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Navigating Uncertainty in Clinical Social Work Practice: A Pilot Simulation-Based Study

Abstract

While clinical social work has a strong conceptual understanding of uncertainty, there is a lack of empirical data on how practitioners navigate uncertainty in practice. This paper reports findings of the data generated from a simulation-based pilot study designed to explore clinical social workers’ encounters with uncertainty and the strategies they use to navigate it. Experienced clinicians (n = 4), recent graduates (n = 4) and graduate students (n = 3) participated in a 30-min video recorded case-based simulated session with a live standardized client (SC). Using standardized clients, simulation-based research methodology allowed us to capture moment-to-moment practice behaviours and decisions among social workers. Following each simulation, participants reviewed the video-recorded sessions and engaged in an audio-recorded reflective dialogue with a researcher. Two themes emerged from the data sets: (1) there is a variation between less experienced participants who navigated uncertainty in pragmatic, task focused ways and more experienced practitioners who focused on the wider relationship with the client; and (2) less experienced practitioners tended towards struggling against uncertainty while more experienced practitioners demonstrated an ability to sit and wade within it. These findings offer several implications for clinical social work research and practice, including the important role that simulation methodologies have in exploring clinical practice and the need to understand specific aspects of uncertainty in clinical practice.

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References

  1. Adams, P. (2006). Exploring social constructivism: Theories and practicalities. Education, 34(3), 243–257. https://doi.org/10.1080/03004270600898893.

    Article  Google Scholar 

  2. Asakura, K., Gheorge, R. M., Borgen, S., Sewell, K., & Macdonald, H. (2020). Using simulation as an investigative methodology in researching competencies of clinical social work practice: A scoping review. Clinical Social Work. https://doi.org/10.1007/s10615-020-00772-x.

    Article  Google Scholar 

  3. Baltra-Ulloa, A. J. (2018). Speaking of care from the periphery: The politics of caring from the post-colonial margins. In B. Pease, A. Vreugdenhil, & S. Stanford (Eds.), Critical ethics of care in social work: Transforming the politics and practices of caring (pp. 129–138). London: Routledge.

    Google Scholar 

  4. Beck, B., Halling, S., McNabb, M., Miller, D., Rowe, J., & Schulz, J. (2005). On navigating despair: Reports from psychotherapists. Journal of Religion and Health, 44(2), 187–205. https://doi.org/10.1007/s10943-005-2777-x.

    Article  Google Scholar 

  5. Bent-Goodley, T. B. (2015). The art and science of social work revisited: Relevance for a changing world. Social Work, 60(3), 189–190. https://doi.org/10.1093/sw/swv020.

    Article  PubMed  Google Scholar 

  6. Blom, B. (2009). Knowing or un-knowing? That is the question in the era of evidence-based social work practice. Journal of Social Work, 9(2), 158–177. https://doi.org/10.1177/1468017308101820.

    Article  Google Scholar 

  7. Bogo, M. (2010). Achieving competence in social work through field education. Toronto: University of Toronto Press.

    Book  Google Scholar 

  8. Bogo, M. (2018). Social work practice (2nd ed.). New York: Columbia University Press.

    Book  Google Scholar 

  9. Bogo, M., Katz, E., Regehr, C., Logie, C., Mylopoulos, M., & Tufford, L. (2013). Toward understanding meta-competence: An analysis of students’ reflection on their simulated interviews. Social Work Education, 32(2), 259–273. https://doi.org/10.1080/02615479.2012.738662.

    Article  Google Scholar 

  10. Bogo, M., Katz, E., Regehr, C., & Regehr, G. (2014). OSCE for social work practice performance rating scale. In M. Bogo, M. Rawlings, E. Katz, & C. Logie (Eds.), Using simulation in assessment and teaching (pp. 135–138). Alexandria: Council on Social Work Education.

    Google Scholar 

  11. Bogo, M., Regehr, C., Baird, S., Paterson, J., & LeBlanc, V. R. (2017). Cognitive and affective elements of practice confidence in social work students and practitioners. British Journal of Social Work, 47(3), 701–718. https://doi.org/10.1093/bjsw/bcw026.

    Article  Google Scholar 

  12. Brashers, D. (2001). Communication and uncertainty management. Journal of Communication, 51(3), 477–497. https://doi.org/10.1111/j.1460-2466.2001.tb02892.x.

    Article  Google Scholar 

  13. Bryant, A., & Charmaz, K. (2019). The SAGE handbook of current developments in grounded theory. Thousand Oaks: Sage Publications Ltd.

    Book  Google Scholar 

  14. Carter, J., & Hugman, R. (2016). Rethinking values and ethics in social work. London: Red Globe Press.

    Google Scholar 

  15. Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks: SAGE Publications.

    Google Scholar 

  16. Charmaz, K. (2014). Constructing grounded theory (2nd ed.). Thousand Oaks: SAGE Publications.

    Google Scholar 

  17. Cheetham, G., & Chivers, G. (2005). Professions, competence and informal learning. Cheltenham: Edward Elgar Publishing Ltd.

    Google Scholar 

  18. Cheng, A., Auerbach, M., Hunt, E., Chang, T., Pusic, M., Nadkarni, V., et al. (2014). Designing and conducting simulation-based research. Pediatrics, 133(6), 1091–1101. https://doi.org/10.1542/peds.2013-3267.

    Article  PubMed  Google Scholar 

  19. Cheung, J. C. (2016). Researching practice wisdom in social work. Journal of Social Intervention: Theory and Practice, 25(3), 24–38. https://doi.org/10.18352/jsi.472.

    Article  Google Scholar 

  20. Coholic, D. (2019). Facilitating mindfulness: A guide for human service professionals (1st ed.). Ontario: Northrose Educational Resources Inc.

    Google Scholar 

  21. Council on Social Work Education (CSWE). (2015). Educational Policies and Accreditation Standards for Baccalaureate and Master’s Social Work Programs. Retrieved from https://www.cswe.org/getattachment/Accreditation/Accreditation-Process/2015-EPAS/2015EPAS_Web_FINAL.pdf.aspx.

  22. Dean, R. (2001). The myth of cross-cultural competence. Families in Society, 82(6), 623–630. https://doi.org/10.1606/1044-3894.151.

    Article  Google Scholar 

  23. Denzin, N. K. (2009). The research act: A theoretical introduction to sociological methods (3rd ed.). Upper Saddle River: Prentice Hall.

    Google Scholar 

  24. Derry, S., Pea, R., Barron, B., Engle, R., Erickson, F., Goldman, R., et al. (2010). Conducting video research in the learning sciences: Guidance on selection, analysis, technology, and ethics. Journal of the Learning Sciences, 19(1), 3–53. https://doi.org/10.1080/10508400903452884.

    Article  Google Scholar 

  25. Dore, I. (2020). Social work on the edge: Not knowing, singularity and acceptance. European Journal of Social Work, 23(1), 56–67. https://doi.org/10.1080/13691457.2018.1463971.

    Article  Google Scholar 

  26. Drisko, J. W., & Grady, M. D. (2015). Evidence-based practice in social work: A contemporary perspective. Clinical Social Work Journal, 43, 274–282. https://doi.org/10.1007/s10615-015-0548-z.

    Article  Google Scholar 

  27. Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26(2), 247–274. https://doi.org/10.1080/158037042000225245.

    Article  Google Scholar 

  28. Erickson, F. (2012). Definition and analysis of data from videotape: Some research procedures and their rationales. In J. L. Green, G. Camilli, & P. B. Elmore (Eds.), Handbook of complementary methods in education research (pp. 177–192). London: Routledge.

    Google Scholar 

  29. Fish, S., & Hardy, M. (2015). Complex issues, complex solutions: Applying complexity theory in social work practice. Nordic Social Work Research, 1, 98–114. https://doi.org/10.1080/2156857X.2015.1065902.

    Article  Google Scholar 

  30. Fook, J. (2011). Uncertainty: The defining characteristic of social work? In V. Cree (Ed.), Social work: A reader (pp. 30–39). London: Routledge.

    Google Scholar 

  31. Halamek, L. P. (2013). Simulation as a methodology for assessing the performance of healthcare professionals working in the delivery room. Seminars in Fetal & Neonatal Medicine, 18(6), 369–372. https://doi.org/10.1016/j.siny.2013.08.010.

    Article  Google Scholar 

  32. Gaiswinkler, W., & Roessler, M. (2009). Using the expertise of knowing and the expertise of not-knowing to support processes of empowerment in social work practice. Journal of Social Work Practice, 23(2), 215–227. https://doi.org/10.1080/02650530902923874.

    Article  Google Scholar 

  33. Gibbs, G. (2007). Analyzing qualitative data. Thousand Oaks: SAGE Publications.

    Book  Google Scholar 

  34. Gray, M. (2002). Art, irony and ambiguity: Howard Goldstein and his contribution to social work. Qualitative Social Work, 1(4), 413–433. https://doi.org/10.1177/14733250260620847.

    Article  Google Scholar 

  35. Guba, E., & Lincoln, Y. (1989). Fourth generation evaluation. Thousand Oaks: SAGE Publications.

    Google Scholar 

  36. Guise, J., Hansen, M., Lambert, W., O’Brien, K., & Guise, J. (2017). The role of simulation in mixed-methods research: A framework & application to patient safety. BMC Health Services Research, 17(1), 322–322. https://doi.org/10.1186/s12913-017-2255-7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Houston, S. (2015). Enabling others in social work: Reflexivity and the theory of social domains. Critical and Radical Social Work, 3(2), 245–260. https://doi.org/10.1332/204986015X14302240420229.

    Article  Google Scholar 

  38. Knobloch, L., & Solomon, D. (2005). Relational uncertainty and relational information processing: Questions without answers. Communications Research, 32(3), 349–388. https://doi.org/10.1177/0093650205275384.

    Article  Google Scholar 

  39. Kourgiantakis, T., Bogo, M., & Sewell, K. M. (2019). Practice fridays: Using simulation to develop holistic competence. Journal of Social Work Education, 55(3), 551–564. https://doi.org/10.1080/10437797.2018.1548989.

    Article  Google Scholar 

  40. Logie, C., Bogo, M., Regehr, C., & Regehr, G. (2013). A critical appraisal of the use of standardized client simulations in social work education. Journal of Social Work Education, 49(1), 66–80. https://doi.org/10.1080/10437797.2013.755377.

    Article  Google Scholar 

  41. Longhofer, J., & Floersch, J. (2014). Values in a science of social work: Values-informed research and research-informed values. Research on Social Work Practice, 24(5), 527–534. https://doi.org/10.1177/1049731513511119.

    Article  Google Scholar 

  42. Luntley, M. (2011). Expertise—Initiation into learning, not knowing. In L. Bondi, D. Carr, C. Clark, & C. Clegg (Eds.), Towards professional wisdom: Practical deliberation in the people profession (pp. 27–44). Farnham: Ashgate Publishing Company.

    Google Scholar 

  43. Mason, R. (2011). Confronting uncertainty: Lessons from rural social work. Australian Social Work, 64(3), 377–394. https://doi.org/10.1080/0312407X.2011.574144.

    Article  Google Scholar 

  44. Parker, B., & Myrick, F. (2011). The grounded theory method: Deconstruction and reconstruction in a human patient simulation context. International Journal of Qualitative Methods, 10(1), 73–85. https://doi.org/10.1177/160940691101000106.

    Article  Google Scholar 

  45. Pease, B., Vreugdenhil, A., & Stanford, S. (2017). Critical ethics of care in social work. London: Routledge.

    Book  Google Scholar 

  46. Petrucelli, J. (2010). Knowing, not-knowing and sort-of-knowing: Psychoanalysis and the experience of uncertainty. London: Karnac Books.

    Google Scholar 

  47. Pozatek, E. (1994). The problem of certainty: Clinical social work in the postmodern era. Social Work, 39(4), 396–403.

    Google Scholar 

  48. Regehr, C. (2018). Stress, trauma, and decision-making for social workers. New York: Columbia University Press.

    Book  Google Scholar 

  49. Regehr, C., Bogo, M., LeBlanc, V. R., Baird, S., Paterson, J., & Birze, A. (2016). Suicide risk assessment: Clinicians’ confidence in their professional judgement. Journal of Loss and Trauma, 21(1), 30–46. https://doi.org/10.1080/15325024.2015.1072012.

    Article  Google Scholar 

  50. Ringel, S. (2008). The reflective self: A path to creativity and intuitive knowledge in social work practice education. Journal of Teaching in Social Work, 23(3–4), 15–28. https://doi.org/10.1300/J067v23n03_03.

    Article  Google Scholar 

  51. River, D., Thakoordin, J. M., & Billing, L. (2017). Creativity in social work education and practice: Reflections on a survivor’s art project. Social Work Education, 36(7), 758–775. https://doi.org/10.1080/02615479.2016.1266320.

    Article  Google Scholar 

  52. Rodwell, M. (1998). Social work constructivist research. New York: Garlan Publishing Inc.

    Google Scholar 

  53. Rossiter, A. (2011). Unsettled social work: The challenge of Levinas’s ethics. The British Journal of Social Work, 41(5), 980–995. https://doi.org/10.1093/bjsw/bcr004.

    Article  Google Scholar 

  54. Roy, A. (2016). Field work reflections: Journeys in knowing and not-knowing. Qualitative Social Work, 15(5–6), 748–761. https://doi.org/10.1177/1473325016657868.

    Article  Google Scholar 

  55. Samson, P. (2015). Practice wisdom: The art and science of social work. Journal of Social Work Practice, 29(2), 119–131. https://doi.org/10.1080/02650533.2014.922058.

    Article  Google Scholar 

  56. Schön, D. A. (1987). Educating the reflective practitioner: Toward a new design for teaching and learning in the professions. San Francisco: Jossey-Bass.

    Google Scholar 

  57. Sewell, K. (2020). Examining the place of emotions, affect, and regulation in social work education. Journal of Social Work Education, 56(1), 5–16. https://doi.org/10.1080/10437797.2019.1627262.

    Article  Google Scholar 

  58. Sewell, K., Sanders, J., Kourgiantakis, T., Katz, E., & Bogo, M. (2020). Cognitive and affective processes: MSW students’ awareness and coping through simulated interviews. Social Work Education. https://doi.org/10.1080/02615479.2020.1727875.

    Article  Google Scholar 

  59. Shaffir, R. (2003). The zen of listening (2nd revised). New York: Quest Books.

    Google Scholar 

  60. Spafford, M., Schryer, C., Campbell, S., & Lingard, L. (2007). Towards embracing clinical uncertainty: Lessons from social work, optometry and medicine. Journal of Social Work, 7(2), 155–178. https://doi.org/10.1177/1468017307080282.

    Article  Google Scholar 

  61. Taylor, C., & White, S. (2006). Knowledge and reasoning in social work: Educating for humane judgment. British Journal of Social Work, 36(6), 937–954. https://doi.org/10.1093/bjsw/bch365.

    Article  Google Scholar 

  62. Tosone, C. (2013). On being a relational practitioner in an evidence-based world. Journal of Social Work Practice, 27(3), 249–257. https://doi.org/10.1080/02650533.2013.818941.

    Article  Google Scholar 

  63. Tufford, L., Bogo, M., & Asakura, K. (2014). How do social workers respond to potential child neglect? Social Work Education, 34(2), 229–243. https://doi.org/10.1080/02615479.2014.958985.

    Article  Google Scholar 

  64. Tufford, L., & Katz, E. (2014). Case vignette: Natalya Petrovich. In M. Rawlings, E. Katz, C. Logie, & M. Bogo (Eds.), Using simulation in assessment and teaching (pp. 162–165). Alexandria: Council on Social Work Education.

    Google Scholar 

  65. Vyvey, E., Roose, R., De Wilde, L., & Roets, G. (2014). Dealing with risk in child and family social work: From an anxious to a reflexive professional? Social Sciences, 3, 758–770. https://doi.org/10.3390/socsci3040758.

    Article  Google Scholar 

  66. Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Harvard: Harvard University Press.

    Google Scholar 

  67. Weinberg, M. (2016). Paradoxes in social work practice: Mitigating ethical trespass. London: Routledge.

    Book  Google Scholar 

  68. Weissman, H. (1990). Serious play: Creativity and innovation in social work. Washington, DC: National Association of Social Workers Press.

    Google Scholar 

  69. Wilkins, D., & Jones, R. (2018). Simulating supervision: How do managers respond to a crisis? European Journal of Social Work, 21(3), 454–466. https://doi.org/10.1080/13691457.2017.1366429.

    Article  Google Scholar 

  70. Wilkins, D., Khan, M., Stabler, L., Newlands, F., & Mcdonnell, J. (2018). Evaluating the quality of social work supervision in UK children’s services: Comparing self-report and independent observations. Clinical Social Work Journal, 46(4), 350–360. https://doi.org/10.1007/s10615-018-0680-7.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Zayas, L. H., Drake, B., & Jonson-Reid, M. (2011). Overrating or dismissing the value of evidence-based practice: Consequences for clinical practice. Clinical Social Work Journal, 39, 400–405. https://doi.org/10.1007/s10615-010-0306-1.

    Article  Google Scholar 

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Todd, S.L., Occhiuto, K., Asakura, K. et al. Navigating Uncertainty in Clinical Social Work Practice: A Pilot Simulation-Based Study. Clin Soc Work J 49, 286–297 (2021). https://doi.org/10.1007/s10615-021-00800-4

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Keywords

  • Uncertainty
  • Not knowing
  • Simulation
  • Clinical practice