Science,Social Work,and Intervention Research

Abstract

Intervention research is an important, yet often neglected, focus of social work scholars and investigators. The purpose of this article is to review significant milestones and recent advances in intervention research. Methodological and analytical developments in intervention research are discussed in the context of science and social work. Critical Time Intervention, a psychosocial approach to preventing homelessness and improving mental health outcomes among adult populations, is described as an example of rigorous intervention research in social work.

Keywords

intervention research social work science mental illness homelessness

A significant amount of social work practice and policy efforts are aimed at developing social interventions for people in vulnerable or adverse situations. Evaluating the effects of interventions for diverse populations across substantive problem areas is fundamental to improving outcomes for individuals, families, neighborhoods, and communities. In this context, intervention research is critical to the larger discussion of science and social work found in this special issue.

Social work’s mission to prevent and treat individual and social problems leads to a logical assumption about the importance of designing and testing interventions for vulnerable populations, neighborhoods, and communities. Yet prior studies have shown that relatively few social work investigators conduct intervention research and that social work lags significantly behind intervention research in disciplines such as public health and psychology (Fraser, Richman, Galinsky, & Day, 2009; Jenson, 2010). Further, a very small percentage of peer-reviewed publications in the social work literature describe outcomes from intervention trials (Jenson, 2005; Rosen, Proctor, & Staudt, 1999). The lack of attention to intervention research in social work is somewhat surprising in view of past and current efforts aimed at integrating elements of practice (intervention) and science in social work education and research (Brekke, 2012; Briar, 1974; Fraser et al., 2009; Kirk & Reid, 2002; Rothman & Thomas, 1994).

There are notable exceptions to the lack of intervention research in social work. In recent years, investigators have developed and tested interventions aimed at preventing problem behavior in children and adolescents (Fraser et al., 2005; Hawkins, 2006; Jenson & Dieterich, 2007), improving mental health outcomes for children and adults (Ell, Lee, & Xie, 2010; McKay et al., 2010), and preventing homelessness among adults with serious mental illness (Herman & Mandiberg, 2010). Findings from controlled trials conducted by these and other social work investigators have led to important advances in understanding the etiology of individual and social problems and in improving outcomes for individual clients, neighborhoods, and communities.

Advances in social work intervention research and the heightened attention to the role of controlled trials in the context of science and social work are encouraging. This article is a response to a presentation made by Daniel Herman at the second Roundtable on Science and Social Work at Bainbridge Island, WA, on July 17, 2013. Herman and colleagues (2011) have been testing the effects of a program called Critical Time Intervention (CTI) in randomized controlled trials in New York City (Herman & Mandiber, 2010). CTI seeks to prevent homelessness and improve mental outcomes among adults suffering from serious mental illness during the transition from institutional care to community living.

In this article, elements of CTI are reviewed in the context of recent advances in work intervention research. Milestones in connecting science to social work intervention research and methodological developments in social work intervention research are discussed. Finally, recommendations for advancing intervention research through programs like CTI are noted.

The Intersection of Science and Social Work Intervention Research

Early Developments

Discussion of the connection between science, practice, and intervention research is not new. In an oft-cited article dating to the early 20th century, Flexner (1915/2001) grappled with the question of whether social work was a legitimate profession. In his treatise, he also noted the relatively weak integration between research and practice that characterized early social intervention. Social work pioneers such as Jane Addams (1911) suggested that systematic data collection and information processing were critical aspects of effective individual-level interventions and community practice strategies. The persistence of early advocates and subsequent interest in the growing number of empirically based treatments for mental health and other problems in the mid-20th century set the stage for later efforts to link science and intervention research.

The effects of social work interventions on client outcomes became a focal point in the discussion of science and intervention during the 1970s. Several reviews of the treatment outcome literature in social work revealed few effective interventions for clients (Fischer, 1976, 1978). These findings, accompanied by similar results in criminal justice and other fields (e.g., Martinson, 1974), called attention to the inadequate methodology used in outcome studies and, in general, highlighted the fragile link between science and practice.

The disappointing results from treatment outcome reviews contributed to the endorsement of the scientist–practitioner model, a framework first adopted by psychology at a 1949 conference in Boulder, Colorado (Raimy, 1950). The scientist–practitioner framework encouraged social workers to rigorously evaluate the effects of intervention with clients by using research strategies associated with single-subject design (Barlow, Hayes, & Nelson, 1984; Jayaratne & Levy, 1979). In the 1980s, most schools of social work offered or required graduate-level research courses in single-subject design. Some readers will recall their classroom or instructional experiences in the study and application of this methodology. The fact that nearly all social work graduate programs allocated instructional time to convey the scientist–practitioner model to students was a testament to the importance relegated to the framework.

Unfortunately, the combined effects of past efforts to connect science and practice were only modestly successful. Evaluations of the scientist–practitioner model revealed that relatively few practitioners engaged in systematic practice evaluation (Kirk & Reid, 2002). Many practitioners suggested that the principles associated with single-subject design inhibited their ability to engage in effective and sensitive practice with clients. Investigators also found that most practitioners did not consider empirical evidence when selecting interventions for clients (Rosen, Proctor, Morrow-Howell, & Staudt, 1995).

Social work and other social science organizations have also led efforts to integrate science, practice, and intervention research. In 1988, the National Institute of Mental Health (NIMH) appointed the Task Force on Social Work Research to lead an investigation of the status of social work research. The Task Force examined virtually all aspects of social work research, including the productivity of social work faculty, the apparent lack of federally funded social work researchers, and the nature of advanced research training in social work doctoral programs (Task Force on Social Work Research, 1991). Chaired by David Austin from the University of Texas at Austin, the Task Force conducted the most thorough review of social work research in history.

A 1991 report by the Task Force on Social Work Research produced recommendations that contributed to a number of advances in social work research. Motivated by the work of the Task Force, the NIMH funded seven Social Work Research Development Centers in schools of social work during the 1990s. Each center targeted a specific population and each developed and tested diverse intervention approaches. NIMH centers offered support to junior faculty members and created positive research climates in schools of social work that led to an increase in the number of federally funded grants by social work investigators. Task Force efforts also influenced important guidelines on research training in doctoral education. The Group for the Advancement of Doctoral Education (GADE, 1992) issued a document in 1992 that placed considerable emphasis on the quality and rigor of research training. Finally, the Task Force fostered an environment that led to the creation of national organizations designed to promote social work research. Included in this effort was the Institute for the Advancement of Social Work Research (IASWR) and the Society for Social Work and Research (SSWR). IASWR worked tirelessly to promote social work research by creating a stronger research infrastructure at the national level until its eventual closure in 2009. As a testament to the profession’s interest in research, the annual SSWR conference is now host to nearly 1,500 participants. The visibility afforded the NIMH Task Force created greater national awareness of research conducted by social work investigators (see Austin, 1999, for an assessment of task force accomplishments).

Efforts to advance intervention research were also being made in psychology and related disciplines during the 1990s. In psychology, concern about the failure of many therapists to use empirically supported treatments led to the American Psychological Association (APA) Task Force on the Promotion and Dissemination of Psychological Procedures in 1993 (Barlow, Levitt, & Bufka, 1999). The Task Force was established by the APA Society of Clinical Psychology (Division 12) to identify efficacious treatments across a range of mental health disorders and problems. APA Task Force members with expertise in diverse therapeutic approaches and populations developed criteria for treatments deemed to be well established and empirically validated and for treatments considered to be probably efficacious. Well-established treatments were those therapies that evidenced efficacy in at least two independent and rigorous experimental studies. Probably, efficacious treatments were therapies in which only one study supported a treatment’s efficacy or therapies that had been tested by a single investigator (Barlow et al., 1999).

The APA Task Force recognized randomized clinical trials as the most rigorous and acceptable method of producing empirically supported treatments. In lieu of randomized trials, findings from a large series of single-case design experiments were accepted as criteria. The Task Force initiated a search of efficacious and probably efficacious treatments in 1993. The subsequent list of efficacious therapies has since been updated twice (Chambless, Sanderson, Shoham, et al., 1996; Chambless, Baker, Baucom, et al., 1998).

These developments and milestones illustrate important advances in the relationship between intervention research, practice, and science. However, most social work investigators and historians would likely agree that early efforts to link science and intervention research met only incremental levels of success.

Recent Advances

Interest in intervention research has been partially fueled by a parallel increase in the application of evidence-based practice (EBP) in social work and other disciplines in the past 15 years (Gambrill, 2006; Jenson & Howard, 2008). The promotion of EBP in social work was attributed initially to individual scholars and small groups of researchers (e.g., Gambrill, 1999, 2003; Howard & Jenson, 1999; Proctor & Rosen, 2003; Thyer, 2004). These early efforts were aimed largely at exposing social workers to definitions of EBP and to concurrent developments in evidence-based medicine. Discussion of the process of applying EBP principles to social work practice and policy soon followed (Bilson, 2004; Gambrill, 2006; Gibbs, 2003). A significant number of social work researchers and educators have since acknowledged the importance of EBP. More important, the recent surge of interest in EBP is raising awareness about the importance of considering empirical evidence in selecting interventions among practitioners who may not have considered such evidence in the past.

Support for EBP is evident in the exponential growth in the number of books and articles addressing the topic (Jenson & Howard, 2008). Sessions on EBP have increased significantly at recent national social work conferences sponsored by the SSWR and the Council on Social Work Education. Furthermore, a 2006 University of Texas at Austin symposium on EBP signaled an increasing recognition in the importance of teaching EBP in the social work curriculum. The Austin conference led to the publication of a 2007 special issue of Research on Social Work Practice that summarized the viewpoints of presenters at the symposium. Transparency in the use of EBP in practice and education, steps required to teach EBP, and structural curricular reforms consistent with EBP were among the topics discussed in the issue.

A parallel development that more clearly articulates the process of conducting intervention research has also emerged in recent years. The idea of developing and testing interventions under rigorous and controlled conditions can be traced to early scholars such as Rothman and Thomas (1994). These investigators defined stages of intervention research that provided an important foundation for social work investigators. In recent years, these early ideas have been reframed and further defined (Fraser et al., 2009; Jenson, 2010) in ways that provide a conceptual and methodological blueprint for scholars interested in conducting intervention research.

Content addressing intervention research has gained visibility at national and international conferences in recent years. For example, intervention research was the topic of a conference hosted by the School of Social Work at the University of Southern California in 2010. The conference highlighted the work of social work intervention researchers and led to a special issue of Research on Social Work Practice in 2010. Recent sessions at the annual meeting of the SSWR have also been organized to focus solely on topics of intervention research (Fraser, Testa, Grinstein-Weiss, & Jenson, 2013).

CTI and Social Work Intervention Research

Advances in intervention research are best illustrated by case examples of social work scholars who have developed and tested interventions. As described in this issue, Herman and colleagues have been examining the effects of a structured community support program called CTI on adults with severe mental illness. CTI is a psychosocial intervention aimed at reducing the risk of homelessness for individuals with severe mental illness during the transition from institutional care to community living. Herman and associates (2011) have been testing the effects of CTI in randomized trials in New York City (Herman & Mandiberg, 2010). See Herman (this issue) for a detailed description of CTI program components.

The evolution and testing of CTI reflects both the process and importance of conducting social work research. Herman and colleagues painstakingly developed CTI by talking to practitioners about possible program components. These discussions led to a programmatic emphasis on helping adults with serious mental illness during the transition from institutional care to community living. The role of CTI workers was defined and intervention elements began to take shape during this initial phase. These early intervention elements were subsequently exposed to a series of pilot studies and refinements. Over time, intervention strategies in CTI were defined, routinized, and tested in randomized controlled trials (Herman et al., 2011; Herman & Mandiberg, 2010). Positive findings from these trials, described by Herman in this issue, have led to wider efforts aimed at disseminating and replicating the intervention at a much broader level.

CTI meets criteria for what most investigators would identify as well-conceived and rigorous intervention research. Its focus on a key transition in the lives of people suffering from mental illness addresses compelling individual, community, and societal needs. While somewhat atheoretical in nature, CTI is a pragmatic intervention that targets time-specific needs of a very vulnerable population. Its emphasis on transitions, an oft-neglected time period in interventions for many client groups, meets a significant need in the lives of people with severe mental illness. Furthermore, CTI has now undergone testing under the type of rigorous methodological conditions that allow its developers to speak with confidence about the effects of the program on people’s lives.

In this issue, Herman notes that CTI has had the greatest impact on reducing hospitalization and homelessness among participants. The effect of the intervention on measures of social functioning and social integration remains more elusive. Subsequent tests of CTI should be used to examine social functioning and well-being more carefully. In addition, mechanisms of change in CTI have not been delineated extensively in the group’s published articles. In this regard, it would be helpful to conduct mediation analyses to further specify how participation in CTI leads to positive outcomes. Outcomes for subpopulations might also be explored more fully by Herman and colleagues.

Where does CTI go from here? Positive findings from efficacy trials of programs like CTI eventually lead to questions of effectiveness and generalization. Having demonstrated positive outcomes in efficacy trials, CTI may be ready to undergo a larger effectiveness study at the community level. Randomized trials of community prevention initiatives designed to reduce risk and prevent child and adolescent problem behaviors like substance abuse and delinquency may provide important lessons for CTI (Hawkins, Catalano, Arthur, & Egan, 2008; Spoth, Redmond, Clair, Shin, Greenberg, & Feinberg, 2011). Finally, cost–benefit analyses of CTI should be considered. Findings from cost–benefit studies of the intervention will be necessary to include CTI in social legislation or policy directives aimed at improving the lives of people with serious mental illness.

Advancing Social Work and Science Through Intervention Research

CTI and other rigorously tested social work interventions offer great promise for advancing principles of social work and science. Intervention research is compatible, indeed integral, to the fundamental principles of science and social work discussed by Brekke and other authors in this issue. Intervention research should be a cornerstone of any larger discussion of science and social work. Strategies to advance this discussion are noted below.

Strategies to Enhance Social Work, Science, and Intervention Research

Define and test theories of change in intervention trials

Efficacious interventions are based on theoretical propositions and empirical evidence that lead to well-specified theories of change. Theories of change are necessary to test causal relationships, identify mediating variables and processes, and examine the efficacy of an intervention. Figure 1 illustrates the premise behind articulating a theory of change in an intervention trial. In this figure, direct and mediating effects of a hypothetical intervention are shown to illustrate why theories of change are critical to asserting cause and effect in intervention research. Understanding the influence of mediating factors on outcomes is critical in intervention research. Tests of mediating factors often shed light on the underlying latent processes or mechanisms of change that produce outcomes in efficacy or effectiveness trials. See Jenson & Bender (2014) and Fraser et al. (2009) for additional information about theories of change in intervention research.

Figure 1.

A hypothetical theory of change in intervention research.

Apply recent methodological and analytical advances to social work intervention research

Methodological and analytical advances have greatly increased the precision of research in the past decade. In intervention research, new design options such as cluster or group-randomized experimental designs that control for levels of influence have become increasingly common in intervention trials. To illustrate, Jenson and Dieterich (2007) used such a design to control for classroom- and school-level effects in a group-randomized trial of a school-based bullying prevention program in Denver. Group-randomized designs are particularly relevant in social work because intervention trials occur frequently in schools, neighborhoods, communities, or other settings where subjects are nested in some larger context. Therefore, multilevel modeling analysis is used commonly to account for levels of influence in group-randomized designs (Jenson & Dieterich, 2007).

Ensuring pretest equivalency between experimental and control groups has long been a concern in intervention research. Randomization to an experimental or control condition is not always possible in social work research. Furthermore, some critics of randomization have argued recently for a more “realist” approach to evaluating social and health interventions (Bonell, Fletcher, Morton, Lorenc, & Moore, 2012). An important advancement to ensure pretest equivalency comes in the form of propensity score analysis (Guo & Fraser, 2009). Propensity score analysis is an analytic tool used to redress imbalances in subject characteristics found among two or more groups at baseline. Finally, investigators have also applied increasingly sophisticated tools to estimate and impute missing values in intervention trials (Rose & Fraser, 2008).

Teach principles of intervention research across the educational continuum

Clearly, at its highest level, intervention research is a complicated endeavor that requires a host of substantive, political, and methodological skills. However, the core steps in conducting basic intervention research—specifying a problem, creating or selecting an intervention or program, and testing effectiveness—are in many ways similar to the steps used by experienced clinical and community practitioners. Exposure to the process and discussion of the importance of intervention research should be increased at all levels of social work education.

Link elements of intervention research to EBP and translational research

Current attention to EBP and translational research offers another opportunity to advance intervention research in social work. We have learned a great deal about the effectiveness of interventions for a broad range of individual and social problems in the past several decades. Research, policy, and governmental entities concerned with improving the dissemination of efficacious interventions have created registries of effective programs that are widely available to practitioners, educators, and the general public (e.g., Campbell Collaboration Library, 2013; Center for the Study and Prevention of Violence, 2013). Such dissemination efforts, viewed by many as key products or outcomes of EBP, can be easily conveyed to the practice community.

The larger issue of translating knowledge gained from intervention research to the field is a challenging one. To date, translational research mechanisms in social work have proceeded at a rather slow pace (Brekke, Ell, & Palinkas, 2007). One example of effective translation is evident in the dissemination efforts associated with cost–benefit analyses of prevention programs being conducted by Aos, Lieb, Mayfield, Miller, and Pennucci (2004). Results of these analyses are providing important and practical data to policymakers and practitioners as they search for solutions to complex funding and program implementation questions. A second example of effective translation is seen in the current test of Communities That Care (CTC), a prevention approach used to guide community representatives through a process of identifying salient risk factors for problem behaviors and selecting appropriate interventions to reduce risk (Hawkins et al., 2009). Results from a cluster-randomized trial of CTC involving 24 small towns in seven states indicate that eighth-grade youth in the experimental (CTC) condition report significantly less alcohol, binge drinking, smokeless tobacco, and delinquency than youth in control group communities (Hawkins et al., 2009).

Adopt successful strategies from the fields such as public health and prevention

Public health and prevention principles have been widely used in the past decade to develop and test interventions in school, family, and community settings (Jenson & Bender, 2014). Outcomes from controlled prevention trials in disciplines like public health and prevention science indicate that empirically based and theoretically sound curricula can reduce risk, increase protection, and prevent the onset of child and adolescent problems. Knowledge gained from intervention trials guided by a public health approach to prevention has significantly improved our understanding of the onset and persistence of childhood and adolescent problems. Common designs used in these studies may offer important lessons for social work researchers.

Conclusion

Defining a clear vision for social work and science is a complex task characterized by many moving parts. Intervention research such as CTI has important implications for science and social work. Herman and colleagues work on CTI point to the importance of capitalize on social work’s long-standing reliance on theories of social ecology. Investigators should use ecological frameworks to identify risk and protective factors for problems encountered by vulnerable populations and articulate theories of change that are relevant to such groups. Theories should hypothesize and test mechanisms of change as part of an effort to improve the efficacy of interventions and services for clients of all types. To improve precision, effective interventions should be tailored when necessary to account for differences in race, culture, gender, and context. Finally, outcomes for subpopulations should be analyzed and evaluated.

Social work researchers are well positioned to conduct intervention research. Scholars like Herman have successfully navigated the challenges of conducting randomized controlled trials in very challenging settings and with very difficult population groups. Intervention research characterized by investigations of CTI represents a significant advance in the intersection of science and practice. Scholars are advised to study CTI and replicate its processes in intervention research aimed at other substantive problems and clients.

Footnotes

Author’s Note

This article was presented at the Islandwood Roundtable on Science in Social Work, July 17–18, 2013, Bainbridge Island, WA. It was invited and accepted by the Editor.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

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