Health and mental health social workers need information literacy skills.
Health and mental health social workers increasingly view evidence-based practice as prescriptive, with researchers in centers of scholarship developing research for practitioners. This situation has exacerbated the rift between researchers and social workers who are expected to carry out empirically supported practices, although they are not involved in the production of research or even in the synthesis of evidence that supports particular practices and rejects others. People with research expertise and the resources to conduct empirical inquiry are generally located in academic institutions and do not necessarily call on practitioners themselves to critically examine evidence-based practice models. When these prescribed practices move from the rarified conditions under which randomized controlled trials are conducted into agency settings, they confront real-world organizational realities, Real-world "intrusions" may limit fidelity to the model produced by this "gold standard" of research. As a result, technology transfer, or reliability for replication of evidence-based practices, may be compromised. Perhaps most disheartening is how this situation encourages passivity among people in the field to engage in research or remain fluent with current research. Continuing knowledge development is a shared responsibility at all levels of the social work profession (Lewis, 2003), and current education and practice structures are not encouraging practitioners to be partners in this process. We assert that people closest to direct services are best positioned to point out practice realities that distort programs. Although practices may be supported by high-level empirical evidence, they may not prove effective or even feasible under real-world conditions.
Originally, evidence-based practice was proposed for physicians to make use of the convergence of an explosion of information and technology, so that clinicians could use the growing body of research available through online databases. Ultimately, other health professionals were supposed to formulate clinical questions, critically assess empirical studies, and decide on the best approaches to bring to a dialogue with clients. The clients were meant to be active partners in decision making about their own care.
The institution of the Cochrane Collaboration (http://www:cochrane.org./index.htm) and the Campbell Collaboration (http://www. campbellcollaboration.org/) formalized this process, and both apply rigorous, transparent standards to their reviews of research studies. Although they are meant to serve policymakers, health workers, and people who use services, the extent to which medical social workers consult their readily available Web sites is unclear. Unlike nursing, speech therapy or rehabilitation therapy, or other health professions that have produced a burgeoning literature on information literacy skills as a central concern for educators (Jacobs, Rosenfeld, & Haber, 2003; Nail-Chiwetalu & Bernstein Ratner, 2007), the social work literature is for the most part silent in this area. With the exception of two recent texts that promote a bottom-up approach to evidence-based practice (Courneyer, 2004; Gibbs, 2003) and Gary Holden's remarkable informatics Web site for social workers (http://www:nyu.edu/socialwork/ip/), we see little evidence that social work education at large is proactive in ensuring that social work health professionals have easy access to up-to-date knowledge about practice, that is, the promise of online access to research.
We maintain that for social work students and practitioners to use 21st-century technology and the burgeoning body of research evidence in their practice, they must become conversant with the retrieval, evaluation, and synthesis of information for problem solving and decision making in their clinical social work practice. We reject the idea that practitioners should be passive recipients of practice directives when other health professionals are actively engaged in critical evaluation of the literature in their fields. Their mastery of the ever-evolving knowledge base for practice can only enhance their prestige in health and mental health services; social workers will only become increasingly marginalized if they do not keep up. Evidently, social workers in health settings already have the basic tools on hand to become critical consumers of research. One example of this comes from our own work in this area. Research students in our program conducted two exploratory studies about practitioners' access to computers and search engines in the workplace and found that among our graduates and field instructors, more than 95 percent have both. At least half of these respondents work in health and mental health; however, it was virtually impossible to determine whether they were using these tools for scholarly purposes, shopping, or personal e-mail.
Other health profession educators are working collaboratively with librarians to develop important information literacy skills in their education programs. Information literacy involves a basic knowledge of search strategies combined with an understanding of both print and electronic research resources. It entails the use of critical thinking when interacting with information retrieved from these sources (Burrows, 2006). Tenner (2006) argued that today's students, and by extension providers who have come through these educational systems, are poorly prepared to read critically and write cogently; a situation he feels is exacerbated by their lack of skills in structuring online searches.
The process is not a mystery. Search techniques involve generating synonyms and key words; methods for identifying and recording successful search terms and collecting them into a personal search term thesaurus; learning Boolean operators; searching for terms in particular fields; and using sensitivity and specificity techniques to retrieve relevant items and exclude irrelevant ones. Students also need to learn about discipline-specific bibliographic databases, such as Medline and PsycINFO. They should learn to discern the reliability of sources available online and critically evaluate the literature they retrieve, including classification of articles on the basis of levels of evidence. Librarians and educators can help develop criteria for evaluating the specific elements of peer-reviewed articles, including problem formulation, methods, findings, and implications of the findings. In the end, we need to teach health and mental health social work students and practitioners how to incorporate the results of their bibliographic search findings and summaries into their own writing as part of original research, case and field reports, and literature reviews. We need a medical social work workforce that engages actively in knowledge development in our field.
The rapidly changing landscape of health care technology demands that workers have fluency in not just the practices du jour, but also the skills needed to identify and define the next generation of interventions and practices. Information literacy, informatics, and evidence-based practices are not going to vanish just because we want them to. Social work practitioners have to be involved in the development of the very evidence that is increasingly driving the decision making and resource allocations in health and mental health care. To sit passively by or shy away from this responsibility is not only dangerous for our profession, it also jeopardizes care to communities that are already being devastated by health inequalities. In our baccalaureate and master's training programs and through clinical and continuing education certifications and other mechanisms, professional social workers must develop an aggressive agenda to use and inform emergent practice. It is not sufficient for a few academic scholars to proclaim sole rights over knowledge development and implementation. If it takes a village to raise a child, how many social workers will it take to save our health and mental health care services?
Burrows, S. (2006). A review of electronic journal acquisition, management, and use in health sciences libraries. Journal of the Medical Library Association, 94, 67-74.
Cournoyer, B. R. (2004). The evidence-based social work skills book. Boston: Pearson Education.
Gibbs, L. E. (2003). Evidence-based practice for the helping professions: A practical guide with integrated multimedia. Pacific Grove, CA: Thompson Brooks/Cole.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press.
Jacobs, S. K., Rosenfeld, P., & Haber, J. (2003). Information literacy as the foundation for evidence-based practice in graduate nursing education: A curriculum-integrated approach. Journal of Professional Nursing 19, 320-328.
Lewis, C. (2003). Preparing the next generation of researchers. Social Work Education, 22, 577-587.
Nail-Chiwetalu, B., & Bernstein Ratner, N. (2007). An assessment of the information-seeking abilities and needs of practicing speech-language pathologists. Journal of the Medical Library Association, 95, 182.
Parker-Oliver, D., & Demiris, G. (2006). Social work informatics: A new specialty. Social Work, 51, 127-134.
Tenner, E. (2006, March 28). Searching for dummues. New York Times, p. F12.
Darrell P. Wheeler, PhD, MPH, is associate professor and associate dean for research, School of Social Work, Hunter College, City University of New York, 129 East 79th Street, New York, NY 10021; e-mail: email@example.com. Harriet
Goodman, DSW, LMSW, is associate professor and deputy executive officer, PhD Program in Social Welfare, School of Social Work and Graduate Center, Hunter College.