Approved Mental Health Professional Survey update

We have received an excellent response to the national Approved Mental Health Professional (AMHP) survey in the first month of its administration. Almost 350 AMHPs have completed the survey so far.

The 2012 national AMHP survey is evaluating whether levels of stress and burnout have changed for this group of professionals in the last decade. Also, as it is the first national survey since the widening of the statutory role to other mental health professionals, it will allow us to compare levels of stress and burnout between social work and non-social work AMHPs for the first time.

To enable the survey to provide important data to inform AMHP policy and practice nationally we need a high response from AMHPs across England. We have had a great start, but there is still a long way to go. In particular, we would like to hear from more non-social work AMHPs as all but 17 respondents are social workers so far. Therefore, if you know a non-social work AMHP, please ask them to take the survey (please see link at the bottom of this post).

The survey is being promoted via social media and AMHP leads across the country. We are very grateful to the support of everyone who have helped to spread the word about it. Particularly, we are grateful for the following sites who have  posted information about the study:

Community Care news

Community Care blogs

Masked AMHP

The not so big society

The Care Guy

Care Training

We still need your help to achieve a high response over the next two months. There are a number of ways in which you can help to promote the survey:

1) If you are an Approved Mental Health Professional working in England, please take the survey if you have not done so already. The link is below.

2) If you know an Approved Mental Health Professional working in England, please email them the link to the survey.

3) If you don’t know any Approved Mental Health Professionals working in England but want to help distribute the survey, please use social media tools such as twitter, facebook, linkedIn, blogs or whatever you use to connect with other people, to send the link around.

The online survey takes only 10-15 minutes to complete and an information sheet containing further details about the study is displayed on the first page. If you would like to read more about and/or complete the survey please click on the link below:

https://www.surveymonkey.com/s/stressandthestatutoryrole

This study is being led by Janine Hudson, an experienced AMHP studying the MSc Mental Health Social Work with Children & Adults programme at the Institute of Psychiatry. The survey questionnaire has been pre-tested by AMHPs and other social workers. The survey will remain open until the end of March 2012.

Thank you in advance for your time and support.

Ruby Wax and co-production

Today I had the pleasure of meeting Ruby Wax, probably the best campaigner for the elimination of stigma against mental health problems. Although I am a critic of the cult of celebrity, when it is used as a force for good I am suitably impressed.

Ruby was the guest speaker at a Hestia seminar on co-production. She used some of the material from her ‘Losing it’ tour to promote her latest initiative. In February she is launching a new website – blackdogtribe.com – to create a ‘tribe’ to challenge mental health discrimination. Learning from gay pride, Ruby has a vision of people with mental health problems coming out loud and proud about their experiences. It will culminate in a momentous celebration on World Mental Health Day in October 2012.

Ruby is using her celebrity to empower people to find the confidence to talk about their experiences and share it with others. Like most social networking sites, blackdogtribe.com will build social capital and should be a force for tremendous good.

It is rather difficult to follow a performer such as Ruby Wax, but that is exactly what seminar organiser Elvis Langley asked me and others to do. I was a member of a panel to take questions from seminar participants and discuss some of the issues arising from the day. I was in esteemed company, sharing the platform with Peter Beresford, Mike Seal, Stephanie Royston-Mitchell, Mimi Nunez Trejos and Anthea Sully.

I felt ambivalent about joining a panel such as this as it implied I had answers to delegates’ questions. I mentioned this quandary when I introduced myself and instead posed a question to the floor. How do we break down professional barriers to achieve true co-production in services at both a macro and micro level? I don’t know the answer to this, but I think it requires changing people and challenging worldviews. Easier written in a blog post than achieved in reality…

I had in mind the intervention model we are developing on the Connecting People study when I talked about ‘micro co-production’ during the session this afternoon. This refers to workers and individuals co-designing interventions and its outcomes to achieve user-defined goals. In reality, this means workers sitting alongside individuals and exploring their assets – what they are good at or passionate about. They then use their assets to achieve goals the individual sets for him or herself. It is only after we developed the intervention model that I realised it embodied co-production principles. It has social capital at its heart, as well as one of its anticipated outcomes.

One questioner challenged the panel to name four co-production values (to help distinguish the concept from others such as ‘user involvement’). I suggested that it embodies equality, genuine partnership, empowerment (of both worker and individual) and adds value to existing services. The man who posed the question noted that we did not mention reciprocity. I kicked myself under the table for not being clever enough to come up with this myself.I should have mentioned this because reciprocal relationships are at the heart of co-production, right as they are at the heart of the Connecting People intervention model.

I left the seminar invigorated. I had met a celebrity who is genuinely doing good; I had met up with some great people from Hestia I know through the Connecting People study; I had met the commissioner of Kingston RISE as well as its director; I had met people I didn’t expect to see there; and Elvis, the seminar organiser, had told me that the idea for the day came from a conversation I had had with him ages ago (flattery goes a long way…). Perhaps most importantly, I came away with two more potential research projects to engage in. If only there were more hours in the day…

Social workers’ learning about empirical research methods: a problem of pedagogy or epistemology?

In common with other social science disciplines, the debate about what constitutes knowledge in social work is located in the wider divisions between positivist and constructivist perspectives about the nature of social reality [1]. The former finds expression in the evidence-based practice movement which argues that social work interventions should be based on the best available evidence derived through empirical research. In contrast, constructivists challenge notions of the objectivity of knowledge, arguing that it is socially constructed.

Social workers draw upon knowledge derived from a range of perspectives to become effective practitioners. Mental health social workers, for example, who work alongside psychiatrists and psychologists whose practice is largely defined by evidence derived from randomised controlled trials about the effectiveness of interventions, need to be able to articulate their own evidence base to justify their role in mental health services [2]. However, technical knowledge alone is insufficient for the complexity of social work practice, which frequently draws upon unconscious tacit knowledge which practitioners create themselves [3].

Advanced post-qualifying education in social work draws upon a range of epistemological traditions to assist the professional development of advanced practitioners. For example, it both supports practitioners to articulate their tacit knowledge and enables them to contribute to the profession’s evidence base through original empirical research [4]. However, our experience on the MSc Mental Health Social Work with Children & Adults at the Institute of Psychiatry is that practitioners frequently find learning about empirical research methods to be the most challenging aspect of the programme.

Social workers are more likely to have backgrounds in the humanities rather than the sciences, making them less familiar with empirical research methods at the beginning of their social work training. When they are included in social work curricula, empirical research methods are taught alongside other methods, such as participatory research, reflecting the discipline’s diverse epistemological paradigms [5]. It even appears that teaching empirical research methods to social work students has been a long-standing pedagogical challenge for many educators [6]. The result has been that social workers gain only a limited understanding of empirical research methods through their qualifying education and early post-qualifying training, which inhibits their ability to read, appraise and implement research in their practice [7, 8].

Our previous research with experienced social workers suggests that the quality of their learning is influenced more by their prior knowledge of empirical research methods than by the teaching modality used to deliver it [9], reflecting Ausubel’s [10] theory of assimilative learning. Understanding students’ prior knowledge structures through concept mapping can assist educators to more effectively engage with their students’ learning [11]. Concept mapping methodologies also permit students and educators to share knowledge structures and to make explicit any variances in their epistemological perspectives, which may act as barriers to both learning and teaching.

An effective empirical research methods module will equip students with the skills to appraise empirical research and integrate relevant findings into their social work practice. However, a higher order learning outcome would be that practitioners adopt empiricism as a practice paradigm. Popper [12] maintained that the mission of science is to disprove hypotheses. Translated to social work practice, this requires practitioners to be aware of evidence that runs counter to the theoretical assumptions on which they are basing their decisions and actions [13]. A study of social workers found that they tended to use confirmatory search strategies when finding information about cases, but when they were asked to justify their use of information they adopted less biased strategies and were more open to contradictory information [14]. This suggests that practitioners can use deductive as well as inductive methods of acquiring information to inform their practice. This higher order learning outcome could be achieved through a constructive alignment [15] of module learning and teaching with an assessment of students’ ability to use empirical methods in their day to day social work practice.

An understanding of how experienced practitioners learn (many of whom have been out of formal education for a number of years) may help to inform the pedagogy of empirical research methods modules. Further, integrating new knowledge with what practitioners bring to the classroom may help to avoid students adopting surface learning strategies, which can result in ‘non-learning’ [16]. Notwithstanding the irony of using constructivist methods to inform the learning and teaching of empirical research methods, there are undoubtedly many pedagogical and epistemological challenges facing social work educators who aim to enhance the quality of learning of empirical research methods for experienced social workers.

References

1. Pease, B., Challenging the dominant paradigm: social work research, social justic and social change, in The SAGE Handbook of Social Work Research, I. Shaw, et al., Editors. 2010, SAGE: London. p. 98-112.
2. Nathan, J. and M. Webber, Mental health social work and the bureau-medicalisation of mental health care: Identity in a changing world. Journal of Social Work Practice, 2010. 24(1): p. 15-28.
3. Schon, D., The Reflective Practitioner: How Practitioners Think in Action. 1983, New York: Basic Books.
4. Nathan, J., The making of the advanced practitioner in social work, in Reflective Practice in Mental Health: Advanced Psychosocial Practice with Children, Adolescents and Adults, M. Webber and J. Nathan, Editors. 2010, Jessica Kingsley: London. p. 29-45.
5. Shaw, I., et al., eds. The SAGE Handbook of Social Work Research. 2010, Sage: London.
6. Epstein, I., Pedagogy of the perturbed: Teaching research to the reluctants. Journal of Teaching in Social Work, 1987. 1(1): p. 71-89.
7. Morago, P., Dissemination and implementation of evidence-based practice in the social services: A UK survey. Journal of Evidence-Based Social Work, 2010. 7(5): p. 452-465.
8. Pope, N.D., et al., Evidence-based practice knowledge and utilization among social workers. Journal of Evidence-Based Social Work, 2011. 8(4): p. 349-368.
9. Webber, M., et al., Social workers can e-learn: evaluation of a pilot post-qualifying e-learning course in research methods and critical appraisal skills for social workers. Social Work Education, 2010. 29(1): p. 48-66.
10. Ausubel, D., The Psychology of Meaningful Verbal Learning. 1963, New York: Grune & Stratton.
11. Novak, J.D., Learning, Creating and Using Knowledge: Concept Maps as Facilitative Tools in Schools and Corporations. 1998, Hillsdale, NJ: Lawrence Erlbaum.
12. Popper, K., The Logic of Scientific Discovery. 1959, London: Hutchison.
13. Munro, E., The role of theory in social work research: A further contribution to the debate. Journal of Social Work Education, 2002. 38(3): p. 461-470.
14. Osmo, R. and A. Rosen, Social workers’ strategies for treatment hypothesis testing. Social Work Research, 2002. 26(1): p. 9-18.
15. Biggs, J. and C. Tang, Teaching for Quality Learning at University: What the Student Does. 3rd ed. 2007, Buckingham: Open University Press/McGraw Hill.
16. Kinchin, I.M., S. Lygo-Baker, and D.B. Hay, Universities as centres of non-learning. Studies in Higher Education, 2008. 33(1): p. 89-103.

Relevant research for Approved Mental Health Professionals

Each year I contribute a training session on research for Approved Mental Health Professional (AMHP) trainees. I find the day very enjoyable as it provides me with an opportunity to engage with practitioners and their knowledge of the research which underpins their practice.

I am not surprised that these practitioners (mostly social workers, but increasingly nurses or occupational therapists too) are generally unaware of recent research findings which are relevant for their practice. Continuing professional development opportunities for social workers generally provide few opportunities for them to critically engage with relevant research for their practice. Critical appraisal skills are rarely taught and practitioners are generally provided with little or no time to read research papers. However, I have noticed a small change in the last decade and believe that social workers are beginning to become more aware of the research which could potentially inform their practice.

The training session I lead for AMHP trainees includes a critical introduction to the paradigm of evidence-based practice; a discussion about critically appraising research; and a discussion about how research can meaningfully inform AMHP practice. My text book on evidence-based practice (Evidence-based Policy and Practice in Mental Health Social Work) forms the reader for the session.

At the end of the day I provide the AMHP trainees with a reading list of studies that have been conducted that could usefully inform AMHP practice. It is by no means a systematic review of studies, or even a comprehensive list, but it includes 150 references which AMHPs may find useful to consult in the course of their practice. I have decided to make this list publicly available as a way of saying ‘thank you’ to all the Approved Mental Health Professionals currently participating in the national survey which we are currently undertaking.

The list of references can be downloaded by clicking here. Please download it and share it with your AMHP colleagues. If there are pieces of research which you think could be usefully added, please let me know and I’ll add them to the list.