Academic journal article
By Walsh, Joseph; Green, Robert; Matthews, Janice; Bonucelli-Puerto, Brenda
Social Work , Vol. 50, No. 1
In the past decade it has become even more important for clinical social workers to demonstrate their practice effectiveness. Evidence-based practice uses data in the professional literature to guide assessments and interventions that facilitate client change (Vandiver, 2002). This development is related to social work's increased emphasis on accountability to clients and third-party payers and its desire to further the knowledge base of the profession. In the field of mental health, evidence-based practice begins with a careful assessment that serves as a guide for making accurate diagnoses and selecting intervention strategies (Vandiver). Knowledge of diagnostic assessments and intervention strategies does not guarantee practice effectiveness. Still, being aware of and applying the most current literature on the etiology of mental disorders (often using DSM-IV terminology because of its dominance in many agencies) is central to the implementation of effective interventions.
Since at least the beginning of the 1990s, research on the etiology of many mental disorders has suggested the relevance of neurobiological factors. Although this research--from psychiatry, psychology, social work, and other disciplines--is far from conclusive regarding the specificity and extent of biological etiology, it has become widely accepted with respect to schizophrenia and major depression. This knowledge should help guide decisions that social workers and other practitioners make about clinical intervention. Several recent research reports suggest that social workers may underestimate the influence of biological factors and even hold family members primarily accountable for an individual's mental illness (Johnson et al., 2000; Rubin, Cardenas, Warren, Pike, & Wambach, 1998). These findings are alarming in their implication that many social workers, representing the nation's largest profession providing outpatient mental health care (Gambrill, 2002; O'Neill, 1999), are not using current knowledge about mental disorders in their practice. The validity of these findings may be questioned, however, because the self-report measures of practitioners' views used in the studies did not allow respondents to provide disorder-specific responses. This article presents the results of a national study using disorder-specific measures to determine more clearly whether contemporary social workers are making accurate, research-based assessments of the etiology of mental disorders.
A substantial amount of practice-relevant, research-based knowledge about mental illness has accumulated during the past 25 years. Some of these findings have verified the influence of family and social environments on the etiology of a variety of disorders (Bebbington & Kuipers, 1994; Brekke & Mathiesen, 1995; McNaughton, Patterson, Irwin, & Grant, 1992). Findings about the role of neurobiological factors dominate recent literature. Their influence has been so profound that some mental health scholars conclude that they have transformed our basic understanding of mental illness. This body of research knowledge has been described as a "neuropsychiatric revolution" (Johnson et al., 2000) and a "remedicalization of psychiatry" (Psnau, 1987).
This new knowledge has resulted in criticism and changes to the curricula of graduate schools of social work, increasing advocacy by consumer organizations, and changes in the objectives of professional in-service training (Bentley & Walsh, 2001; Davis, 1987; Drolen, 1993; Johnson et al., 1990; Rapp & Hanson, 1988; Werrbach & DePoy, 1993; Williams & Ell, 1998). Changes in the views of mental illness espoused by the general public also have been documented. Although participants in the 1996 General Social Survey believe "stressful circumstances" are the most important causes of mental illnesses in general, "a chemical imbalance of the brain" was the second most commonly endorsed cause of schizophrenia and major depression (Link, Phelan, Bresnahan, Stueve, & Pescosolido, 1999). …