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, who say they practice strict discipline at home. Yet, the client’s behavior only gotten worse.  When you arrive at the school to meet with the boy, you notice he has difficulty maintaining eye contact with you, appears distracted, and has a few bruises on his legs.  At the same time, he is also a gifted artist, and you two spend the hour in which you assess him painting and drawing.

• 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 rely on food from the dollar store or convenience stores in order to live or simply order takeout.  You are becoming concerned about your clients’ health, as many of them are obese and say they are unable to buy fresh food.  Because convenience stores are more expensive and your clients mostly survive on minimum wage jobs or Supplemental Nutrition Assistance Program (SNAP) benefits, they often have to rely on food pantries towards the end of the month once their money runs out.  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 do 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 city and has hired you as a consultant to work on the grant proposal.  After conducting a needs assessment in collaboration with local social service agencies and interviewing people who are homeless, you meet with city councilmembers to talk about your options to create a program.  Local agencies want to spend the money to build additional capacity at existing shelters in the community.  They also want to create a transitional housing program at an unused apartment complex where people can live after the shelter and learn independent living skills.  On the other hand, the clients you interview want to receive housing vouchers so they can rent an apartment from a landlord in the community.  They also fear the agencies running the shelter and transitional housing program would dictate how to live their lives and impose unnecessary rules, like restrictions on guests or quiet hours.  When you ask the agencies about client feedback, they state that clients could not be trusted to manage in their own apartments and need the structure and supervision 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 in some cases, just “the self” alone. That is our misbehaving child in case 1.  When social workers investigate groups and communities, such as our food desert in case 2, their inquiry is 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, as in case 3. These domains interact with each other, 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 you are an expert in the areas of children’s mental health, community responses to food deserts, and homelessness policy.  Don’t worry, I’m not either.  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 answer to these questions.  It will, however, teach you how to answer these questions for yourself.  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 make sure their interventions are helping, not harming, clients and to contribute to social science as well as social justice.

Again, assuming you did not have advanced knowledge of the topics  in the case studies, when you thought about what you might do in those practice situations, you were likely using intuition (Cheung, 2016). ^[1] Intuition is a way of knowing that is mostly unconscious.  You simply have a gut feeling about 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. We all probably have times we can recall when we learned something because we experienced it. If you grew up in Minnesota, you would observe plenty of kids learning each winter that it really is true that your tongue will stick to metal if it’s very cold outside. Similarly, if you passed a police officer on a two-lane highway while driving 20 miles over the speed limit, you would probably learn that that’s a good way to earn a traffic ticket.

Intuition and direct experience are powerful forces.  Uniquely, social work is a discipline that values intuition, though it will take quite a while for you 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 a period of time.  Social workers also reflect on their practice, independently and with colleagues, which sharpens their intuitions and opens their mind 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 distractible and getting 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 say, “give him therapy.”  Well…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.  If we guessed wrong, we could be wasting time, or worse, actively harming 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 me and you, must train our 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 minute and browse around to get a sense of how baked-in cognitive biases are to how humans think.

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 all 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 order to avoid challenging what we already believe to be true.

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—that people experiencing poverty usually spend their money responsibly and genuinely need help accessing fresh and healthy food.  This would be an example of selective observation, only looking at the cases that confirm their biased beliefs about people in poverty and ignoring evidence that challenges that perspective.  Likely, these are 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, someone who the person considers an authority told them that people in poverty are lazy and manipulative.  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.

Now, it is important to note that experts in the field should generally be trusted to provide well-informed answers on a topic, though that knowledge should be receptive to skeptical critique and will develop over time as more scholars study the topic.  There are limits to skepticisim, 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.  The problem with informal observation is that sometimes it is right, and sometimes it is wrong. And without any systematic process for observing or assessing the accuracy of our observations, we can never really be sure that our informal observations are accurate.  In order to minimize the effect of cognitive biases and come up with the truest understanding of 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 accounts for the limitations of cognitive biases—not perfectly, though—by ensuring observations are done rigorously, following a prescribed set of steps.  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.