The Use of Decision Support Systems in Social Work: A Scoping Study Literature Review.

Journal of Evidence-Informed Social Work

ISSN: 2376-1407 (Print) 2376-1415 (Online) Journal homepage: http://www.tandfonline.com/loi/webs21

The Use of Decision Support Systems in Social Work: A Scoping Study Literature Review Pernilla Liedgren, Gudrun Elvhage, Anna Ehrenberg & Christian Kullberg To cite this article: Pernilla Liedgren, Gudrun Elvhage, Anna Ehrenberg & Christian Kullberg (2015): The Use of Decision Support Systems in Social Work: A Scoping Study Literature Review, Journal of Evidence-Informed Social Work, DOI: 10.1080/15433714.2014.914992 To link to this article: http://dx.doi.org/10.1080/15433714.2014.914992

Published online: 10 Jun 2015.

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Date: 05 November 2015, At: 20:02

Journal of Evidence-Informed Social Work, 00:1–20, 2015 Copyright q Taylor & Francis Group, LLC ISSN: 2376-1407 print/2376-1415 online DOI: 10.1080/15433714.2014.914992

The Use of Decision Support Systems in Social Work: A Scoping Study Literature Review Pernilla Liedgren, Gudrun Elvhage, Anna Ehrenberg, and Christian Kullberg Downloaded by [Florida State University] at 20:02 05 November 2015

Health and Welfare, Dalarna University, Falun, Sweden

Decision support systems are known to be helpful for professionals in many medical professions. In social work, decision support systems have had modest use, accompanied by strong criticism from the profession but often by praise from political management. In this study the aim of the authors was to collect and report on the published evidence on decision support systems in social work. The conclusion of the authors is that a decision support system gives support to social workers in conducting a thorough investigation, but at the same time gives them the freedom to make autonomous decisions that might be the most helpful for and used by social workers. Their results also indicate that decision support systems focusing on atypical rather than typical cases are perceived as the most useful among experienced staff. Keywords: Scoping study literature review, decision support system, implementation

The need for social work to be evidence-based is supported by both politicians and researchers (McNeece & Thyer, 2004). There is also extensive research showing that social work resting only on tradition, authority, or common sense is an obstacle to professionalization and leads to adverse effects for clients (Munro, 1998). There are, however, varying opinions on what constitutes evidence-based social work and how it should be implemented. Austin, Claassen, Vu, and Mizrahi (2008) claim that it is demanded of social workers today to be evidence- or research-informed and to use the best available knowledge. For this to be feasible it is necessary to promote an environment in which research-minded practice and practitioners can develop (Austin, Dal Santo, & Lee, 2012). Sacket, Strauss, Richardson, Rosenberg, and Haynes (2000) define evidence-based practice as the integration of the best research evidence, together with clinical expertise and patients’ values. Later researchers have developed this definition further, shedding more light on the complexity of clinical judgment to acknowledge contextual influences such as organizational resources, and patients’/clients’ status (Di Censo, Guyatt, & Ciliska, 2005; Haynes, Devereaux, & Gyatt, 2002). Different systems or tools to support decision making can improve a practice if informed by research. The decision support system (DSS), defined as “an infrastructure and enabling technology for enhancing decision-making process” (Wang & Cheung, 2011, p. 3336), has been suggested as a possible way to enhance social work practice by making it more evidence-based. In this article we use the term DSS as a general term to cover all these different attempts to enhance decision-making in social work. By “decision” we imply a result of a deliberate process, carried out by one or more people, to choose a course of action (Taylor, 2013).

Address correspondence to Pernilla Liedgren, Health and Welfare, Dalarna University, Ho¨gskolegatan 2. Falun, 79188 Sweden. E-mail: [email protected]

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The Promoting Action on Research Implementation in Health Services (PARIHS) model developed in the area of nursing implies that evidence, context, and facilitation are three key elements to a successful implementation of evidence into practice (Kitson, Harvey, and McCormack developed the framework [1998], and Rycroft-Malone developed the PARIHS model [2004]). In relation to the social work background, Fitch (2007) developed a causal model for evaluating success factors in relation to DSSs. Fitch’s study concludes that usefulness is the strongest indicator of DSS satisfaction. The next most significant variable is capabilities of the DSS. Capabilities imply a broad range of indicators, such as accuracy, speed of interpretation of results, and range of functions of the DSS. Fitch also reports on some important co-varying relationships for successful implementation of a DSS, namely between implementation and capabilities and environment and capabilities. Fitch states that the implementation strategy and environmental constraints affect the capabilities of the system. “Environment” in this case refers to the larger information system external to the specific DSS. Environment, according to Fitch, concerns only different computer systems, not the context Rycroft-Malone (2004) intends, which is the physical environment of the healthcare setting. An example of how such environmental factors can hamper the capability of the DSS is when an agency does not involve users’ input when designing the system. In this case there is a risk that technological barriers might hinder the system from being used. Moreover, the relationship between capabilities and configuration are important for DSS satisfaction. Configuration refers to the way the system provides information to the user. If professionals are having problems managing the system, it is hard to take seriously any comments concerning the outcome of the system since they have been hindered from drawing any conclusions about it. The use of DSSs in social work and other professions has been debated. On the one hand, the DSSs have been shown to facilitate medical decision making by limiting errors and supporting the use of evidence-based practices in healthcare (Kawamoto, Houlihan, Balas, & Lobach, 2005). On the other hand, studies from social work show that the DSSs in themselves may oversimplify reality, and that inexperienced SWs (social workers) tend not to develop their professional expertise and skills (Gillingham, 2011; Gillingham & Humphreys 2010). As the actual use of these kinds of DSSs is a fairly unexplored area of social work, it is important to get an overview of the literature and to summarize the experiences of the implementation of such DSSs. The aim of the authors in this study is to provide an overview of ongoing or ended implementation of DSSs in social work. The study is guided by the following research questions: . . . .

In which areas of social work have DSSs been implemented for evidence-based practice? What are the characteristics of DSSs? What is the knowledge base of DSSs? What kind of barriers and facilitators to implementing DSSs in social work are reported in the studies?

METHOD The study was performed as a scoping literature review. Relevant databases were identified and search terms as well as search strategies were developed, supported by a skilled librarian. The literature review is a so-called scoping study (Arksey & O’Malley, 2005). This means that the review was carried out in order to cover and account for what has been reported in scientific journals from completed or ongoing implementations of DSSs in social work. This approach was chosen to avoid limiting the review to determining, and emphasizing, the quality of the included studies (which is usually the case with systematic literature reviews).

DECISION SUPPORT SYSTEMS IN SOCIAL WORK

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TABLE 1 Search Terms Used in Search Strategy for the Databases Block 1

Combination

“social work*” OR “social practice” OR “social service”

AND

Block 2 “decision support” OR “practice guideline*” OR “structured assessment” OR “decision-making tool*”

Three different meta-search engines were used: Scopus, Web of Science, and ProQuest. The search was made from the first year records were available1 to February 2014. The criteria for inclusion were that the articles were written in English, had been peer-reviewed, and reported on implementation of a DSS in social work. The chosen articles include both systems that had been used in ordinary work and those that only had been tested. The studied articles were found by the combination of different search terms in search blocks. Terms from two blocks were combined to complete the block search. In each block, Boolean logic (using OR and truncation *) was used to combine the search terms, and when combining the blocks the term AND was used, as shown in Table 1. The first block consisted of the terms: “social work*” OR “social practice” OR “social service.” The second block consisted of the terms: “decision support” OR “practice guideline*” OR “structured assessment” OR “decisionmaking tool*.” Relevant literature was also obtained using a manual so-called chain search, which means that the lists of references in the retrieved articles were searched. An initial scan was done of the titles, sorting out articles with an outspoken medical focus or context. The retrieved abstracts from the literature search were analyzed by three of the authors in order to assess their relevance in relation to the aim and the research question of the study. In the study, we describe the users of the DSS as SWs. In some studies they were described as caseworkers, youth probation officers, counselors, child welfare workers, etc. but to avoid confusing the reader, persons using the DSS have been described as SWs or users. The database search process is presented in Figure 1 and the final selection of articles is presented in the Appendix (references to them in the article are made in the order of their appearance in the Appendix). The search yielded 362 peer-reviewed articles. Of these, 24 were found in Scopus, 119 in Web of Science, and 219 in ProQuest. Reading through the abstracts, articles reporting on social work or on DSS that had been used in ordinary work were included. Theoretical contributions in the form of editorials or full articles without any report of an actual implementation of DSS were excluded. This resulted in 41 remaining articles. After the reading of the full-text papers, excluding 24 non-relevant articles, sorting out seven duplicates and adding seven relevant articles found in the reference lists of the original sample, 17 articles remained for analysis. Of the chosen articles there were six reporting from three studies, that is: Gillingham (2011) and Gillingham and Humphreys (2010); Monnickendam, Savaya, and Waysman (2005); and Savaya, Monnickendam, and Waysman (2000); and finally Savaya (1998) and Savaya and Spiro (1997). Throughout the article we will comment with footnotes when a remark relates to the same study but different articles.

RESULTS The articles found report implementations of DSSs from four countries: the United States (six articles; 1997–2009), Canada (two articles; 2007–2010), Israel (seven articles; 1997–2006) and Australia (two articles; 2010–2011). The studies were performed in various areas of social work including child and family (including family counseling) in 11 articles (nine DSS); youth service (including youth probation) in three articles (two DSS); rehabilitation in two; and mental health in one article. Most of

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Years searched: First year available to February 2014.


Scopus Abstracts: 24 articles

Web of Science Abstracts: 119 articles

Abstracts review according to relevance. Inclusion/exclusion criteria applied: 362 articles remaining

Articles discovered in the reference lists: 7

Full text review according to relevance: 41 articles remaining

ProQuest Abstracts: 219 articles

Excluded articles: 321

Duplicate articles: 7 Excluded articles: 24

Unique articles included in the study: 17

FIGURE 1 Schematic overview of the literature search for articles and the results for the different steps in the process.

the articles reported on evaluation on implementation of DSS in ordinary work that was continuing, however, some reports were from unsuccessful implementations where the DSS had only been used during the study. In one article, the DSS was tested via actors that SW assessed as clients.

Educational Background of the Participants Nine articles did not contain any information concerning the educational background of the participants. In one of the articles (Nolan, 1997), the participants were presented as paraprofessionals; however, the authors did not give any evidence of their formal competence. Other articles where educational background of SW was lacking were Benbenishty and Triestman, (1998); Fitch (2007); Lyle and Graham (2000); Lyons, Doueck, Koster, Witsky, and Kelly (1999); and Oysemian and Benbenishty (1997); Parada, Barnoff, and Coleman (2007); Savaya et al. (2000); Savaya, Spiro, Waysman, and Golan (2004). In the four articles that provided some description of the background of the participants the participants’ field of specialization was specified but their educational background was not described (Gillingham & Humphreys, 2010; Monnickendam et al., 2005; Savaya, 1998; Savaya & Spiro, 1997). In some articles the authors provided a more thorough description of the participants’ background, education by level, as well as professional orientation (Foster & Stiffman, 2009; Gillingham, 2011; Regehr, Bogo, Shlonsky, & LeBlanc, 2010; Savaya, Monnickendam, & Waysman, 2006). A detailed description of the educational background of the participants can be found in the Appendix.


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Characteristics of the DSSs Varying terms were used to characterize the different DSSs in the articles. However, no article defined what distinguished their specific DSS from other systems.


Descriptive or Normative DSSs In analyzing the DSSs we have categorized them depending on how they help the users to make decisions. One way of making such a categorization is to make a distinction between descriptive and normative DSSs. Descriptive DSSs can be described as those that only give the users information on an aggregated level. Normative DSSs on the other hand, give instructions on how to act or decide in specific situations as well as information on an aggregated level. The descriptive DSS does not provide any practical benefits for the SW in the short run, except for information on a group level and later, as an overview of the clients’ development or abilities. However, since many contacts with clients last for a long time, these banks of information give SWs access to a quick overview of individual clients as well as groups of clients. The results of the categorization of types of DSS are summarized in Table 2. As can be seen in Table 2, normative DSSs are somewhat more common compared to descriptive ones. Descriptive DSSs are reported by Savaya and colleagues (2006). In this system, the SWs enter information in the DSS and are eventually able to produce a variety of reports on the aggregated level. The DSS reported by Savaya and colleagues (2004) functions in a similar way. Both the study by Savaya (1998) and the one by Savaya and Spiro (1997)2 are based on the McMaster Clinical Rating Scale (MCRS) and provide graphical representation about the recovery TABLE 2 Types of DSS: Descriptive or Normative (Presented for the Year of Publication and the Number the Article is Given in the Review) Year 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 Sum

Descriptive

Normative

(1) (2) (3) (4) (5) (6) (7) (8) (9)

(14) (16)(17) 5 (3)a

(10) (11) (12) (13) (15) 12 (11)

Note. Of the descriptive DSSs, article 14 and 17 are based on the same study, and among the normative system 1 and 3, 7 and 9 are based on the same study. a Reports on numbers of studies.


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of the client. Another descriptive DSS is described by Oyseman and Benbenishty (1997). In this DSS the SWs enter information, and are then referred to an appropriate information search by being asked more questions by the system. The DSS helped the SW in the way that information was provided about the clients by being copied and transferred to appropriate places in the administrative system. The system was mainly formed as an administrative tool to help the SW produce different reports. One example of a normative model is the DSS which was embedded in the electronic case files, described by Gillingham (2011) as well as by Gillingham and Humphreys (2010).3 Another normative DSS is the risk assessment measures in Regehr and colleagues (2010), as well as the system in Foster and Stiffman (2009); named IMPROVE (Intervention for Multisector Provider Enhancement), designed to increase SWs identification of mental health and substance abuse problems. If the SW chose three or more checklist items in an evaluation, a referral list appeared, which was related to the observed behaviors. In the decision-making tools in Parada et al. (2007) the Eligibility Spectrum prescribes what actions must be taken in response to the observed child. Furthermore, Monnickendam and colleagues (2005) and Savaya and colleagues (2000)4 describe the evaluation process in three stages: (a) first the DSS presents the SW with 80 fixed-choice questions, both objective and evaluative, (b) after entering the answers, the SW chooses one of five standard recommendations that are permitted according to law, and (c) after that the system runs the data through a statistical model and generates a recommendation. If the two recommendations are identical, the process ends; if the two recommendations differ, the SW needs to decide whether to accept or reject the DSS suggestion. Also, the DSS provides two blank lines where the SW needs to explain why he or she rejected the DSS recommendation or why he or she changed her mind. Moreover, the risk assessment instrument in Lyle and Graham (2000) responds with a risk level for the child, and the behavior rating scales in Lyons et al. (1999) contained threshold scores as an indication that the circumstances around a child were disquieting. In Benbenishty and Triestman (1998) the DSS works in a similar way to the one in Savaya and colleagues (2000). In Nolan (1997) the SWs also get a recommendation after filling in the information in the DSS. Finally, the DSS studied by Fitch (2007) is also categorized as normative. It consists of a risk assessment instrument used in child protective services, which is a form that is completed together with the family. If a majority of questions are answered affirmative, the child is considered as being at risk. Interactivity DSS The question of the interactivity of the DSSs concerns the questions of if, to what extent, and in what situations the DSSs provide adaptive feedback depending on the information the SW enters into the system. The results of the categorization of the dimensions are summarized in Table 3. As can be seen in Table 3, four of the DSSs presented in the review are interactive, 10 are noninteractive, and in three of the cases it is unclear whether the DSS is interactive or non-interactive. Of the interactive systems, Foster and Stiffman (2009) present a DSS in which SWs are supposed to select three or more checklist items in their assessment. Having done that, a referral list, related to the observed behavior appears. In the articles by Monnickendam and colleagues (2005)and Savaya and colleagues (2000)5 the SW declares why she or he insists on a recommendation that differs from that of the DSS. If the recommendation from the DSS is sidestepped, nothing further happens except for registration in the system. In the DSS described by Oysemian and Benbenishty (1997) the SWs complete information about the child and the DSS directs the user to an appropriate information search either by requesting detail or by changing pathways. The DSS also requests further details from the SWs in cases when needed. Of the non-interactive DSSs, four give information on an aggregated level; this is reported in Savaya and colleagues (2006); Savaya and colleagues (2004); Savaya (1998); and Savaya and Spiro (1997).6 These DSSs are all designed to give information about the clients (as developed over time)


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TABLE 3 Interactivity of the DSS (Presented for the Year of Publication and the Number the Article is Given in the Review) Interactivity of DSSs


Year 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 Sum

Interactive

Non-interactive

Unclear

(3)

(1) (2)

(4) (5) (6) (7) (8) (9)

(10)

(16) 4 (4)a

(11) (12) (13) (14) (15) (17) 10 (8)

3 (3)

Note. Article 1 and 3, 7 and 9 and 14 and 17, respectively, refer to the same study. a Reports on numbers on studies.

and in some cases as descriptions of different client groups. The other non-interactive DSSs (Benbenishty & Triestman, 1998; Fitch, 2007; Gillingham & Humphreys, 2010; Lyons et al., 1999; Nolan, 1997; Parada et al., 2007) are those that provide information on the expected risk level about the clients in question as the user enters data. For three of the studied articles it is not possible to determine whether the DSSs can be considered as interactive or not (Gillingham, 2011; Lyle & Graham 2000; Regehr et al., 2010). Static or Dynamic DSS The DSSs were assessed regarding whether they were formed as static or dynamic devices. The DSSs are categorized as static if they were built on predetermined manuals that are updated occasionally by expert committees. The DSSs are considered dynamic if they adapt to and develop as SWs enter new information. The results of the categorization of the extent to which the DSSs developed when entering information or not, are summarized in Table 4. As can be seen in Table 4, dynamic DSSs were quite uncommon. Only two articles presented such DSSs, namely Savaya (1998) and Savaya and Spiro (1997) which report from the same study. Knowledge Base of the DSSs Previously Developed Instruments In 10 of the reviewed articles (8 DSS) the authors describe the DSS as being partly or completely based on already developed tools, scales, or instruments. These instruments could be considered as

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P. LIEDGREN ET AL. TABLE 4 Types of DSS: Static or Dynamic (Presented for the Year of Publication and the Number the Article is Given in the Review)


Year 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 Sum

Static

Dynamic

(1) (2) (3) (4) (5) (6) (7) (8) (9)

(10) (11) (12) (13) (15) (16) 15 (13)a

(14) (17) 2 (1)

a

Reports on numbers of studies

using best practice at the time. However, this does not mean they are based on strong evidence. Gillingham (2011) referred to four structural decision-making (SDM) tools, developed by the Children’s Research Center in Wisconsin, and Gillingham and Humphreys’ (2010) model used four SDM tools implemented by the Department of Child Safety in Queensland.7 The first tool is intended to assist in decisions on which cases should be accepted for investigation, while the second tool is intended to give a time-line for the investigation. The third tool is used to decide the level of safety of the child; safe, conditionally safe (in need of a safety plan), or unsafe (in need of removal from caregivers). The fourth tool is used at the end of the investigation to determine the level of risk of a child and to assist with the decision on whether the child needs further support from the department. Regehr and colleagues (2010) use three tools from the Ontario Risk Assessment Model. The first instrument measures risk for the child (future harm, maltreatment, and other perceived harm); the second instrument also measures risk (caregiver’s current and previous behavior, ability to supervise, and attitude toward the child). Finally, the third instrument assesses the potential future risk for the child. Moreover, in Parada et al. (2007), the DSS is based on three tools from the Ontario Assessment Model, the same model which is used in the case reported in Regehr and colleagues (2010). In Lyle and Graham (2000) the DSS is based on Illinois CANT 17B—and is similar to the DSS in Gillingham and Humphreys (2010), that the authorities require to be used. The CANTS 17B contains 14 items of which four factors concern the child and nine factors focus on family and contextual aspects. In Lyons and colleagues (1999) Child Well-Being Scales includes 43 behaviorrating scales, divided into four dimensions concerning the child: (1) parenting role performance; (2) familial capacities; (3) child role performance; and (4) child capacities. In Savaya (1998) and Savaya and Spiro (1997)8 the DSS is based on McMaster Clinical Rating Scale (MCRS). MCRS is made up of different scales which measure various dimensions of family functioning. Oysemian and Benbenishty (1997) use an integrated information system (IIS) that was developed in Israel before it was adapted to the local context in Michigan. This instrument was


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mainly developed to structure front line practice but also to provide a rich database for informed policy decisions and to automate reporting. When used in Michigan, the system needed to be contextualized and the focus changed from children previously in care, to family systems in care. Finally, in Foster and Stiffman (2009) the DSS was based on a Child Behavior Checklist (CBSL) which met the Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria.


Instruments Developed for the Specific Study In five (4 DSS) of the articles referred to, the researchers reported that they developed the instrument themselves; Monnickendam and colleagues (2005) and Savaya and colleagues (2000) made a statistical analysis of more than 1,000 cases to capture policies and key variables to find, variables that would predict which recommendations the youth probation would most likely make. In Savaya and colleagues (2004) an external expert devised a battery of clinical measurements designed to measure the effects of a specific program on the residents (in juvenile homes). In Benbensishty and Triestman (1998) the researchers developed the DSS through a statistical analysis of 92 cases.9 In addition, they also included information from experts obtained through think-aloud sessions, to identify certain rules. In Nolan (1997) the process of developing the DSS started with a literature review to identify factors important in predicting successful vocational rehabilitation. The factors were processed in a statistical analysis of 9,000 past cases to determine which factors helped to discriminate between those individuals who had completed a service program and/or attained employment and those who had not. Five statistically significant factors were found. To these results, knowledge from expert vocational rehabilitation counselors was added. In two of the articles it is unclear how the DSS was developed (Fitch, 2007; Savaya et al., 2006). In Savaya and colleagues (2006) it is stated that SWs were to ask the clients questions (the questions were listed in an appendix); however, there was no explanation of why these particular questions were to be asked. In Fitch (2007) the description is like the one in Savaya eand colleagues (2006); questions that SWs were to ask were listed in an appendix and if the SW ticked a majority of those boxes the child was considered to be at high risk of abuse. What Kinds of Barriers and Facilitators to Implementing DSSs in Social Work Are Reported in the Studies? The conclusions that the authors make from the studies are presented below, divided into barriers and facilitators, but also categorized by assigning the comments given to the following subheadings: (a) the DSSs, (b) the SWs, and (c) the context. Barriers to Implementation The DSSs. Some of the conclusions that are drawn concerning the DSSs focus on barriers to their use. Gillingham (2011) highlights the discrepancy between the claims made by the developers of the DSSs concerning how they should be used when importing a system from one culture to another. The DSS was developed to be used together with clinical assessments, and problems arose when management at the new site decided it should be used as the sole decision-making tool rather than as a supplement to professional decisions. Successful implementation is more viable if research and clinical as well as patient experience are appreciated. In this case it seems as if the clinical as well as the patient’s experience were not valued as evidence (Rycroft-Malone, 2004). Some comments focus on problems with how the DSS was constructed. In one case the DSS was considered by the researchers as inadequate since it could not deal with complexity, had a tendency to result in overestimation of the risk of harm to the child, and was ill-suited to aiding professional judgment (Gillingham & Humphreys, 2010). Fitch (2007) suggests that SW could give a DSS high

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scores on an evaluation because it is easy to use and gives accurate information that is valuable for other aspects of their job; however, the information is not helpful in assessing risk and making decisions. The SWs. Negative attitudes toward the DSS were expressed in some of the articles; SWs in some cases considered the DSS tool as a decree, rather than help (Gillingham & Humphrey, 2010). A leadership style (autocratic), making decrees to employees is confirmed as negative to a successful implementation according to Rycroft-Malone (2004). Benbenishty and Triestman (1998) explained the lack of enthusiasm among SWs regarding the DSS in their study by the SWs belief that so many factors must be considered in a decision that the DSS cannot possibly incorporate all of them. As a consequence, the SWs rely on their knowledge instead of the DSS when making decisions in different situations. A version of this disbelief is described by Savaya (1998). The SWs in their study seemed reluctant to use the DSS and since they did not use it, they were unable to appreciate its benefits. This can perhaps be compared to what Fitch (2007) concluded as the covarying relationship between implementation and capabilities that affects the satisfaction with a DSS. If SWs do not appreciate the DSS and its abilities from the start, they will not use it. However, despite their reservations, SWs have a tendency to use the less complicated, more structured tasks in the DSS, and more for administrative than clinical purposes (Savaya, 1998). Savaya (1998) as well as Savaya and Spiro (1997)10 states that the agency needs to provide the SWs with paid time to fill out the forms, provide accessible computers, and to provide the clinicians with more real-time feedback to make use of the findings. Savaya and colleagues (2006) believe that education and training would be an antidote to the SW lack of belief. Monnickendam and colleagues (2005) concludes that although DSSs of this type should provide means for helping workers to structure their thoughts and to consider all the information relevant for their decision, the SWs only use the computerized consulting DSS as a source of help to help them reflect on atypical cases (when uncertain), and only in a routine manner in the typical cases. In one article, SWs were described as acting in a manipulative manner toward the DSSs. Lyle and Graham (2000) suggest the SWs might inflate the risk scores while using the DSS, in order to make sure that families are accepted for service. Another issue described is the great differences in assessments of families, even with validated measures (Regehr et al., 2010). Moreover, the same authors conclude that SWs need an ongoing consultation concerning the system, and must develop critical thinking skills in relation to decision making. Fitch (2007) concludes that SWs chose to consult supervisors and other professionals at work prior to using the DSS. The context. There are some implications in the studied articles that the organizational context can hinder the implementation of DSS into practice. The SWs in the study by Foster and Stiffman (2009) were positive about the DSS although they did not adopt it. The reasons for this are explained in terms of organizational conditions; “Many other organizational factors impact the assessment – referral process that when not accounted for in the design and implementation of DSSs inhibits the overall uptake into practice” (p 118). Referring to the PARIHS model it seems as if the model also has relevance for the social work context. If the organizational structures are unclear, it will create a barrier for implementation (Rycroft-Malone, 2004). The need for a supportive environment as an imperative for success is also discussed by Savaya and colleagues (2004). In some of the articles it is concluded that the introduction and operation of a DSS requires changes in the policies, structure, and procedures of the organization. Management must plan and invest in changes needed for the operation. Also, procedures and routines must be established, as well as systems for the provision of feedback, and the utilization of information. Moreover, training is essential before and during the project (Benbenishty & Triestman, 1998; Gillingham, 2011; Oysemian & Benbenishty, 1997; Savaya et al. 2004,). In addition, instruments and procedures can cause cultural and technical problems that need to be solved (Savaya et al., 2004). Savaya and colleagues (2000) identify a positive connection between the perceived importance of the DSS



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among senior and middle management and the enforcement of the DSS. This is also confirmed by the PARIHS model as a factor for successful implementation, with leaders that inspire staff and are able to create a culture that is positive toward evidence (Rycroft-Malone, 2004). Another aspect of the context that is discussed in Savaya and colleagues (2000) is the mixed messages that the professionals (probation officers) get. They are told to use the DSS, but at the same time are not given enough support and feedback to use it (see also Benbenishty & Triestman, 1998). Lack of feedback is also confirmed by the PARIHS model as an obstruction to implementation (RycroftMalone, 2004). Savaya and Spiro (1997) suggest that a more engaged organization could demand mandatory participation from the SWs as an antidote to the lack of commitment, and in that way force the SWs to use and understand the positive aspect of the DSS. This suggestion is not supported by the PARIHS model, which advocates a more engaged, democratic empowering form of leadership, to stimulate engagement among participants (Rycroft-Malone, 2004). Besides the sometimes lacking commitment among managers and SW, a problem with lack of material support is put forward. In Savaya (1998) it is concluded that a lack of computers as well as problems with the implementation of too many innovations at once is a hindering factor.

Facilitators to Implementation The DSSs. SWs give varying comments on the DSS. The SWs in the article by Parada et al. (2007), for instance, express positive perceptions about the implemented system. They are confident that the structure of the DSS helps them to remember to check important points while doing the assessments. At the same time, the SWs feel that the DSS gives them the freedom to make autonomous decisions. Fitch (2007) states that usefulness is the strongest indicator of satisfaction with the DSS. Nolan (1997) reports on the successful use of a DSS that is based on statistical data, to identify important variables for making sound assessment decisions. Added to that is the SWs’ heuristic knowledge. The DSS described in Nolan (1997), DISXPERT, handled 78,000 cases with a staff of 11. Before the DSS implementation, a staff of 31 persons handled 70,000 cases. The assessments seemed to improve since the dropout rate of the persons who were referred to education and training programs declined by over 80%; that is, the matching process seemed to have improved. Nolan explains the success of the system as follows: (a) it is less time-consuming in its screening and assessment, (b) it provides high quality in the screening and assessment process, and (c) it provides structured process for more uniform, high quality results but at the same time is flexible to change when needed. Savaya and colleagues (Savaya et al., 2000; Savaya et al., 2004) made four recommendations concerning the development of DSSs: (a) to involve SWs in development, (b) to make an introduction that clearly conveys the principles, aims, motives, and benefits of a DSS, (c) to monitor and supervise, give regular feedback, and to maintain the DSS in a conscientious way, and finally (d) to enlist middle management as champions of the DSS. The SWs. The users in the Monnickendam and colleagues (2005) study did not reflect on the decisions they made, or give them much attention when the DSS recommended another decision in ordinary cases. Resistance to using the DSS, as is found in the study by Savaya and colleagues (2000), is explained by SWs’ lack of understanding of the rationale and aim of the DSS. On the other hand, those SWs who were involved in the development of the DSS were occupied in intense discussions of the systematic DSSs content, aims, and ideology that accompanied its development. They also utilized the system more than other districts in the study. A holistic approach was that the user who is a part in the development of the system will promote the usage of the system according to the PARIHS framework (Rycroft-Malone, 2004).

12

P. LIEDGREN ET AL.

In some cases, the systematic DSSs are appreciated but not used in everyday work, except when earlier attempts using their established method were not considered effective (Foster & Stiffman, 2009). The context. Oysemian and Benbensishty (1997) pointed out the benefits from the process of implementation and usage of the DSS. The implementation has resulted in clarification of current practice and organization of workflow.


DISCUSSION The aim of the authors in this study was to account for ongoing or ended implementation of computerized supportive DSSs in social work that has been reported in scientific journals. In this final section we summarize the findings by answering the research questions and discussing them in relation to the possibilities for using evidence in social work practice. The studies were performed in various areas of social work, including child and family youth service, rehabilitation, and mental health. It is striking and at the same time somewhat deplorable that the background of the SWs participating in many of the studied implementations is not specified. It would be rather interesting to see in what way the participants’ professional background and profession affect to what degree and how they used the DSSs. In the manner the studies are presented it is not possible to draw any conclusion on that matter since we lack proper data in as many as nine of the articles. For the development of professional social work this is unsatisfactory. It also has consequences for the interpretation of the results since we do not really know the background of the participants. Thus, it is not possible to draw conclusions about issues such as whether more highly educated social workers use DSS more. We analyzed the DSSs in different ways, depending on how they helped the users to make decisions. One of the analytic categorizations made in the results was based on the distinction between descriptive (only giving the users information on an aggregated level) and normative (giving both information on an aggregated level and instructions to SW on how to act or decide). The studied DSSs were also divided into interactive and non-interactive systems. The question in this case concerned if, to what extent, and in what situations the supportive DSSs provide adaptive feedback depending on the information the SW enters into the DSS. Furthermore, the DSSs were classified as either static (built on predetermined manuals that were updated less frequently by expert committees) or dynamic (adapted to and developed when SWs entered new information). Moreover, the results show that in eight of the DSSs (10 articles) the authors considered the system to be based either partly or completely on already developed tools, scales, or instruments. In four DSSs (five articles) the researchers reported developing the instrument themselves, and in two of the articles it was unclear how the DSS was developed. The results concerning implementation were in line with other research concerning the possibilities of using tools, instruments, and systems to improve professional practice (c.f. Fitch, 2007; Kitson et al., 1998; Kitson et al., 2008). Kitson and colleagues (1998; 2008) argue that it is not only evidence from research assisted by guidelines and other tools that is important for successful implementation of evidence in professional practice. The two other components, namely the qualities of the context in which the evidence is being introduced, and if and how the implementation process is facilitated, are of equal importance. The results from the present study support this. They indicate that the organizations played an important role. In some cases organizational factors facilitated the implementation of DSSs and in other cases they hampered it (Benbensishty & Triesman, 1998; Foster & Stiffman, 2009; Savaya, 1998; Savaya et al., 2000; Savaya et al., 2004). Savaya and colleagues (2000) for instance suggest that the management’s



13

enforcement might be a critical factor for the implementation, and Savaya (1998) suggests that computer support provided by the organization is of great importance. Results also indicated that such facilitators as project coordinators and administrators as well as technical personnel were important to support the use of the DSSs. Another important context factor mentioned was training in using the DSS (Savaya et al., 2004). Another reflection of the result is that in order to improve professional use of supportive DSSs, the provision of research-based, up to date, and well-designed tools, instruments, and systems was crucial. This is also usually stressed from an evidence-informed point of departure (cf. Rosen & Proctor, 2003). What is interesting about the results however is that they indicate that the involvement of the professionals in the development of the DSSs might be as important as the quality of the system in itself and the information it is built on. The results show that SWs tend to be very selective when using the DSSs intended to support them. They tend to use parts of, or the whole concept in particular situations when they believe it will be useful, while leaving it aside in other instances. This means that SWs are not numb and undifferentiated receivers of the DSSs that are implemented. Rather, they seem to be quite active in letting or not letting the different DSSs influence, guide, or steer their work. The results also indicate that failure to recognize SWs’ professional discretion also may lead to under use of DSSs. The results from the studied articles show for instance that problems with valuing risks in a realistic way and problems dealing with the complexity lead to resistance to using the DSSs (Benbenishty & Triestman, 1998; Foster & Stiffman, 2009; Gillingham & Humphrey, 2010; Monnickendam et al., 2005; Savaya, 1998; Savaya & Spiro, 1997; Savaya et al., 2000). This can be compared with results from other research showing that staff might find it necessary to manipulate data input to the DSSs in order to be able to use the DSS or to only use it in certain circumstances, as a consultative device, rather than as part of ordinary work (cf. English & Pecora, 1994; Lyle & Graham, 2000). A reflection on these kinds of inconsistencies between system and user is that if DSSs are treated as an alternative to professional judgment, one must bear in mind that two of the three “legs” of evidence-based practice are definitively missing, namely the users’ perspectives and the professional expertise (cf. Gillingham, 2013; Sacket et al., 2000).

Conclusions The conclusion of the study is that DSSs that give support to SWs to conduct a thorough investigation but at the same time give freedom to make autonomous decisions might be the most helpful for SWs, and thus the most frequently used (Parada et al., 2007). The results also indicate that DSSs focusing on atypical rather than typical cases are perceived as the most useful among experienced staff (Foster & Stiffman, 2009; Monnickendam et al., 2005). Involving SWs in developing the DSS is also a success factor that was mentioned (cf. Savaya et al., 2000). One way of doing this that is suggested by Savaya and colleagues (2004) is to start to develop the DSS on a smaller scale, with a few clearly defined aims for end-users, in a certain segment of the service work, and from that continue building up the DSS bit by bit. Savaya and colleagues (2000) suggest that a viable recipe for success might be to introduce the DSS in such a way that its principle aims, motives, and benefits become understandable, and to offer supervision, feedback, and maintenance of the DSS, both concerning technical aspects and its judgments and recommendations. Savaya and Spiro (1997) also suggest that mandatory participation from the SWs might facilitate implementation. It seems as if DSSs sometimes work as instruments to implement the latest policy regulations or as instruments using a scale or tool that have been used and developed in some other situation. It seems to us that there is a need for further research on DSSs that suits the actual situations that social workers face.

14

P. LIEDGREN ET AL.


Limitations The review resulted in a relatively small number of reported implementations of DSSs. These results might be due to several causes. The results could indicate that the use of DSSs in social work is quite uncommon. Another viable explanation could be that studies and evaluations of DSSs are quite often presented in different forms of “grey literature” or are reported in other forms than peer-reviewed research articles, which was the literature base for this study. If this is the case, it can be said to be a weakness of the literature search strategy. The limited number of articles obtained may also be a consequence of the keywords that were used. Although the search terms that were used were intended to include as broad a scope as possible it cannot be completely ruled out that, despite this, the search was too narrow. It might also be that, as this area of research within social work is quite undeveloped, the keywords have not yet begun to be used in the databases that were searched. These weaknesses of the research method should be taken into consideration when interpreting the presented results. In one of the articles (Nolan, 1997) the participants were presented as paraprofessionals, with no further specification of their formal competence. We have chosen to include this article as the services in which the participants worked can be classified as social work even though it was sometimes difficult to know to what extent these workers could actually be considered as being part of the social work profession, and it was unclear what, if any education they had.

NOTES 1. Scopus contains publications from 1823 and onward (http://cdn.elsevier.com/assets/pdf_file/0019/148402/ contentcoverageguide-jan-2013.pdf); Web of Science contains publications from 1973 and onward (http://thoms onreuters.com/products/ip-science/04_062/wos-next-gen-brochure.pdf); and PsychINFO have publications from 1597 and onwards (http://www.apa.org/pubs/databases/psycinfo/index.aspx). 2. Savaya (1998) and Savaya and Spiro (1997) refer to the same study. 3. Gillingham (2011) and Gillingham and Humphreys (2010) refer to the same study. 4. Savaya, Monnickendam, and Waysman (2006) and Savaya et al. (2004) refer to the same study 5. Same study. 6. Savaya (1998) and Savaya and Spiro (1997) refers to the same study. 7. The articles refer to the same study. 8. These articles refer to the same study. 9. The study focused on decisions made by SWs, serving as mental health officers, on whether or not to recommend discharge from compulsory duty in the Israeli army due to mental or emotional difficulties. 10. Refers to the same study.

REFERENCES Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. Austin, M. J., Claassen, J., Vu, C. M., & Mizrahi, P. (2008). Knowledge management: Implications for human service organizations. Journal of Evidence Based Social Work, 5, 361–389. Austin, M. J., Dal Santo, T. S., & Lee, C. (2012). Building organizational supports for research-minded practitioners. Journal of Evidence-Based Social Work, 9, 174 –211. Benbenishty, R., & Triestman, R. (1998). The development and evaluation of a hybrid decision support system for clinical decision-making: The case of discharge from the military. Social Work Research, 22, 1– 21. Di Censo, A., Guyatt, G., & Ciliska, D. (2005). Evidence based nursing: A guide to clinical practice. London, England: Mosby, Inc. (Elsevier Health Sciences). English, D., & Pecora, P. (1994). Risk assessment as a practice method in child protective services. Child Welfare, 73, 451 –473. Fitch, D. (2007). Structural equation modeling the use of a risk assessment instrument in child protective services. Decision Support Systems, 42, 2137–2152.



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Foster, K., & Stiffman, A. (2009). Child welfare workers’ adoption of decision support technology. Journal of Technology in Human Services, 27, 106 –126. Gillingham, P. (2011). Decision-making tools and the development of expertise in child protection practitioners: Are we “just breeding workers who are good at ticking boxes?”. Child and Family Social Work, 16, 412–421. Gillingham, P. (2013). The development of electronic information systems for the future: Practitioners, “embodied structures,” and “technologies-in-practice.” British Journal of Social Work, 43, 430–445. Gillingham, P., & Humphreys, C. (2010). Child protection practitioners and decision-making tools: Observations and reflections from the frontline. British Journal of Social Work, 40, 2598– 2616. Haynes, R. B., Devereaux, P. J., & Gyatt, G. H. (2002). Clinical expertise in the era of evidence based medicine and patient choice. ACP Journal Club, 136, A11–A14. Kawamoto, K., Houlihan, C. A., Balas, E. A., & Lobach, D. F. (2005). Improving clinical practice using clinical decision supportive frameworks: A systematic review of trials to identify features critical to success. British Medical Journal, 330, 765–772. Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based practice: A conceptual framework. Quality in Health Care, 7, 149–158. Kitson, A., Rycroft-Malone, J., Harvey, G., McCormack, B., Seers, K., & Titchen, A. (2008). Evaluating the successful implementation of evidence into practice using the PARiHS framework: Theoretical and practical challenges. Implementation Science, 3, 1 –12. Lyle, C., & Graham, E. (2000). Looks can be deceiving: Using a risk assessment instrument to evaluate the outcomes of child protection services. Children and Youth Services Review, 22, 935 –949. Lyons, P., Doueck, H., Koster, A., Witsky, M., & Kelly, P. (1999). The child well-being scales as clinical tool and a management information system. Child Welfare, LXXVIII, 241– 258. McNeece, A. C., & Thyer, B. A. (2004). Evidence-based practice and social work. Journal of Evidence-Based Social Work, 1, 7– 25. Monnickendam, M., Savaya, R., & Waysman, M. (2005). Extent type of worker utilization of an integrated information system in a human service agency. Social Work Research, 29, 21 –30. Munro, E. (1998). Improving SWs’ knowledge base in child protection work. British Journal of Social Work, 28, 89–105. Nolan, J. (1997). DISXPERT: A rule-based vocational rehabilitation risk assessment system. Expert Systems with Applications, 12, 465–472. Oysemian, D., & Benbenishty, R. (1997). Developing and implementing the integrated information system for foster care and adoption. Computers in Human Services, 14, 1– 20. Parada, H., Barnoff, L., & Coleman, B. (2007). Negotiating “professional agency”; Social work and decision-making within the Ontario Child Welfare Supportive DSS. Journal of Sociology & Social Welfare, XXXIV, 35 –56. Regehr, C., Bogo, M., Shlonsky, A., & LeBlanc, V. (2010). Confidence and professional judgment in assessing children’s risk of abuse. Social Work Practice, 20, 621–628. Rosen, A., & Proctor, E. K. (2003). Developing practice guidelines: Issues, methods, and research agenda. New York, NY: Columbia University Press. Rycroft-Malone, J. (2004). The PARIHS framework—A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19, 297–304. Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Edinburgh, England: Churchill Livingstone. Savaya, R. (1998). The potential and utilization of an integrated information system at a family and marriage counseling agency in Israel. Evaluation and Program Planning, 21, 11–20. Savaya, R., Monnickendam, M., & Waysman, M. (2000). An assessment of the utilization of a computerized decision support system for youth probation officers. Journal of Technology in Human Services, 17, 1 –14. Savaya, R., Monnickendam, M., & Waysman, M. (2006). Extent type of worker utilization of an integrated information system in human service agency. Evaluation and Program Planning, 29, 209–216. Savaya, R., & Spiro, S. (1997). Reactions of practitioners to the introduction of a standard instrument to monitor clinical outcomes. Journal of Social Service Research, 22, 39–55. Savaya, R., Spiro, S., Waysman, M., & Golan, M. (2004). Issues in the development of a computerized clinical information system for a network of juvenile homes. Administration in Social Work, 28, 63–79. Taylor, B. (2013). Professional decision-making and risk in social work. London, England: Sage. Wang, W., & Cheung, C. (2011). A narrative-based reasoning with applications in decision support for social service organizations. Expert Systems with Applications, 38, 3336–3345.

1. Gillingham, Philip (2011) Same case as Gillingham and Humphreys (2010)

Author/s and publication year

Final Selection of Articles

Decision-making tools and the development of expertise in child protection practitioners: are we “just breeding workers who are good at ticking boxes?” Child and Family Social Work, 16, 412 –421.

Title and area of social work Child and family

In which areas of social work have DSSs for evidencebased practice been implemented?

APPENDIX

What are the What is the characteristics knowledge base of the DSS? of the DSSs?

DSS based Normative All the 46 participants were on already defined by educational level Unclear developed whether it is as well as educational tools, scales interactive orientation; eleven were or or nonqualified SWs, one was a instruments. interactive Bachelor of Social Work Static student on placement, 31 had a bachelor degree in either psychology, behavioral science, social science/community welfare, human services, criminology or law. For one of the participant no specific qualifications were recorded and one reported that she did not have a degree. Five of the participants had completed the Graduate Certificate in Human Services (Child Protection).

Educational background of the participants


Australia

Country of original study

16 P. LIEDGREN ET AL.

No information on educational background of SW.


Child and family

Child and family

Structural equation modeling the use of a risk assessment instrument in child protective services. Decision Support Systems, 42, 2137 –2152.

5. Fitch, Dale (2007)

6. Parada, Henry, and Negotiating “professional Barnoff, Lisa, and Coleman, Brienne (2007) Agency:” Social work and decision-making within the Ontario Child Welfare Supportive DSS. Journal of Sociology & Social Welfare, XXXIV, 35 –56.

DSS based on already developed tools, scales or instruments.

Of the 28 participants, 85% held Normative a bachelor level degree, 8% Interactive Static held a master’s degree in social work and 8% held another type of master’s degree.

Child and family

Child welfare workers’ adoption of decision support technology. Journal of Technology in Human Services, 27, 106 –126.

4. Foster, Kirk A., and Stiffman, Arlene (2009)

Normative Noninteractive Static

USA

Australia

Canada


(Continued)

Canada

Unclear how the USA DSS was developed.



Participants were described as child protection practitioners in the Department of Child Safety, Queensland.

Child and family

Child protection practitioners and Decision-making tools: Observations and reflections from the front line. British Journal of Social Work, 40, 2598 –2616.

3. Gillingham, Philip, and Humphreys, Cathy (2010) Same case as Gillingham (2011)


DSS based on Of the 96 child welfare workers, Normative already 2.1% had community college Unclear developed whether it is diplomas in social service tools, scales interactive work, 3.1% had BSW and or or non29.2% had a master’s degree instruments. interactive. in social work, and the remaining workers had other Static university degrees.

Child and family

Confidence and professional judgment in assessing children’s risk of abuse. Research on Social Work Practice, 20, 621 –628.

2. Regehr, Cheryl, Bogo, Marion, Shlonsky, Aron, and LeBlanc, Vicki (2010)



17


Youth service

Issues in the development of a computerized clinical information system for a network of juvenile homes. Administration in Social Work, 28, 63 – 79.

9. Savaya, Riki, Spiro, Shimon E., Waysman, Mark, and Golan, Miriam (2004)

Israel Researchers developed the instrument for the specific study.


Normative The SWs as a group were described as youth probation Interactive Static officers that, in accordance with government regulations were licensed SWs with at least a bachelor’s degree in social work.

Youth probation

Thinking processes in SWs’ use of a clinical decision support system: A qualitative study. Social Work Research, 29, 21 –30.

8. Monnickendam, Savaya, and Waysman (2005) Same case as Savaya, Monnickendam, and Waysman (2000)

Descriptive Noninteractive Static

Unclear how the Israel DSS was developed.


Of the 136 participating SWs 63 Descriptive Nonpercent were described to interactive have a BSW and 27 percent Static had a master’s degree in social work. Most of the participants were SWs (89%), 1.5% were psychologists and 8.1 percent had related professions.

What is the What are the characteristics knowledge base of the DSSs? of the DSS?

Rehabilitation


Extent and type of worker utilization of an integrated information system in a human service agency. Evaluation and Program Planning, 29, 209 –216.

Title and area of social work


7. Savaya, Riki, Monnickendam, Menachem, and Waysman, Mark (2006)


– continued



Israel Researchers developed the instrument for the specific study. Israel

Normative NonInteractive Static


Mental health

Family counseling Participants were described as Descriptive certified SWs, although the Noninteractive educational level of certified Dynamic SWs was not specified.

The development and evaluation of a hybrid decision support system for clinical decisionmaking: the case of discharge from the military. Social Work Research, 22, 1–21.

The potential and utilization of an integrated information system at a family and marriage counseling agency in Israel. Evaluation and Program Planning, 21, 11 –20.

13. Benbenishty, R., and Triestman, R. (1998)

14. Savaya, Rivka (1998) Same case as Savaya and Spiro (1997)


(Continued)

USA




Child and family

The child well-being scales as a clinical tool and a management information system. Child Welfare, LXXVIII, 241 –258.

12. Lyons, Peter, Doueck, Howard, Koster, Andrew J., Witsky, Melissa K., and Kelly, Patricia L. (1999)

USA

DSS based on Normative already Unclear developed whether it is tools, scales interactive or or noninstruments. interactive Static


Child and family


Looks can be deceiving: Using a risk assessment instrument to evaluate the outcomes of child protection services. Children and Youth Services Review, 22, 935 –949.

Normative Interactive Static


Youth probation

10. Savaya, Riki, Monnickendam, Menachem, and Waysman, Mark (2000) Same case as Monnickendam, Savaya, and Waysman, 2005) 11. Lyle, Charles Gene, and Graham, Elliott (2000)

An assessment of the utilization of a computerized decision support system for youth probation officers. Journal of Technology in Human Services, 17, 1–14.



19

Reactions of practitioners to the introduction of a standard instrument to monitor clinical outcomes. Journal of Social Service Research, 22, 39 – 55.

Descriptive Interactive Static



USA

Israel

DSS based on already developed tools, scales or instruments. DSS based on already developed tools, scales or instruments.

USA Researchers developed the instrument for the specific study.

What is the What are the characteristics knowledge base of the DSSs? of the DSS?

Family counseling Participants were described as Descriptive certified SWs, although the Noninteractive educational level of certified Dynamic SWs was not specified.


Child and family Developing and implementing the integrated information system for foster care and adoption. Computers in Human Services, 14, 1–20.

16. Oysemian, Dapfana, and Benbenishty, Rami (1997)

17. Savaya, Rivka, and Shimon, Spiro E. (1997) Same case as Savaya (1998)

Participants were presented as paraprofessionals; however, the authors do not give any evidence of their formal competence.


DISXPERT: A rule-based vocational Rehabilitation rehabilitation risk assessment system. Expert Systems With Applications, 12, 465 –472.

Title and area of social work


15. Nolan, James R. (1997)


– continued



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