Conflictos derivados de la falta de información completa y

In social work, increasing pressure towards scientific-evidence and the development of interventions on sound evidence is crucial to the sustainability of the field in today’s neoliberal environments (Driessens, Saurama, & Fargion, 2011). This alludes to evidence- based policy and practice, which has become the dominant paradigm within medicine, and social care also (Orr & Jain, 2014).

Intervention research involves the use of scientific methods to show that a particular change strategy is both efficacious and effective. Efficacy focuses on assessing outcomes of interventions in highly controlled settings, where most alternative explanations of causality can be eliminated and the researcher has confidence that the intervention was responsible for the observed outcomes. Such studies are almost always randomised and the researcher

provides direct supervision of the delivery of the intervention. Although effectiveness studies have a similar level of rigour they differ from efficacy studies in that they attempt to

& Perkins, 2010). Often tested at several sites, effectiveness studies evaluate replicability for implementation in different contexts.

Interventions may be developed at the individual, family, group, organisational, community, and societal levels. Social work practice is comprised of interventions that range from single techniques such as motivational interviewing (MI) to multicomponent

programmes such as assertive community treatment (ACT). Historically, practice was influenced by the authority of clinicians and through experience, which led to the

development techniques that could be used in various circumstances (Fraser et al., 2011). Over the past decade there has been a burgeoning interest in research-informed, evidence- based practice in social work and health care. The link between science and social work has reached the point that the two concepts are intertwined in the very definition of the discipline, as provided by the International Federation of Social Workers.

“...Social work bases its methodology on a systematic body of evidence-based knowledge derived from research and practice evaluation, including local and indigenous knowledge specific to its context...” (International Federation of Social Workers, 2000, p. 1).

The failure of science to readily transfer to service settings has led to greater interest in the processes needed to move science to service successfully. Evidence-based practice (EBP) is the process of inquiry intended to guide practitioners in making the best possible decisions about interventions or services for people, informed by rigorous and effective methodology (Webber, 2014). EBP is making some inroads in social work education,

particularly in American graduate social work programmes (Thyer & Myers, 2010). However, it remains to be seen if EBP will provide an enduring foundation for professional social work practice, as the latest effort to make social work a genuine example of an applied social science.

In a US survey, Mullen and Bacon (2004) found that social workers were poorly informed about practice guidelines, infrequently read research papers, and viewed supervisors as the conduit for practice knowledge. Cooke et al.’s (2008) survey of UK social care

workers, indicated poor implementation of research in practice, finding that less than 15% of their sample had access to research-based practice guidelines and of these only one-third reported using EBP. A systematic review exploring social workers' EBP attitudes, adoption, knowledge, and skills found numerous challenges to EBP implementation (Scurlock-Evans & Upton, 2015). These included time management, research accessibility, and misperceptions of the role of evidence in decision making.

In the UK, the social work contribution to the mental health evidence base is sparse, suffering from a combination of structural, economic, and academic constraints (McCrae, Murray, Huxley, & Evans, 2005). For example, without a budget for research the local authority setting is regarded as lacking research opportunities for social workers.

Consequently, mental health services rely upon evidence from psychiatry and psychology to inform practice and policy.

Webber (2014) argues that without an evidence base of its own, social work in UK mental health services is becoming marginalised to statutory roles, whilst health clinicians deliver interventions recommended by clinical guidelines. The National Institute for Health and Care Excellence (NICE) develops guidelines for UK practitioners about evidence-based interventions. However, the guidelines are predominately composed of randomised controlled trials (RCT) evidence which results in very few mental health social interventions being included. Therefore, a rigorous process of intervention development, grounded in the reality of real-world practice, may improve the effect of mental health social interventions and facilitate its subsequent implementation into routine practice (Anderson, 2008).

Recognising the insufficient evidence on the effectiveness of social interventions that support people with mental health conditions, Webber and colleagues (2015a) set out to develop the CPI to articulate good practice and enhance the evidence base for mental health social work. The CPI is communicating the process of a mental health worker assisting an individual to enhance their social network and engage in their community.

Whilst the social capital literature is building to show a clear link between social relationships and mental wellbeing, there was a paucity of evidence in this area of practice (Newlin et al., 2015). The relationship of the worker and the service user is central to the CPI model, as an evolving, mutual relationship which is not typical of traditional “clinician– patient” roles (Webber et al., 2015a). Instead of the worker treating the individual with a particular therapy, as most psychosocial interventions do, the individual is supported to pursue his or her interests through social activities. The agency in which the intervention occurs is seen as a core element to the intervention’s success. Barriers to this way of working include self-stigma or discrimination toward the individual, and a lack of local knowledge, insufficient time or resources to engage on the worker’s side.

A quasi-experimental pilot study evaluated the effect of the CPI on access to social capital, social inclusion and mental wellbeing for 155 people with a mental health problem or a learning disability receiving care and support from health and social care practitioners in the UK (Webber et al., 2018). Participants exposed to practice with high fidelity to the CPI model had significantly higher access to social capital (p=.03, partial η2_{=.05) and perceived social}

inclusion (p=.01, partial η2_{=.07), and lower service costs (-£1,331 (95%CI=-£69 to -£2593),}

post-test than those exposed to low fidelity to the model. All participants had significantly higher mental wellbeing post-test (p<.001). High fidelity CPI was only achieved in one National Health Service / Local Authority setting. These preliminary results suggest that when fully implemented the CPI can improve social outcomes for people with a mental health problem or learning disability.

The application of evidence-based social interventions and those that promote social capital, such as the CPI, may have potential to enhance practice of mental health workers and improve outcomes for people with mental health conditions globally. Social interventions have been neglected in the field of GMH but may better capture the local social environment and its impact on mental health conditions.