analysis that may be applicable to her other work. The study results revealed that R/S abuse in IPV was a serious issue that Black clergy often faced in ministry. Furthermore, they desired training to help them to better prepare in responding to this problem. The project did not end at manuscript development, rather the efforts to address this issue continue as we develop and plan to implement R/S specific IPV training for Black clergy in St. Louis.

Case 2 (Chicago, IL) Community-engaged research using a Community Collaborative/Advisory Board (CCB)

A colleague who knew of my interest in the intersection of religious faith and IPV connected me with a priest at St. Pius V parish who was looking for someone to evaluate a portion of the church’s domestic violence program.  The project combined evaluation research and action research. I sought and obtained funding tosupport the first step of a multi-phase project involving process evaluation in preparation for a longitudinal impact (i.e. outcome) evaluation. I convened a collaborative board of relevant stakeholders from different organizations and relocated to Chicago (Pilsen neighborhood) to embark upon the research. Over the course of one year, I lived in the community and collected various types of data from a variety of sources while the CCB and I developed an evaluation plan that would meet the organization’s needs. The primary research questions explored were: “What is The Men’s Group (TMG)?” and “Why do participants attend and remain engaged in TMG?” We discovered that TMG was a trauma-informed, culturally-tailored (to Latino men), spirituality and group based partner abuse intervention program (PAIP) aiming to stop violence perpetration and help participants become self-aware. Men remained engaged in the PAIP because they were met with respect by staff/facilitators, reported gaining benefits because of participation, and connected with other group members through a brotherhood. A quasi-experimental design using quantitative data is currently underway.

Case 3 (Grand Prairie, TX) Youth-led CBPR

The Grand Prairie Storm Track & Field Association (GP Storm) reached out to me after their founders saw me present on the potential of hip-hop music influencing public perceptions about IPV. Our shared interest on increasing Black/African-American representation in health-related research careers brought us together. I invited high school students who were affiliated with the program to join me in examining this area, but also encouraged them to develop a set of their own research questions that they were excited to explore. We met weekly over the course of 3 months in the summer of 2019 and analyzed the lyrics of 7 hip-hop songs. The youth-led research team consisted of six Black/Multiracial young women (5 high school; 1 middle school), the organization founder/director, a PhD student, and myself. The findings revealed that hip-hop music brings awareness to IPV/A by discussing Death, Denial, Freedom, and Physical violence/various types of consequences. Partnering with the GP Storm and affiliated students (the community researchers) allowed the research team to examine research questions that were of interest to a wider audience and do so by drawing on multiple perspectives, thereby improving the rigor of the study. The research did not end here; rather next steps involve hosting a listening party as an intervention to reduce violence and acceptability thereof amongst youth and adults.

Lessons learned

I have learned a few lessons through conducting community-engaged research that I think are worth sharing. It is imperative that you are comfortable openly discussing race and diversity if you plan on engaging in action research with communities of color. This applies, regardless of your own identity, but is especially relevant for those who are an “outsider” in terms of gender or race/ethnicity. The second lesson is that trust need not be earned once, rather you must continuously build and maintain trust in order to conduct sound research. You must also plan to nurture and intend to maintain these relationships in a humanistic manner, beyond that of “a research product.” If your intentions are genuine and you are honest with any trepidations, that plus meaningful project delivery will carry you far.

Refer to following articles for more exploration into this research:

Davis, M., ^Johnson, M., Bowland, S. (In Draft) “I hate it…but it’s real”: Black Clergy Perspectives on Intimate Partner Violence related Religious/Spiritual Abuse

Davis, M., ^Dahm, C., Jonson-Reid, M., Stoops, C., Sabri, B. (Revisions Submitted-Awaiting Final Decision). “The Men’s Group” at St. Pius V: A Case Study of a Parish-Based Voluntary Partner Abuse Intervention Program.

^denotes community partners

Key Takeaways

• Action research is conducted by researchers who wish to create some form of social change.
• Stakeholders are true collaborators in action research.
• Action research is often conducted by teams of interdisciplinary researchers.
• Action research- research that is conducted for the purpose of creating some form of social change in collaboration with stakeholders
• Stakeholders – individuals or groups who have an interest in the outcome of your study

Image attributions

protest by BruceEmmerling CC-0

Maxine Johnson and Maxine Davis by Maxine Davis CC BY-NC-ND

Community Researchers in Partnership by Maxine Davis CC BY-NC-ND

GP Storm by Maxine Davis CC BY-NC-ND

Foundations of Social Work Research Copyright © 2020 by Rebecca L. Mauldin is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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• Open access
• Published: 16 May 2024

Factors associated with clinical nurse’s mental health: a qualitative study applying the social ecological model

• Qiang Yu 1   na1 ,
• Chongmei Huang 2 , 3   na1 ,
• Yusheng Tian 1 ,
• Jiaxin Yang 1 ,
• Xuting Li 1 ,
• Meng Ning 4 ,
• Zengyu Chen 4 ,
• Jiaqing He 1 &
• Yamin Li 1  

BMC Nursing volume  23 , Article number:  330 ( 2024 ) Cite this article

Metrics details

The prevalence of burnout, depression, and anxiety among Chinese nurses was 34%, 55.5%, and 41.8% respectively. Mental health problems have significant impacts on their personal well-being, work performance, patient care quality, and the overall healthcare system. Mental health is influenced by factors at multiple levels and their interactions.

This was a descriptive qualitative study using phenomenological approach. We recruited a total of 48 nurses from a tertiary hospital in Changsha, Hunan Province, China. Data were collected through focus group interviews. Audio-recorded data were transcribed and inductively analysed.

Four major themes with 13 subthemes were identified according to the social ecological model: (1) individual-level factors, including personality traits, sleep quality, workplace adaptability, and years of work experience; (2) interpersonal-level factors, encompassing interpersonal support and role conflict; (3) organization-level factors, such as organizational climate, organizational support, career plateau, and job control; and (4) social-level factors, which included compensation packages, social status, and legislative provision and policy.

Conclusions

Our study provides a nuanced understanding of the multifaceted factors influencing nurses’ mental health. Recognizing the interconnectedness of individual, interpersonal, organizational, and social elements is essential for developing targeted interventions and comprehensive strategies to promote and safeguard the mental well-being of nurses in clinical settings.

Trial and protocol registration

The larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676 .

Reporting method

This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Peer Review reports

The prevalence of mental health problem among clinical nurses is high. As the largest group of health systems, clinical nurses play a crucial role in promoting health and preventing disease [ 1 ]. Although they are trained to provide care for their patients, they rarely cared about themselves [ 1 ]. Clinical nurses are suffering from mental health problems, including stress, anxiety, depression, and burnout. A meta-analysis involving 45,539 nurses from 49 countries revealed that a global prevalence of burnout symptoms was 11.23% across various specialties [ 2 ]. In Australia, the prevalence of depression, anxiety and stress among nurses was 32.4%, 41.2% and 41.2%, respectively [ 1 ]. In Italy, the prevalence of generalized anxiety disorder among nurses is 50% [ 3 ].In Spain, 68% of nurses had depression, anxiety, insomnia and distress to some degree, and 38% of them had moderate or severe symptoms [ 4 ]. A survey of clinical nurses from 30 Chinese provinces indicated that the rates of burnout, depression, and anxiety was 34%, 55.5%, and 41.8%, respectively [ 5 ]. Mental health problems may compromise physical, mental, and social health and even increase suicide risk [ 6 ].

The mental health problems among clinical nurses affects their personal well-being, work performance, patient care quality, and the healthcare system. Remarkably, their mental health problems not only heighten the risk of physical conditions such as heart disease, chronic pain, gastrointestinal distress, and even mortality [ 7 ], but also correlate with absenteeism, intention to leave, and elevated turnover rates [ 8 , 9 ]. These increased turnover rates exacerbate the financial challenges faced by healthcare institutions [ 10 ]. The presence of one or more of these mental health problems can contribute to occupational mishaps, including medical errors [ 1 , 11 ], compromised work performance, and a pessimistic workplace demeanor [ 12 ]. Nurses with mental health problems are at 26–71% more likely to make medical errors [ 13 ]. Furthermore, their mental health may imperil the well-being of patients and the quality of health services [ 14 ]. Moreover, these challenges can contribute to reputation harm, diminished productivity, and decreased clinical efficacy of the hospital [ 15 ]. Therefore, it is necessary to identify factors associated with their mental health for developing and implementing targeted intervention.

Previous studies have identified several factors associated with clinical nurses’ mental health, with some limitations [ 16 ]. According to the social ecological model, mental health is affected by factors at multiple levels and interaction between factors. However, most studies explored factors at a single level or a single type of factors. For instance, studies focused on factors either at individual (psychological characteristics) [ 17 , 18 ], or interpersonal (e.g., social support) [ 19 , 20 , 21 ], organizational (e.g., workplace violence) [ 22 ], or societal level (e.g., social status) [ 23 , 24 ]. Therefore, these studies fail to offer a complete picture of factors at multiple levels and examine interactions between factors. Additionally, the majority of extant studies adopt quantitative design with standardized measurements, which may neglect the intricacies of personal experiences and the significance of context.

To fill aforementioned gap, our study is aimed to explore associated factors for mental health at all four socio-ecological levels and to understand the interactions between factors from the perspective of clinical nurses.

Study design

This study adopted a qualitative descriptive design with focus group interviews. Qualitative description design is widely used to gather insight from key informants about poorly understood healthcare questions [ 25 , 26 ]. The design was considered appropriate because this study aimed to obtain a detailed description of participants’ perceived influencing factors of mental health. Focus group interviews were used for data collection to encourage the free exchange of information and to yield richer data and deeper insights into the topic.

This study was conducted in a tertiary hospital in Changsha, Hunan Province, China. The hospital has 3000 nurses and 137 head nurses.

Participants

This study included clinical nurses and head nurses who were employed by the hospital for one year or over. They were recruited, using both convenience and purposive sampling between April to May 2023. The study was advertised through the existing network of the authors. Potential participants were approached by the authors via WeChat with an explanatory statement. The explanatory statement included a brief introduction of the study and invited potential participants to contact the first author directly to arrange the interview time and venue. Purposive sampling was used to obtain maximum variation, within participants’ characteristics including gender, years of work experience, clinical work area, and having an administrative position or not.

Data collection

We conducted seven focus groups (seven- eight participants in each group) in the meeting room of the hospital between April to May 2023. We introduced the purpose of the research and topics before conducting the group interview. The interview guide were developed based on the literature review, including following questions: (1) How about your mental health in daily work? (2) What are the factors influencing your mental health? (3) How does mental health affect your daily life? (4) When you felt down, what kind of coping strategies do you adopted? (5) What external factors (e.g., individual, interpersonal and environmental factors) are conducive to promoting your mental health? The interviews were conducted in Mandarin. The second author acted as a facilitator for focus groups, and she participated workshop in qualitative research as part of master course. The fourth author acted as a note taker who took field notes and observed the interaction within the groups. The duration of the focus group interviews ranged from 65 to 94 min (mean 81.5 min).

Data analysis

Preliminary data collection and data analysis were conducted simultaneously, which enabled collection to cease on reaching data saturation. All audio recordings were transcribed in Mandarin using Xunfei software, and the accuracy was verified by the first, third, and fifth authors. Then, all the data were input entered into excel for analysis. Three authors (the second, eighth, and ninth authors) independently coded the transcripts line by line and then deliberated to form a preliminary coding framework. Constant comparative analysis ensured consistent coding across transcripts. They developed a preliminary coding framework after coding the first three transcripts, refining it iteratively with subsequent transcripts. This was repeated with further transcripts, and the subthemes were refined and reduced in number by grouping codes together. Following the development of the final coding framework, the remaining transcripts remained open to new additions if needed.

Final themes were constructed using an inductive process. The social ecological model was used to group themes. This model was used to connect the findings with the literature and conceptual framework. The social ecological model [ 27 ] is used to describe multiple factors affecting mental health and explore healthcare behaviors [ 28 , 29 ], these factors grouped into four levels: intrapersonal, interpersonal, organizational and societal level. This model includes four levels: individual, interpersonal, organizational and societal. Individual level identifies biological, character traits and psychological factors. Interpersonal level examines communication and interaction with individuals in social networks. Organizational level contains resources obtained from organizations and through social interactions. Societal level focuses on factors that help create an atmosphere conducive to maintaining mental health.

The study’s rigor was established through meticulous attention to credibility, transferability, dependability, and confirmability [ 30 ]. Credibility was achieved by rigorously analyzing the data by the research team. Transferability was ensured by providing a comprehensive description of the study setting and detailed narratives of participant experiences. Additionally, dependability and confirmability were upheld through a meticulous audit of methodological decisions made by the research team throughout the study process.

Participant’s characteristics

Fifty nurses were invited to participate in this study, and two declined the invitation; the remaining 48 nurses completed the interview. More female nurse participated in the study ( n  = 37) rather than male ( n  = 5). The participants’ social demographic characteristics are presented in Table  1 .

Main findings

As shown shown in Fig. 1, factors associated with clinical nurses’ mental health were categorized four themes and 13 subthemes: (1) individual-level factors, (2) interpersonal-level factors, (3) organization-level factors, and (4) social-level factors.

Factors associated with clinical nurse’s mental health

Individual-level factors

Participants reported that their mental health could be impacted by personality traits (i.e., optimistic/negative life outlook), quality of sleep, workplace adaptability, and years of work experience. Some participants mentioned that adaptability was important for them to manage emotional and practical daily challenges in the face of rapidly changing and unpredictable circumstances.

When novice nurses take care of patients by themselves, they may experience increased stress, especially when patients’ condition changes suddenly during the night shift (F1P4).

Interpersonal-level factors

Participants perceived that interpersonal support and role conflict were associated with their mental health.

Interpersonal support

Our participants identified that interpersonal support was playing an important role in maintaining their mental health. They explained that talking to their families, friends, colleagues and supervisor were an effective way to relieve work stress.

I sought to the person I trust the most (my family) and talked all the unpleasant things with them when I felt very stressed (F3P3).

Role conflict

Participants mentioned that it was inevitable for them to experience role conflict (i.e., work-family conflict and work-school conflict) because of the demanding and challenging conditions of the job. They felt guilty when work pressures interfered with family responsibilities. Some participants identified that their emotional stress increased when their work interfered with their ability to meet the demands of their kids’ school. The demands of long study hours and early clinical hours caused stress among them and kept them from household responsibilities of cooking, cleaning, and spending time with children. Participants also felt that family support of their career choices helped their job performance.

. my father was diagnosed with lung cancer two years ago. He was resuscitated many times during his treatment. However, I was always busy working at the fever outpatient department and couldn’t spend much time with him. I still feel sad…(F7P4) .

Organization-level factors

Participants perceived that their mental health was influenced by the following four organizational-level factors, including (1) organization climate, (2) organization support, (3) career plateau, and (4) job control.

Organization climate

In this study, organization climate included emotional climate and workplace incivility. Participants perceived the importance of the emotional climate due to the transmissive nature of emotional states. It was easy to be infected by the negative emotions of colleagues, so that the entire department can generate or maintain a negative emotional climate, vice versa.

Some colleagues are always complaining, which affects others’ the mood (F3P4).

Most participates identified it was common for them to experience workplace incivility which came from their nurses, physicians, supervisors and patients. They felt disrespected, threatened reprimanded, and emotionally abused, which evoke negative emotions, such as anxiety, depression, exhaustion.

Organization support

Participants perceived that organization support (i.e., instrumental and emotional support) were related to job satisfaction and mental health. Participants identified various forms of instrumental support, including physical environment, sufficient human resource, task assistance, training opportunities and flexibility in work schedule. The support helped them to perform job roles, which also carried emotional meanings. Emotional support included listening to work concerns, allowing to vent emotions, and providing words of encouragement. The support provided socioemotional resources, involving affection, sympathy, understanding, acceptance, and recognition.

. we definitely don’t want our supervisor to scold us without getting the full picture (of the whole thing), and we really hope that supervisor investigate what really happened…(F7P2) .

Career plateau

Our participants, especially seniors frequently mentioned the challenge of double career plateau which includes hierarchical plateau and content plateau. They felt frustrated and even hopeless when they were experiencing a permanent end in career advancement. Some participants perceived little opportunity for vertical improvement because of the flattened pyramid shape within the hospital. Some participants expressed the concern about future professional recession because they have limited opportunities to master new skills.

Everyone think that our nurses don’t seem to have a future, especially the male nurses… only one or two nurses can really be head nurses (F2P1).

Job control

Many participates complained that they lack of control over work time and tasks. They had to extend their work time without compensation, leading to work-family conflicts. They felt exhausted and disgusted when they were asked to attend training and meetings immediately after night shifts. Additionally, some participants got annoyed by research tasks because they were not interested in it, and some participants felt incompetent at it because they did not receive relevant training.

we were asked to attend meetings and participate training and other activities after we finish our night shift. It’s really annoying (F7P5).

Social-level factors

Participants identified three social-level factors associated with the mental health, including (1) compensation package, (2) social status, and (3) legislative provision and policy.

Compensation package

Many participants were not satisfied with their compensation package. They indicated feelings of inadequate reward for their efforts and the level of responsibility, and unfairness of salary compared with doctors. Some participants felt unsafe because the institute did not buy pension insurance for them.

I did not have pension insurance, I feel stressed (laughing)… I reckon that as long as our profession enjoys good welfare and incentives…People will regard nursing as a valuable profession…(F2P8) .

Social status

Some participants perceived their social status as low, and it is common for them to receive discrimination from patients, relatives and doctors. Participants shared their experience of being viewed as servants by patients in the ward, which made them feel humiliated. They frankly voiced that their low social status, low salary and unsatisfactory professional image made them reluctant to recommend this career to others.

…In the eyes of most people, our status, ,are indeed low, they (patients) look down on us as if we were just waiters (F7P7)… .

Legislative provision and policy

Participants believe that legislative provision and supportive policy was an effective approach to improve social status and professional image.

How do you advocate for the rights of nurses? I believe the legal aspect is more important…(F5P4) .

To our knowledge, this is the first qualitative study which explored factors associated with mental health of clinical nurses by using socio-ecological model. The study advances the literature by emphasizing (1) the mental health is influenced by multi-level factors which include intrapersonal - (i.e., personality traits, quality of sleep, workplace adaptability, and years of work experience), interpersonal (i.e., interpersonal support and role conflict), organizational (i.e., organization climate, organization support, career plateau, and job control), and social-level factors (i.e., including compensation package, social status, and legislative provision and policy), (2) the interaction between factors, and (3) the reciprocal relationship between individuals’ mental health and their environments.

Consistent with the findings of previous research [ 31 , 32 , 33 , 34 , 35 ], our study found that nurses experience more work-to-family conflict than family-to-work conflict, leading to a feeling of stress and guilt. This may be because work and family life are mutually incompatible to some extent. Nurses experience high levels of physical, cognitive, and emotional demands due to the nature of the nursing profession. Meanwhile, most nurses are women, indicating a substantial number of dual-career or single-woman-headed households. They always are expected to take the primary responsibility for childcare and housework by themselves and society [ 36 ]. Therefore, they feel guilty when their work interferes with household duties and family responsibilities, or work detracts from quality time with their families. Notably, our study also found that organizational support (i.e., supportive working environment and flexibility in work schedule) and family support systems could help to mitigate work-family conflict. Consistently, organizational support has been identified as a valuable resource for fostering positive work attitudes and alleviating depressive symptoms [ 37 , 38 ].

Our study recognized the occurrence of double career plateau in nursing. This is because hierarchical and content plateau are closely connected. For example, the hierarchical plateau could lead to the content plateau. Nurse staff are more like to decrease their effort and consciously avoid holding more responsibilities due to the absence of promotion opportunities. Vice versa, nurse staff who are unable to expand their job expertise have limited opportunity for promotion. Notable, our study found that some nursing staff have initiated strategies to manage career plateau by improving academic qualifications. This finding was supported by previous evidence showing that more and more nurses are pursuing master’s and doctorates degrees [ 39 ]. Therefore, those nurses are more likely to experience role conflict and have compromised mental health [ 40 ]. Because they must navigate the added role of a student in addition to their professional career and family responsibilities within limited time and energy [ 41 ]. The career plateau not only leads to mental health problems (e.g.,depression, psychological stress, and burnout) but also exerts adverse effects on physical health. These effects manifest as irritability, outbursts, deteriorating service attitudes, confrontations with managers [ 42 ]. Nursing organizations and managers can address career plateau by providing more opportunities for advancement in nursing positions and titles and by establishing multi-dimensional career advancement pathways. For instance, implementing hierarchical management for nurses [ 43 ] can diversify career opportunities, motivate them, and ease the sense of professional stagnation, thereby alleviating mental health issues linked to career plateaus.

Our study found that nurses experience workplace uncivil acts from various sources, involving other nurses, physicians, supervisors, patients, and visitors. Consistently, evidence indicated that 65.7 − 90.4% of nurses were exposed to some degree of incivility. Previous studies have examined how this destructive behaviour affects organizational and individual outcomes, and which factors influence it [ 44 , 45 , 46 , 47 , 48 ]. Workplace incivility could cause emotional distress and productivity losses in nurses. This situation may be detrimental to patient safety and satisfaction. These negative outcomes could leads to financial strain on healthcare organizations [ 49 ]. Uncivil interactions within the healthcare team could be triggered by organizational and interpersonal factors, such as lack of support, heavy workload, inadequate personnel, and long working shifts. Particularly, these interactions negatively affect nurses who are the backbone of the team. Similarly, these factors were identified as risk factors of mental health of nurses in our study. We also found that support from other supervisors and coworkers could create healthy work environment, which is associated with improved mental health of nurses.

Strengths and limitations

A strength of this study was the use of the social ecological model as a theoretical framework. Contributory factors identified within each level of the framework were discussed by participants. This highlights that interventions developed around these contributory factors have the potential to improve clinical nurses’ mental health.

This study only recruited clinical nurses in one tertiary hospital, which may limits its generalizability. Our participants were recruited through the existing network of the author team, which may lead to selection bias.

This groundbreaking study has utilized the socio-ecological model to illuminate the intricate web of factors influencing the mental health of clinical nurses. The findings underscore the need for holistic interventions that address not only intrapersonal and interpersonal factors but also organizational and social-level factors to promote nurses’ well-being. By acknowledging the complexities of the nursing profession, healthcare organizations, managers, and policymakers can take proactive steps to create supportive environments, foster career development, and mitigate the adverse effects of workplace incivility. Ultimately, these efforts hold the promise of enhancing the mental health and overall job satisfaction of clinical nurses, which in turn contributes to improved patient care and healthcare system performance.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors extend their sincere thanks to the research participants.

This study was supported by the grant of the 2023 Scientific Research Projects of the Chinese Nursing Association (Nurses’ mental health study, ID: ZHKY202306).

Author information

Qiang Yu and Chongmei Huang should be considered the joint first authors. Qiang Yu and Chongmei Huang made equal contributions to this manuscript.

Authors and Affiliations

Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China

Qiang Yu, Yusheng Tian, Jiaxin Yang, Xuting Li, Jie Du, Jiaqing He & Yamin Li

School of Nursing, Ningxia Medical University, Yinchuan, China

Chongmei Huang

School of Nursing, Changsha Medical University, Changsha, China

Xiangya School of Nursing, Central South University, Changsha, China

Meng Ning & Zengyu Chen

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Contributions

YQ, HCM, TYS, YJX and LYM designed the study. HCM and YJX performed the interview. YQ, HCM, TYS, LXT, CZY, DJ and HJQ analyzed data. YQ, HCM, TYS, LXT, NM, CZY, DJ and HJQ did background researches, helped data transcriptions using software. YQ have drafted the manuscript. LYM supervised the research and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yamin Li .

Ethics declarations

Ethics approval and consent to participate.

The Ethics Committee of National Clinical Medical Research Center, Second Xiangya Hospital, Central South University approved this study (No.2023 − 0267). Formal written informed consent was obtained from each participant. Apart from the aim and pro-cedure of this study, nurses were also told that the participation wouldn’t affect them or their career, the whole interview would be audio-recorded and the anonymous records would only be used for this study. Besides, they were told about their rights to refuse to answer any question or withdraw at any time as well. With agreement to participant, they would sign an informed consent, after which they would be officially included in the study and interviewed. All methods were performed in accordance with the guidelines and regulations of the Declaration of Helsinki.

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Yu, Q., Huang, C., Tian, Y. et al. Factors associated with clinical nurse’s mental health: a qualitative study applying the social ecological model. BMC Nurs 23 , 330 (2024). https://doi.org/10.1186/s12912-024-02005-9

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DOI : https://doi.org/10.1186/s12912-024-02005-9

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SF Program Isn't Just 'Free Beer' for Unhoused. It's Backed Up by Research

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Over the last few days, social media commenters and conservative news outlets have piled on after AI entrepreneur Adam Nathan asked his followers on X, formerly Twitter, “Did you know San Francisco spends $2 million a year on a ‘Managed Alcohol Program?’’’

Nathan, the founder of AI marketing company Blaze and chair of the Salvation Army San Francisco Metro Advisory Board, posted last Tuesday describing the program as “giving out free beer” to unhoused people with alcohol use disorder.

Tech executive Garry Tan, who has often criticized San Francisco’s harm reduction policies for drug use, replied to the thread, calling the program “harm acceleration.” A Fox News headline declared it “buys vodka shots for homeless alcoholics.”

But while providing alcohol to people with alcohol use disorder can seem counterintuitive, research shows that such harm reduction strategies can be helpful, according to Keanan Joyner, a professor and researcher in the Clinical Research on Externalizing and Addiction Mechanisms Lab at UC Berkeley.

“The science is very clear at this point that harm reduction as a general strategy for treating alcohol and other drug use disorders is very effective. It’s a very positive thing,” Joyner said.

San Francisco’s Managed Alcohol Program, or MAP, provides housing, three meals a day, nurse-administered alcohol — usually in the form of beer or vodka — dosed to keep clients at a “safe level of intoxication,” and enrichment activities. It started in 2020 as public health officials responded to the COVID-19 pandemic, and its goal isn’t to reduce patients’ alcohol use or lead to abstinence but to increase their safety and overall quality of life.

Nathan, who did not immediately respond to KQED’s attempts to reach out for comment, said in his thread on X that while some studies and explanations support MAP, the concept “just doesn’t feel right.”

Joyner said that feeling isn’t uncommon, making harm reduction strategies for alcohol and substance use disorders the “most difficult topic for academics who study this.”

However, harm reduction strategies can result in fewer missed work days, trips to the emergency room, ambulance rides, and other disruptions to daily life for those with alcohol use disorder.

“This program seems good,” Joyner said. “I think it’s very good at doing what it’s intending to do, which is to reduce drinking levels to a manageable level without inducing severe withdrawal.”

According to San Francisco’s Department of Public Health, an internal analysis of MAP found a fourfold reduction in the usage of emergency department services by clients in the six months after their intake compared to the six months prior. It also reported that clients called emergency medical systems and visited the hospital half as often.

The program is run out of a 20-bed facility on the grounds of a former hotel and bar in the Tenderloin, where clients live in a “closed campus” environment under the supervision of staff.

The site’s bar, which has taps that previously dispensed beer and cannot be removed due to the leasing agreement, is one element that opponents of the program have taken issue with. So is its funding.

“Why isn’t every public health dollar not going to prevention and treatment?” Nathan wrote in one of the posts in his X thread.

Funding programs like MAP, however, can actually have monetary benefits to the public, especially since not all people with alcohol use disorder are willing to go through abstinence-based treatment programs, Joyner said.

He explained that when someone uninsured goes to the emergency room for withdrawal, an injury or other medical emergency related to alcohol use, “the city quote-unquote ‘pays.’”

“When you’re trying to consider the cost of implementing programs [like MAP], you’re not doing it against zero,” Joyner said. “How many people are going to show up in our emergency departments and ambulances? How much money does that cost? You’re comparing that amount of money to the amount of money that you’re spending on funding towards this type of program.”

A 2022 analysis by the Department of Public Health estimated that in the six months it tracked MAP’s impact, the program saved approximately $1.7 million. MAP costs over $5 million annually, and the department said it is in the process of finding this funding through Medi-Cal reimbursement.

The program is not without its shortcomings. MAP has served just 55 clients in its four years of operation, and a presentation from last October showed that although clients used fewer emergency services while in the program, some who left the facility returned to relatively frequent utilization of these services.

Still, public health officials believe the program is effective.

“This is a program for a really small but highly vulnerable subsection of the population of people with alcohol use disorder — really severe and pretty end-stage alcohol use,” Dr. Joanna Eveland, the chief medical officer for SFDPH’s Whole Person Integrated Care Program, told KQED.

“Within the SF Department of Public Health, we like to be data-driven, and the data we have for this program really support a significant decrease in [emergency medical services] utilization,” Eveland said. “Having freed up the resources that were taking people to the emergency room three, four or five times a day, now those are resources that we can use to support more people getting on the road to recovery through other SFDPH services.”

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