Using decision analysis: connecting "classroom" and "field"

This paper reports on the findings of a small-scale research project investigating the views of social work students on the use of decision analysis. After giving the context of the research, the article reports on what was found when students, who had just completed a Decision Making and Risk module, were asked for their opinions on the component parts of decision analysis, its use as a practice tool and their attitudes to using it on placement. The research found that the respondents in general took a critical and supportive stance towards the use of decision analysis in social work and, with extra teaching and a positive approach from their practice assessor, would be happy to use decision analysis. When the same group of students completed a follow-up questionnaire on a placement recall day, half of them had thought about using decision analysis but only three had gone on to discuss this with their practice assessors. Some issues in relation to connecting 'classroom' and 'field' are identified and the paper concludes that a number of further steps would be necessary to realise the potential of decision analysis to help students be more systematic and analytical in their approach to decision makin

Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

Managing risk and decision-making

This chapter critically considers risk and its management in social wor

Inputs to an adoption panel: a case study

Terence O'Sullivan reports on an observational case study of an adoption panel and focuses on some of its inputs, namely social work reports, social worker attendance and applicant attendance. The research found that although the outputs of the panel meetings were well defined, including the recommendations to the agency decision-maker, the inputs lacked a clear sense of purpose. It was hypothesised that this related to a lack of clarity as to the prime purpose of the panel, in particular whether it was a decision-making group that made recommendations to the agency decision-maker or a decision-validation group, confirming recommendations made by agency social workers. The article discusses ways in which the purpose and inputs of the panel meetings could be aligned with one another and how this could lead to the panel becoming a forum for more open dialogue between panel attendees and panel members

Some theoretical propositions on the nature of practice wisdom

• Summary: The author aims to advance the theoretical understanding of practice wisdom by presenting three propositions in relation to its nature and process. A model of practice wisdom is constructed that seeks to address some issues of critical, accountable and knowledgebased practice, while retaining its flexible, creative and intuitive use of practice knowledge. • Findings: It is argued that a critical, accountable and knowledge-based practice wisdom requires distinctive knowledge production processes, the ability to make reasoning explicit, and credible and valuable knowledge. Models of experienced practice development are needed if social work educators are to effectively facilitate the growth of practice wisdom. Such models will need to set out a framework of how such factors as disposition towards knowledge, professional education, practice experience and practice contexts influence whether practitioners engage in wise practice. • Applications: The article makes a contribution to the debate about the nature of social work practice and how entrants to social work can become effective practitioners. Practitioners, researchers and social work educators can use the presented framework to review their thinking about the nature of social work practice and the place practice wisdom has in contemporary social work

Processes and outputs of an adoption panel: a case study

This article examines the processes and outputs of an adoption panel and is the second by Terence O'Sullivan to report on an observational case study. The research investigates how representative and participative panel members were, how attendee presence was structured, what the panel focused on and how conclusions were reached. The panel considered social work proposals in relation to looked after children whose permanence plan was adoption. A scrutiny process was observed that took the form of identifying issues, asking questions, being reassured (or not), coming to a conclusion and giving feedback. The importance of the panel's work stems from its scrutiny of social work proposals and the article suggests various ways in which this could be made more effective

Making good decisions

This chapter explains how to make good decision

Decision making in social work

This book develops a framework for professional decision making in social work practice which integrates potentially fragmented aspects to a coherent systemic approach that incorporates personal, interactional, institutional and societal levels of analysis. It includes, the impact of practice contexts on decision making, involvement of service users and carers, stakeholders working together, using different forms of knowledge, managing emotions, framing situations, analysing options, constructing arguments and using supervision

A knowledge management framework for cross-cultural management in aid-related multinational projects

Le texte intégral de ce document de travail n'est pas disponible en ligne. Une copie papier est disponible à l'Annexe de la bibliothéque. Effectuez une recherche par titre dans le catalogue pour réserver le document. // The full text of this working paper is not available online. A print copy is available in the Library Annex. Search by title in the catalogue to request the paper

The strength of association between psychological factors and clinical outcome in tendinopathy: A systematic review

Objective: Tendinopathy is often a disabling, and persistent musculoskeletal disorder. Psychological factors appear to play a role in the perpetuation of symptoms and influence recovery in musculoskeletal pain. To date, the impact of psychological factors on clinical outcome in tendinopathy remains unclear. Therefore, the purpose of this systematic review was to investigate the strength of association between psychological factors and clinical outcome in tendinopathy. Methods A systematic review of the literature and qualitative synthesis of published trials was conducted. Electronic searches of ovid MEDLINE, ovid EMBASE, PsychINFO, CINAHL and Cochrane Library was undertaken from their inception to June 2020. Eligibility criteria included RCT’s and studies of observational design incorporating measurements of psychological factors and pain, disability and physical functional outcomes in people with tendinopathy. Risk of Bias was assessed by two authors using a modified version of the Newcastle Ottawa Scale. High or low certainty evidence was examined using the GRADE criteria. Results Ten studies of observational design (6-cross sectional and 4 prospective studies), involving a sample of 719 participants with tendinopathy were included. Risk of bias for the included studies ranged from 12/21 to 21/21. Cross-sectional studies of low to very low level of certainty evidence revealed significant weak to moderate strength of association (r = 0.24 to 0.53) between psychological factors and clinical outcomes. Prospective baseline data of very low certainty evidence showed weak strength of association between psychological factors and clinical outcome. However, prospective studies were inconsistent in showing a predictive relationship between baseline psychological factors on long-term outcome. Cross sectional studies report similar strengths of association between psychological factors and clinical outcomes in tendinopathy to those found in other musculoskeletal conditions. Conclusion The overall body of the evidence after applying the GRADE criteria was low to very low certainty evidence, due to risk of bias, imprecision and indirectness found across included studies. Future, high quality longitudinal cohort studies are required to investigate the predictive value of baseline psychological factors on long-term clinical outcome