Abstract
Many advancements have been made in the field of program evaluation over the past few decades, particularly with the push for more outcome-informed practice (Thyer & Myers, 2007). This text informs both beginning practitioners and seasoned practitioners about the complexities and nuances of such practice using an evidence-based approach. It was written for use as a bona fide introductory text for social workers to evaluate their practice, and it is organized into three parts: foundations of outcome-informed practice, monitoring and interpreting client progress, and practical methods for measuring client progress.
The first subsection (foundations of outcome-informed practice), successfully establishes the importance of outcome-informed evidence-based practice, which can be defined simply using the three “M”s: Measuring client outcomes, Monitoring them consistently throughout an intervention, and Modifying the intervention, if necessary. The authors argue that traditional evidence-based practices are not always effective for every practice situation, in part, because they are based on data from specific clients who do not always represent all client demographics. Recently, Wodarski (2011) referred to this as “using homogeneous interventions with heterogeneous clients” (p. 578). The book offers examples showing that few evidence-based interventions have been examined with clients of color, gay or lesbian clients, and other minorities. Throughout the text, the authors provide illustrative case examples of diverse individuals and groups to illustrate how outcome-informed practice is useful for dealing with a range client challenges, presented in a variety of practice situations.
The chapters in Subsection 1 reinforce the necessity of using outcome-informed practice methods to improve client–worker relationships, further develop practitioner skills, and become more accountable in practice. They also stress that the goals of interventions are not to demonstrate their own effectiveness, but that selected interventions should help clients achieve their goals. The authors convey that these goals should be always at the forefront of a practitioner’s mind, and if they are not being achieved, a practitioner should know sooner rather than later, so that the intervention can be adapted as necessary.
Subsection 2 (monitoring and interpreting client progress), outlines how to perform effective outcome-informed practice, which is particularly valuable for novice practitioners. In the assessment phase, the authors discuss the importance of defining a client’s goals and objectives using multiple data sources (i.e., self-assessment, tone of voice, appearance, etc.), case conceptualization, and identifying the limitations of diagnosis. A major asset of the assessment chapter in this subsection is the detailed discussion of case conceptualization, involving critical thinking to integrate a theory or model of human behavior to describe a client’s problems. This leads to offering suggestions for the causes of the current situation and unfolding the origins of the problems, which are particularly useful when working with clients having multiple challenges. Case conceptualization is deemed under utilized in social work, and these authors do an excellent job of explaining and incorporating this rather “forgotten skill” when assessing clients.
Subsection 2 also provides detailed explanations of how to construct graphs by hand, and/or through Microsoft Word, using some creative and fun exercises for monitoring client outcomes. Such explanations and examples promote the fundamental elements of graph-making to promote neatness, legibility, and ease of interpretation. Here, the authors stress the importance of measuring and monitoring a client’s outcomes at regular, frequent, and predesignated intervals in a sensitive and respectful way, to monitor if the client is making adequate progress. They also discuss the visual importance of a graph, which allows a practitioner to assess the client’s progress in “real time” to gauge if change is transpiring, whether that change is beneficial, and if it is at an acceptable rate. Options are presented if change is not occurring or if it is ineffective, inadequate, or happening too gradually. A discussion is then provided on the limitations of visual analysis and how to avoid making empirical mistakes. Finally, if needed, the authors offer information about how to alter the intervention, using other evidence-based practice approaches to align better with a client’s goals.
Subsection 3 (practical methods for measuring client progress) provides more detail about the multiple ways to measure, assess, and compare data. The chapter topics include: foundations in evidence-based outcome measurements, assorted case designs, behavioral observations, having the client self-monitor, and using both individualized and standardized scales. All of these discuss the advantages and precautions that practitioners should take when implementing these methods. These latter chapters are also peppered with poignant case examples to emphasize usual practice situations and obviate common errors in data collection, with each particular method presented.
One criticism of the text is its content arrangement. Namely, the assessment chapter, which could easily go with the subsection on monitoring and interpreting client progress, has been placed in the foundation section, which to this reader seems rather counterintuitive. Social workers regularly assess clients throughout their interventions, as clearly demonstrated in the book, so the information provided should be placed in the respective subsection that discusses the continual monitoring and interpreting of client progress, not in the foundation section. Additionally, some content in latter chapters which discuss the specific methods of measuring client progress could have been reorganized differently, so that it would not require readers to flip back and forth, from various chapters to glean the information needed to implement an outcome-informed evaluation. For example, if a practitioner is having a client self-monitor the frequency and duration of a reoccurring problematic event, the social worker would inconveniently need to refer to pages 73–107 and 230–238 on a regular basis to understand how to construct, chart, and interpret the data collected, which is rather time-consuming.
For the most part, the text has many strong elements, not to mention being extremely clearly written and providing step-by-step instructions on completing well-crafted outcome-based interventions. The authors undoubtedly gave a lot of attention toward the practical use of this text in classroom settings. Their suggested accompanying website (www.ormebook.com) is filled with a variety of useful documents and forms for instructors and students at access and use. Each chapter comes with PowerPoint slides for teaching, chapter-specific resources (i.e., forms for behavioral observations and self-monitoring, additional readings), and Microsoft Word documents for graphing client progress. Likewise, for practitioners, the book includes useful well-established standardized scales in the appendices that are practical for monitoring client progress.
As mentioned previously, another asset presented in nearly every chapter is the multiple case examples targeting the intricacies of real-life social work practice and presented useful explanations about how to handle such challenges when evaluating various interventions. Additionally, at the end of each chapter, the authors provide a practice test reviewing the content covered in the chapter. A particularly valuable and useful feature of these chapter tests are the questions designed similarly to those on the licensing exam, which allows excellent opportunities for both students and beginning practitioners to have such “fingertip” information readily available.
Finally, Outcome-Informed Evidence-Based Practice is a must read for social work educators, students, and practitioners who are looking for clear explanations about the key tenets of outcome-informed practice. Following their suggestions in this regard, serves to sharpen both the ethical relationships between clients and workers and help us provide more meaningful and empirically based interventions tied to relevant outcomes. The text is probably best served for graduate students in research or practice courses, but at all levels of social work, learners could be able to understand and implement these skills provided. As such, I highly recommend this text to instructors who teach this content area, and students/practitioners who want to make informed decisions about the interventions they implement with their clients in respectful and ethical ways.