What would you do?

Imagine you are a clinical social worker at a children’s mental health agency.  Today, you receive a referral from your town’s middle school about a client who often skips school, gets into fights, and is disruptive in class.  The school has suspended him and met with the parents multiple times. They report that they practice strict discipline at home, yet the client’s behavior has only gotten worse.  When you arrive at the school to meet with the boy, you notice that he has difficulty maintaining eye contact with you, appears distracted, and has a few bruises on his legs.  You also find out that he is a gifted artist, so you decide to paint and draw together while you assess him.

• Given the strengths and challenges you notice, what interventions would you select for this client and how would you know your interventions worked?

Imagine you are a social worker in an urban food desert, a geographic area in which there is no grocery store that sells fresh food.  Many of your low-income clients live solely on food from the dollar store, convenience stores, or takeout, as they are unable to buy fresh food.  You are becoming concerned about your clients’ health, as many of them are obese due to these conditions.  Many of your clients survive on minimum wage jobs or Supplemental Nutrition Assistance Program (SNAP) benefits and end up relying on food pantries when their money runs out towards the end of the month.  You have spent the past month building a coalition composed of members from your community, including non-profit agencies, religious groups, and healthcare workers to lobby your city council.

• How should your group address the issue of food deserts in your community?  What intervention would you suggest?  How would you know if your intervention worked?

You are a social worker working at a public policy center focused on homelessness.  Your city is seeking a large federal grant to address the growing problem of homelessness in your area, and you have been hired as a consultant to work on the proposal.  After conducting a needs assessment in collaboration with local social service agencies and interviewing people who are homeless, you meet with city council members to discuss potential programs.  Local agencies want to spend the grant money to increase capacity at existing shelters and to create transitional housing by re-purposing an unused apartment complex. This way, individuals have a place to stay after the shelter where they can learn valuable independent living skills. On the other hand, you are aware that the clients would prefer to receive housing vouchers to rent apartments in the community. The clients also communicated that they fear shelters and transitional housing may impose on their daily lives by placing restrictions on guests and mandating quiet hours.  When you ask the agencies about client feedback, they state that clients cannot be trusted to manage in their own apartments without the structure and supervision that is provided by agency support workers.

• What kind of program should your city choose to implement?  Which program is most likely to be effective?

Assuming you’ve taken a social work course before, you will notice that the case studies cover different levels of analysis in the social ecosystem—micro, meso, and macro.  At the micro-level, social workers examine the smallest levels of interaction, even interactions within “the self,” like in our first case study involving the misbehaving child.  When social workers investigate groups and communities, such as our food desert scenario in case 2, they are operating at the meso-level. At the macro-level, social workers examine social structures and institutions. Research at the macro-level examines large-scale patterns, including culture and government policy, like the situation described in case 3. These domains interact with one another and it is common for a social work research project to address more than one level of analysis. Moreover, research that occurs on one level is likely to have implications at the other levels of analysis.

How do social workers know what to do?

Welcome to social work research.  This chapter begins with three problems that social workers might face in practice and three questions about what a social worker should do next.  If you haven’t already, spend a minute or two thinking about how you would respond to each case and jot down some notes.  How would you respond to each of these cases?

I assume it is unlikely that you are an expert in the areas of children’s mental health, community responses to food deserts, and homelessness policy.  Not to worry, neither am I.  In fact, for many of you this textbook will likely come at an early point in your social work education, so it may seem unfair for me to ask you what the right answers are.  And to disappoint you further, this course will not teach you the right answers to these questions, however it will teach you how to work through them and come to the right answer on your own.  Social workers must learn how to examine the literature on a topic, come to a reasoned conclusion, and use that knowledge in their practice.  Similarly, social workers engage in research to ensure that their interventions are helping, not harming, clients and that those interventions also contribute to social science and social justice.

Assuming that you may lack advanced knowledge of the topics addressed in the case studies, you likely made use of your intuition when imagining how you would react in each situation (Cheung, 2016). ^[1] Intuition is a way of knowing that is mostly unconscious, much like a gut feeling telling you what you should do.  As you think about a problem such as those in the case studies, you notice certain details and ignore others.  Using your past experiences, you apply knowledge that seems to be relevant and make predictions about what might be true.

In this way, intuition is based on direct experience.  Many of us know things simply because we’ve experienced them directly. For example, you would know that electric fences can be pretty dangerous and painful if you touched one while standing in a puddle of water. Most of us can probably recall a time when we have learned something though experience. If you grew up in Minnesota, you would observe plenty of kids learning that your tongue really does stick to a metal pole in the winter. Similarly, you would learn that driving 20 miles above the speed limit on a major highway is a pretty easy way to earn a traffic ticket.

Intuition and direct experience are powerful forces.  As a discipline, social work is unique because it values intuition, however it will take you quite a while to develop what social workers refer to as practice wisdom.  Practice wisdom is the “learning by doing” that develops as one practices social work over time.  Social workers also reflect on their practice, both independently and with colleagues, which sharpens their intuitions and opens their minds to other viewpoints.  While your direct experience in social work may be limited at this point, feel confident that through reflective practice you will attain practice wisdom.

However, it’s important to note that intuitions are not always correct.  Think back to the first case study.  What might be your novice diagnosis for this child’s behavior?  Does he have attention deficit hyperactivity disorder (ADHD) because he is easily distracted and gets into trouble at school, or are those symptoms of autism spectrum disorder or an attachment disorder?  Are the bruises on his legs an indicator of ADHD, or do they indicate possible physical abuse at home?  Even if you arrived at an accurate assessment of the situation, you would still need to figure out what kind of intervention to use with the client.  If he has a mental health issue, you might suggest therapy for the child, but what kind of therapy?  Should we use cognitive-behavioral therapy, play therapy, art therapy, family therapy, or animal assisted therapy?  Should we try a combination of therapy and medication prescribed by a psychiatrist?

We could guess which intervention would be best, but in practice that would be highly unethical.  An incorrect guess could waste our time and the time of our client, or worse, it could actively harm a client.  We need to ground our social work interventions with clients and systems with something more secure than our intuition and experience.

Cognitive biases

Although the human mind is a marvel of observation and data analysis, there are universal flaws in thinking that must be overcome.  We all rely on mental shortcuts to help us make sense of a continuous stream of new information.  All people, including you and I, must train their minds to be aware of predictable flaws in thinking, termed cognitive biases.  Here is a link to the Wikipedia entry on cognitive biases.  As you can see, it is quite long.  We will review some of the most important ones here, but take a moment to browse around the link and get a sense of the extent to which cognitive biases are ingrained in human thinking.

The most important cognitive bias for social scientists to be aware of is confirmation bias.  Confirmation bias involves observing and analyzing information in a way that confirms what you already think is true.  No person is a blank slate.  We arrive at each moment with a set of beliefs, experiences, and models of how the world works that we develop over time.  Often, these are grounded in our own personal experiences.  Confirmation bias assumes these intuitions are correct and ignores or manipulates new information in a way that avoids challenging our established beliefs.

Confirmation bias can be seen in many ways.  Sometimes, people will only pay attention to the information that fits their preconceived ideas and ignore information that does not fit.  This is called selective observation.  Other times, people will make hasty conclusions about a broad pattern based on only a few observations.  This is called overgeneralization.  Let’s walk through an example and see how they each would function.

In our second case study, we are trying to figure out how to help people who receive SNAP (formerly Food Stamps) who live in a food desert.  Let’s say that we have arrived at a solution and are now lobbying the city council to implement it.  There are many people who have negative beliefs about people who are “on welfare.”  These people believe individuals who receive social welfare benefits spend their money irresponsibly, are too lazy to get a job, and manipulate the system to maintain or increase their government payout. People expressing this belief may provide an example like Louis Cuff, who bought steak and lobster with his SNAP benefits and resold them for a profit.

City council members who hold these beliefs may ignore the truth about your client population. Your clients and other people experiencing poverty usually spend their money responsibly and they genuinely need help accessing fresh and healthy food.  This would be an example of selective observation in which they are only paying attention to the cases that confirm their biased beliefs about people in poverty and ignoring evidence that challenges that perspective. Their beliefs are likely grounded in overgeneralization in which one example, like Mr. Cuff, is applied broadly to the population of people using social welfare programs.  Social workers in this situation would have to hope that city council members are open to another perspective and can be swayed by evidence that challenges their beliefs.  Otherwise, they will continue to rely on a biased view of people in poverty when they create policies.

But where do these beliefs and biases come from?  Perhaps an authority figure told them that people in poverty are lazy and manipulative, and these beliefs may have been internalized without questioning.  Naively relying on authority can take many forms.  We might rely on our parents, friends, or religious leaders as authorities on a topic.  We might consult someone who identifies as an expert in the field and simply follow what they say.  We might hop aboard a “bandwagon” and adopt the fashionable ideas and theories of our peers and friends.

It is important to note that experts in the field should generally be trusted to provide accurate information on a topic, though their knowledge should be receptive to skeptical critique, as the state of knowledge will develop over time as more scholars study the topic.  There are limits to skepticism, however.  Disagreeing with experts about global warming, the shape of the earth, or the efficacy and safety of vaccines does not make one free of cognitive biases.  On the contrary, it is likely that the person is falling victim to the Dunning-Kruger effect, in which unskilled people overestimate their ability to find the truth.  As this comic illustrates, they are at the top of Mount Stupid.  Only through rigorous, scientific inquiry can they progress down the back slope and hope to increase their depth of knowledge about a topic.

Scientific Inquiry

Cognitive biases are most often expressed when people are using informal observation.  Until I asked at the beginning of this chapter, you may have had little reason to formally observe and make sense of information about children’s mental health, food deserts, or homelessness policy.  Because you engaged in informal observation, it is more likely that you will express cognitive biases in your responses.  Informal observation can be problematic because without any systemic process for observing or addressing the accuracy of our observations, we can never be sure of their accuracy. In order to minimize the effect of cognitive biases and come closer to truly understanding a topic, we must apply a systematic framework for understanding what we observe.

The opposite of informal observation is scientific inquiry, used interchangeably with the term research methods in this text.  These terms refer to an organized, logical way of knowing that involves both theory and observation.  Science can account for many of the limitations of cognitive biases, though not perfectly. Science ensures that observations are done rigorously by following a set of prescribed steps in which scientists clearly describe the methods they use to conduct observations and create theories about the social world.  Theories are tested by observing the social world, and they can be shown to be false or incomplete.  In short, scientists try to learn the truth.  Social workers use scientific truths in their practice and conduct research to revise and extend our understanding of what is true in the social world.  Social workers who ignore science and act based on biased or informal observation may actively harm clients.