In this OPEN Exchange, we delve into practice expertise, thinking about how this can be combined with the best available research and client experience and values to support better outcomes.
Each edition of OPEN Exchange focuses on a new topic to support evidence-informed practice across our child and family service system.
Evidence-informed practice is a holistic approach to service design and delivery, incorporating the best research evidence with client values and practice expertise. Being evidence-informed means working with clients to identify their goals and selecting the program models, strategies and practices that will work best to achieve these. It is not a static framework but instead a continuous process based on unique service contexts and clients.
What is practice expertise?
Practice expertise is knowledge gained from our study and experience of direct engagement with clients in a variety of settings as well as our understanding of the social world. It includes our knowledge and understanding of what has and hasn’t worked in the past, as well as intuition and personal values. Through processes such as critical reflection and peer supervision, we can fine-tune our practice wisdom, pairing theoretical research with our knowledge of what works to achieve positive outcomes with clients. (1)
When is it used?
Practice expertise is applied across service design, delivery and evaluation. It can be observed across the key stages of client engagement as identified by Gibbs and Gambrill (see diagram below); from the initial client engagement to the identification and the interpretation of relevant sources of evidence. Choosing the best research evidence to guide an action plan requires our discretion and insight, based on what has worked with similar clients in the past. Research evidence alone is not sufficient for success. (2)
Knowledge of culture and context is also valuable practice expertise that assists to determine the interventions that are possible within an individual agency and/or community. Critical reflection and peer supervision can also be used to draw out practice expertise, for example in the evaluation phase to reflect on what did and didn’t work with a client or in a program, and how to use this knowledge in the future.(3)
Figure 1: demonstrates the breadth of practice expertise
Values and assumptions in practice
Just as clients will approach their concerns within their own worldview, as practitioners, we will also be influenced by our own cultural, religious and other beliefs. Values and assumptions can be a useful part of practice, they can assist us to plan and care appropriately for individual clients. However, we must be aware of our personal values and beliefs so as not to overshadow or ignore the client’s beliefs on what change is needed and how this might be achieved. Being critically aware of this is crucial as a clash in values has the potential to undermine our relationship with the client. (4)
Evidence informed practice through critical reflection
Critical reflection is a purposeful learning activity to help us draw knowledge from, and improve practice. When we engage in critical reflection we can explore and better understand the theories and assumptions that underlie our practice and in turn we can strengthen and modify our values, knowledge and behaviour. Fook and Gardner (2007) describe critical reflection as a process and a space for practitioners to ‘articulate the value of knowledge generated from their own experience as practitioners, as well as knowledge from formal or informal training, and how either or both can help generate new knowledge or theory. This validates practitioners’ theory-building and provides a process that can be used in practice’.(5)
Below, is an approach to reflective learning offered by Gibbs (as cited in Gibbs, Brigden & Hellenberg, 2005), which may be used to guide a reflective session with your clinical supervisor or peers. Creating space to unearth the key components of client engagement and to learn from the experience for future clients is an important part of evidence informed practice.
Figure 2: A process for critical reflection (6)
To learn more about critical reflection, check out:
References:
‘What does practice expertise look like in action?’
This month we caught up with Marija Dragic, Manager of Evidence, Innovation and Practice at Windermere Child and Family Services, to learn more about practice expertise and what this looks like in program design and service delivery.
“Practice wisdom, at the design level, saw practitioners on the Design Team from three different service areas bring their knowledge and experience in the development and piloting of the framework. Case managers reflected on their flexible, creative, intuitive and imaginative elements of case practice derived from knowledge and experience. This process provided the perfect link between theory and practice and challenged our research partners (Parenting Research Centre) to ensure that our case management Coaching framework actually made sense in practice.” Marija Dragic
Discussing Windermere’s pilot project that proposes a new case management framework that ‘coaches the coaches (case managers)’ to build adult capacity in emotion regulation, self-management and autonomy, Marija explained ‘the really unique thing about this project is that we are bridging the gap between evidence and the user experience. We have integrated practice wisdom in a considered way by hosting a number of learning circles to look at what is currently being done and how we can improve this.’
Click here for the full interview
