GUEST EDITORIAL Why Social Work Practitioners Need Research Ethics Knowledge James/ clark ial work practitioners are under increasing All projects should be vetted by an institutional pressure to understand and use evidence- review board(IR B)that is affiliated with a university based practice approaches. At the same time, or other entity that is registered with the feder clinicians, scientists, and government officials have government's Office of Human Research Protec- noted that only a handful of assessment and inter- tions. One easy way to verify IRB approval(besides vention approaches have been adequately tested so checking with the investigator or university) is to they might be disseminated for widespread use. To inspect the informed consent form that clients are remedy this situation nificant increase in the required to understand and sign before they are number of community-based research projects is enrolled into a study. The official IRB stamp rent IRl contact informa Co Although researchers and practitioners seem to on the form. A consent form that contains no such come from different worlds, successful community- information might mean the study was not approved based research requires closing the"researcher- or that approval has expired practitioner gap. " Researcher-practitioner part- The Code of Federal Regulations(also known herships are underway in many agency settings. as the"Conmon Rule")designates three major For example, the National Child Traumatic Stress categories of vulnerable people: 45 CFR 46 Subpart Network(inctsn] httP://wwW.nCtsN. org)is a B discusses pregnant women, fetuses, and neonates group of researchers and practitioners who work in Subpart C discusses prisoners; and Subpart D 70 rural and metropolitan sites in the United States. discusses children. The reader can see that each of NCTSN members use innovative child trauma I these groups might be exploited because of thein treatments such as parent-child interaction therapy compromised status in society, cognitive limitations and trauma-focused cognitive-behavioral therapy. associated with age, or their medical vulnerabilities Funded by the U.S. Substance Abuse and Mental In addition, history has taught us that these groups Health Services Administration, NCTSN enables have been inproperly treated by researchers in the clinicians to work closely with researchers to test past. As an illustration, I discuss some of the com- the local effectiveness of their work and participate plexities of pediatric research, especially because so in cross-site evaluation studies to demonstrate the many social workers employed in child welfare agen- network,s national effects cies, schools, hospitals, and mental health settings are If such trends continue it will become ce now or soon will be involved in projects investigating monplace for social work practitioners to join child assessment and treatment technologies research projects. And it will be no surprise that Historically, U.S. federal policies effectively ex social workers will work hard to ensure that their cluded children from all research to protect them clients'rights as research participants are respected. from exploitation. Relatively recently this policy Human subjects protection is a great challenge for was revised because it had created a"pediatric gap community-based researchers because most clients in research knowledge about critical interven- belong to groups who present as among the most tions such as medications, surgical procedures, and iInerable to unethical practices. What follows is psychotherapies. In addition, the lack of evidence a brief review of standards that social work practi- did not routinely prevent many practitioners from tioners and other researchers should aim to follow using unproven therapies with children.Although when conducting research, including a discussion ofI practitioners often use treatments demonstrated to the complexities and challenges involved be effective with adults, there are no guarantees CCC Code: 0037-8046/09 53.00 C2009 National Association of Social Workers
GUEST EDITORIAL Why Social Work Practitioners Need Research Ethics Knowledge James J. Clark S ocial work practitioners are under increasing pressure to understand and use evidencebased practice approaches. At the same time, clinicians, scientists, and government officials have noted that only a handful of assessment and intervention approaches have been adequately tested so they might be disseminated for widespread use.To remedy this situation, a significant increase in the number of community-based research projects is necessary. Although researchers and practitioners seem to come from different worlds, successful communitybased research requires closing the "researcherpractitioner gap." Researcher-practitioner partnerships are underway in many agency settings. For example, the National Child Traumatic Stress Network ([NCTSN] http://www.nctsn.org) is a group of researchers and practitioners who work in 70 rural and metropolitan sites in the United States. NCTSN members use innovative child trauma treatments such as parent-child interaction therapy and trauma-focused cognitive—behavioral therapy. Funded by the U.S. Substance Abuse and Mental Health Services Administration, NCTSN enables clinicians to work closely with researchers to test the local effectiveness of their work and participate in cross-site evaluation studies to demonstrate the network's national effects. If such trends continue it will become commonplace for social work practitioners to join research projects. And it will be no surprise that social workers will work hard to ensure that their clients' rights as research participants are respected. Human subjects protection is a great challenge for community-based researchers because most clients belong to groups who present as among the most vulnerable to unethical practices. What follows is a brief review of standards that social work practitioners and other researchers should aim to follow when conducting research, including a discussion of the complexities and challenges involved. AU projects should be vetted by an institutional review board (IBJ3) that is affiliated with a university' or other entity that is registered with the federal government's Office of Human Research Protections. One easy way to verify IRB approval (besides checking with the investigator or university) is to inspect the informed consent form that clients are required to understand and sign before they are enrolled into a study. The official IRB stamp or current \Ki\ contact information is always listed on the form. A consent form that contains no such information might mean the study was not approved or that approval has expired. The Code of Federal Regulations (also known as the "Common Rule") designates three majoicategories of vulnerable people: 45 CFR 46 Subpart B discusses pregnant women, fetuses, and neonatos; Subpart C discusses prisoners; and Subpart D discusses children.The reader can see that each of these groups might be exploited because of their conipromised status in society, cognitive limitations associated with age, or their medical vulnerabilities. In addition, history has taught us that these groups have been improperly treated by researchers in the past. As an illustration, I discuss some of the complexities of i^ediatric research, especially because so many social workers employed in child welfare agencies, schools, hospitals, and mental health settings are now or soon will be involved in projects investigating child assessment and treatment technologies. Historically, U.S. federal policies effectively excluded children from all research to protect them from exploitation. Relatively recently this policy was revised because it had created a "pédiatrie gap" in research knowledge about critical interventions such as medications, surgical procedures, and psychotherapies. In addition, the lack of evidence did not routinely prevent many practitioners from using unproven therapies with children. Although practitioners often use treatments demonstrated to be effective with adults, there are no guarantees CCC Code: 0037-8046/09 $3.00 O2009 National Association of Social Workers
that they are safe and effective for children the intervention is not studied in community areas adolescents who have unique, developmental that may present more sampling obstacles, that ques- sitivities.Therefore, pediatric research must proceed tion will go unanswered. Research for such settings is to enhance ethical practice and the use of evidence- usually approved only when the focus of the project based treatments is abou those specific populations and settit Young children are unable to give informed Researchers who only recruit children from consent to participate in studies, and therefore, marginalized groups and low socioeconomic status parental permission is required. older children and families can inadvertently stigmatize those children ticipate, even if parents grant the required permission. from nonmarginalized groups who will not benefit Social work researchers need to ensure that parents from the tested interventions raises ethical problems understand the risks and benefits of projects request- even though their inclusion might enhance the ing their childrens participation. The April 2007 validity of research projects editorial by Jorge Delva showed how responsible The NASW Code of Ethics clearly directs social Ind well-informed parents make; such decisions in workers who strongly suspect or discover ethical heir childs best interests and factor in concern for violations to take action. First, it is usually advisable the project's attention to race, culture, language, and to discuss concerns with the research investigator to safety. Unfortunately, some parents face great cogni- seek clarity and, if necessary, remediation.If these tive challenges in understanding the risk or benefits concerns are dismissed or minimized, there are a of such studies and sometimes agree to participate number of alternative pathways for further action in research projects for the wrong reasons Research cannot occur without the sanction of For example, desperate adults can be tempted agency leadership, so consultation with supervisors to sign up children if they believe that they will or administrators can be effective because they are otherwise be denied services to which they are usually aware of the serious ethical and legal rami entitled. Poor adults consent to receive financial fications for the organization if such violations are remuneration or some other incentive that seems taking place. If this is unsuccessful or impractical, too good to pass up. Both of these are examples of the researcher's university IRB can be anonymously oercion, " and IR Bs strive to help researchers to contacted, and this usually generates a vigorous avoid intentional or unintentional coercion investigation because universities face terrible pen Some children are improperly enrolled into clini- alties if ethical violations create harm to research cal research projects because their parents believe that participants. Seeking assistance from a state NASW the experimental intervention will definitely help chapter can also protect complainant anonymity and their child. This is known as the f"therapeutic mis- will ikely incentivize researchers, agency leaders, and conception,'land social workers need to help parents universities to address publicly exposed violations understand that projects testing new interventions Finally, if all else fails, or if because of special cir- offer no guaranteed cure. Empirical findings could cumstances the complainant requires advice before help us understand how to approach these issues, taking any of the actions mentioned earlier, person ut unfortunately, very limited research exists about ally retaining legal counsel can be extraordinarily how parents actually understand the components of effective, although this would require the financial pediatric research studies resour es to pay legal fees Finally, researchers sometimes recruit children The foregoing discussion suggests a few of the ho live in hospitals, in residential programs, or in complexities and challenges involved with pro- state child welfare custody because more research tecting research participants. Yet, it is important to is needed about these populations to help improve remember that it is ethically required to pursue services they receive. However, these individuals also intervention research with vulnerable populations eappen to be subject pools that are readily available, such as children because they would otherwise al- naking them a sort of"captive audience "Validity most always have access to only nonvalidated treat- and ethical problems can arise from studies recruiting ment approaches. Because vulnerable populations ach participants. For example, will a trauma inter- are social workers' primary clientele, practitioners vention validated in a residential treatment setting should join researchers and IRBs in working to generalize to children living in the community? If I protect clients by helping to ensure that their client Social Work VoLUME 54, NUMBER I JANUARY 2009
that they are safe and effective for children and adolescents who have unique, developmental sensitivities.Therefore, pédiatrie research must proceed to enhance ethical practice and the use of evidencebased treatments. ¡ Young children are unable to give informed consent to participate in studies, and therefore, parental permission is required. Older children and adolescents are required to give their assent to participate, even if parents grant the required permission. Social work researchers need to ensure that parents understand the risks and benefits of projects requesting their children's participation. The April 2007 editorial by Jorge Delva showed how responsible and well-informed parents make; such decisions in their child's best interests and factor in concern for the project's attention to race, culture, language, and safety. Unfortunately, some parents face great cognitive challenges in understanding the risk or benefits of such studies and sometimes agree to participate in research projects for the wrong reasons. For example, desperate adults' can be tempted to sign up children if they believe that they will otherwise be denied services to which they are entitled. Poor adults consent toj receive financial remuneration or some other incentive that seems too good to pass up. Both of these are examples of "coercion," and IRBs strive to help researchers to avoid intentional or unintentional coercion. Some children are improperly enrolled into clinical research projects because their parents believe that the experimental intervention viiill definitely help their child. This is known as the ¡'therapeutic misconception," and social workers need to help parents understand that projects testing riew interventions offer no guaranteed cure. Empirital findings could help us understand how to approach these issues, but unfortunately, very limited research exists about how parents actually understand the components of pédiatrie research studies. Finally, researchers sometimes recruit children who live in hospitals, in residential programs, or in state child welfare custody because more research is needed about these populations to help improve services they receive. However, these individuals also happen to be subject pools that are readily available, making them a sort of "captive äudience."Validity and ethical problems can arise fi'om studies recruiting such participants. For example, will a trauma intervention validated in a residential treatment setting generahze to children living in the community? If the intervention is not studied in community areas that may present more sampling obstacles, that question will go unanswered. Research for such settings is usually approved only when the focus of the project is about those specific populations and settings. Researchers who only recruit children from marginalized groups and low socioeconomic status families can inadvertently stigmatize those children further. At the same time,involving healthy children from nonmarginalized groups who will not benefit from the tested interventions raises ethical problems, even though their inclusion might enhance the validity of research projects. The NASW Code of Ethics clearly directs social workers who strongly suspect or discover ethical violations to take action. First, it is usually advisable to discuss concerns with the research investigator to seek clarity and, if necessary, remediation. If these concerns are dismissed or minimized, there are a number of alternative pathways for further action. Research cannot occur without the sanction of agency leadership, so consultation with supervisors or administrators can be effective because they are usually aware of the serious ethical and legal ramifications for the organization if such violations are taking place. If this is unsuccessful or impractical, the researcher's university IRB can be anonymously contacted, and this usually generates a vigorous investigation because universities face terrible penalties if ethical violations create harm to research participants. Seeking assistance from a state NASW chapter can also protect complainant anonymity and wü] likely incentivize researchers, agency leaders, and universities to address publicly exposed violations. Finally, if all else fails, or if because of special circumstances the complainant requires advice before taking any of the actions mentioned earher, personally retaining legal counsel can be extraordinarily effective, although this would require the financial resources to pay legal fees. The foregoing discussion suggests a few of the complexities and challenges involved with protecting research participants.Yet, it is important to remember that it is ethically required to pursue intervention research with vulnerable populations such as children because they would otherwise almost always have access to only nonvalidated treatment approaches. Because vulnerable populations are social workers' primary clientele, practitioners should join researchers and Il^ s in working to protect clients by helping to ensure that their chent Social Work VOLUME 54, NUMBER i JANUARY 2009
populations have the option for research participa- ion and that the studies in which they participate are conducted with scientific and ethical integrity. Practitioners seeking to develop greater knowledge in this area can contact the Office of Research Integrity at their local university for training op- portunities Social worker practitioners are also encouraged to join an IRB and sit as one of the ommunity members required for an IRB to legally function. The following Web site is also very help NASW PRESS POLICY ON for deepening research ethics understanding and skills:http://www.ori/dhhjs.gov/.sw ETHICAL BEHAVIOR he NASw Press expects authors to ad- ames J Clark, PhD, LCSw, is associate dean for research, College of Social Work, University of Kentucky, is associate here to ethical standards for scholarship as articulated in the NAsw Code of ethics dirctor, Center for the Study of Violence against Children; and and Writing for the NASW Press: Information serves on the university institutional review board. He uthor of CSWE's National Statement on Research Integrity for Authors. These standards include actions inSocialWorkwhichcanbefoundathttp://unwucswe.org/ CSWE/research/rescarch/policies. Address correspondence to Jim Clark, POT 659, College of Social Work, University of responsibility and credit only for Kentucky 40506-0027; e-mail: jjclar0O@uky. edu hey have actually performed honestly acknowledging the work of others rk fully documenting their own and others ted wor If possible breaches of ethical standards have peen identified at the review or publication orocess, the NASW Press may notify the au- thor and bring the ethics issue to the attention of the appropriate professional body or other authority. Peer review confidentiality will not As reviewed and revised by NASW National Committee on 30,1997 Approved by NASw Board of CLARk Why Social Work Practitioners Need Research Ethics knowlede
populations have the option for research participation and that the studies in which they participate are conducted with scientific and ethical integrity. Practitioners seeking to develop greater knowledge in this area can contact the Office of Research Integrity at their local university for training opportunities. Social worker practitioners are also encouraged to join an 11\B and sit as one of the community members recjuired for an IRB to legally function.The following Web site is also very helpful for deepening research ethics understanding and skills: http://www.ori/dhhjs.gov/. BÜÜ James J. Clark, PhD, LCSWf I'i associate dean for research, College of Social Work, University of Kentucky; is associate director. Center for the Study of Violence against Children; and serves on the university institutional review board. He is coauthor ofCSWE's National Statement on Research Integrity in Social Work, which can be found at http://ivww.csive.org/ CSWE/research/research/policies. Address correspondence to Jim Clark, POT 659, College of Social Work, University of Kentucky 40506-0027; e-mail:jjclarOO@ukyedu. NASW PRESS POLICY ON ETHICAL BEHAVIOR T he NASW Press expects authors to adhere to ethical standards for scholarship as articulated in the NASW Code of Ethics and Writings for the NASW Press: Information for Authors. These standards include actions such as • taking responsibility and credit only for work they have actually performed • honestly acknowledging the work of others • submitting only original work to journals • fuUy documenting their own and others' related work. If possible breaches of ethical standards have been identified at the review or publication process, the NASW Press may notify the author and bring the ethics issue to the attention of the appropriate professional body or other authority. Peer review confidentiality will not apply where there is evidence of plagiarism. As reviewed and revised by NASW National Committee on Inquiry (NCOI), May 30, 1997 Approved by NASW Board of Directors, September 1997 CLARK / Why Social Work Practitioners Need Research Ethics Knowledge
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