research model social work

Developing Research-Informed Social Work Practice

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• Roberta Greene 4 ,
• Nicole Dubus 5 &
• Nancy Greene 6  

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The resilience-enhancing stress model is a research-informed helping process that combines human behavior theory and social work practice skills. This chapter illustrates how research studies conducted over the past two decades served as the foundation for this model. It presents a metasynthesis of qualitative studies of diverse older adults who overcame discriminatory practices during the Nazi Holocaust, the Cambodian genocide, the British Mandate in Palestine, and the Jim Crow US South. The revelations contained in study participants’ narratives provide an understanding of how participants resisted discriminatory practices.

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Acknowledgments

The research “Forgiveness, Resiliency, and Survivorship Among Holocaust Survivors” in Vol. 20, Issue 4, of the Journal of Human Behavior in the Social Environment was funded by Grant No. 10282 from the John Templeton Foundation: Roberta R. Greene (principal investigator); Marilyn Armour, Harriet L. Cohen, Constance Corley, and Carmen Morano (coinvestigators); Shira Hantman (statistical consultant); and Sandra A. Graham (project manager). The opinions expressed in this chapter are those of the author(s) and do not necessarily reflect the views of the John Templeton Foundation.

Portions of this work were first presented as a paper at the 2019 Annual Scientific Meeting of the Gerontological Society of America in Austin, Texas.

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Greene, R., Dubus, N., Greene, N. (2022). Developing Research-Informed Social Work Practice. In: A Resilience-Enhancing Stress Model. Springer, Cham. https://doi.org/10.1007/978-3-031-08112-5_1

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Theories Used in Social Work

Social workers are employed throughout a variety of settings and guide people from all walks of life. Regardless of their context, social workers can leverage some core theories and practice models to help clients throughout the industry.

Common Theories and Practice Models in Social Work

In many ways, social work is a science. Social workers can guide their clients, but they don’t carry out their practice based on their own opinion and/or style. Instead, social workers study specific clinical theories that are grounded in research to inform how they implement clinical practice in a methodological manner. In fact, clinical social workers need to obtain both a bachelor’s and master’s degree in order to fully understand these theories and master therapeutic practice models.

At its core, social work focuses on “person-in-environment” (PIE) theory. This considers clients within their psychosocial contexts, and it connects to micro, mezzo, and macro levels of social work practice. This guide explores how each theory and practice model functions within the PIE theory.

Social workers learn about these theories during their education. You can learn more about these academic programs with these resources: a guide to social work bachelor’s degrees , master’s degrees , and online master’s degrees .

Why is Theory Important in Social Work?

As any social work professor can tell you, understanding clinical theories are an essential part of a social worker’s job. It allows social workers to explore certain origins of behavior with evidence-based approaches. Social workers also lean on these theories and practices to address client problems with research to back up their practice. This is especially important, as social workers need to avoid personal assumptions or biases from interfering with effective treatment plans.

Learning about these theories can also help social workers implement effective solutions rather than grasping at straws. If a certain therapeutic approach does not work, social workers can examine the reasons and use what they’ve learned to try a different approach.

Common Social Work Theories

Social workers can incorporate components of several different clinical theories in their work with clients. Some popular approaches for social workers include theories of systems, social learning, psychosocial development, psychodynamic, transpersonal, and rational choice.

Many of these theories have been developed within the past century, and several draw upon Sigmund Freud’s theories of psychoanalysis. Some of these theories encompass a broad outlook (such as systems theory), while others focus on specific conflicts (like psychosocial theory). Not every social worker uses every theory, while some social workers might use elements of each one. You can read more information about the most common social work theories below.

Systems theory assumes that human behavior is the result of a larger system comprised of several elements, including the relationships between these elements, as well as external factors like their environment. These factors could involve a person’s family, peers, school, work, or community. Sociologists have identified many different types of systems, including microsystems, mesosystems, exosystems, and macrosystems.

Social work professionals examine how the systems in which their clients live affect their behaviors. For instance, living in a system of poverty can have a significant impact on how a person makes decisions. Social workers can devise strategies based on these systems in order to provide a more concise treatment plan for their client.

Developed by psychologist Albert Bandura in the 1970s, social learning theory accounts for how the behavior of other people can affect somebody’s behavior. Bandura argued that individuals pick up behaviors by observing and imitating the people around them. Unlike behavioral theories, social learning theory proposes that people actively and mentally process other people’s behaviors before imitating them.

Social workers may take into account social learning theory when working with children who take on aggressive or violent behaviors, for example. The children may mimic their parents or other significant adults in their lives. When social workers are able to identify the origin of a child’s behaviors, they are able to effectively create a treatment approach.

Influenced by the seminal work of Freud, psychologist Erik Erikson proposes several stages of development relating to a person’s ego identity, personal identity, and social and cultural identity. Erikson’s theory argues that humans struggle with specific conflicts throughout different stages of their life. Those conflicts include:

• Trust vs. mistrust in infancy
• Autonomy vs. shame and doubt in early childhood
• Initiative vs. guilt in preschool age
• Industry vs. inferiority in school age
• Identity vs. role confusion in adolescence
• Intimacy vs. isolation in young adulthood
• Generativity vs. stagnation in middle adulthood
• Ego integrity vs. despair in maturity

Erikson’s theory suggests that if humans effectively navigate these tensions at each stage of their life, they can develop a healthy ego. Social workers may consider these conflicts when working with their clients. It is important to note that each stage correlates with an emotional stage which could also be in conflict with a developmental stage.

Introduced by Freud at the turn of the 20th century — and popularized by Carl Jung, Melanie Klein, and Anna Freud — psychodynamic theory argues that our personalities develop because of various internal forces. Freud wrote that our personalities are largely shaped during our early childhood, and our personality consists of three main parts: id (impulse), ego (decision-making), and superego (conscience). Psychodynamic theory also prioritizes a person’s unconscious thought process as the root of their behaviors.

Social workers may use psychodynamic theory to help clients examine the underlying causes of certain behaviors — often considering the clients’ childhood — to help explain why they act a certain way. Social workers may offer different types of therapies based on psychodynamic theory, including transference and dream analysis.

Transpersonal theory approaches humans with a holistic philosophy, and considers factors like spirituality, the relationship between the body and the mind, and consciousness. Psychologists generally do not consider transpersonal theory to be scientific, but many therapists or mental health professionals integrate elements of transpersonal theory into their practice. They might use meditation, mindfulness practices, or hypnotherapy on their patients.

Rational choice theory argues that people make decisions and carry out behaviors based on their own rational thought processes, especially if those decisions ultimately benefit the individual. This theory directly opposes some other clinical theories that suggest people make decisions on unconscious thought processes.

Although rational choice theory is often found within economic theory, social workers can also apply these principles to their job. To understand why clients make certain decisions, social workers can examine how those clients believed their choices would benefit them. Social workers also can develop solutions and suggest resources to assist clients with achieving their goals.

Common Practice Models in Social Work

While social workers integrate various clinical theories into their practice, they can also implement specific therapeutic models. The theories above may explain the causes of a person’s struggles; however, practice models allow social workers to carry out specific approaches to treat those struggles.

The section below outlines some of the most common practice models, including cognitive behavioral therapy, crisis intervention model, narrative therapy, problem-solving model, solution-focused therapy, and task-centered therapy. Some of these methods overlap or share characteristics with each other, but each serves a purpose for specific clients and circumstances.

Cognitive behavioral therapy (CBT) identifies unhealthy patterns of thinking and attempts to rewrite these patterns.

People often convince themselves that their frequently distorted thoughts are true. CBT forces individuals to question and confront these distortions. For instance, somebody might find themselves in fear of social situations, because they imagine a worst-case scenario that they will humiliate themselves. CBT pushes that person to examine these assumptions and instead consider new scenarios and outlooks.

People who struggle with anxiety and depression often find CBT helpful, and many clinical social workers incorporate CBT into their therapeutic practice.

Crisis intervention model is much what it sounds like: in times of acute psychological strain or distress, social workers and mental health professionals intervene before that crisis turns into harm. Albert Roberts and Allen Ottens propose seven steps to crisis intervention. These include conducting a safety assessment, establishing psychological contact, identifying the major problems, helping the patient explore their feelings, looking for new coping mechanisms, creating an action plan, and planning follow-ups.

Social workers can use the crisis intervention model for clients suffering from major trauma, post-traumatic stress disorder, or suicidal thoughts, among others. This model of crisis intervention works in a voluntary manner, which means that clients must be open to the process.

Narrative therapy is based on the theory that individuals turn their personal experiences into stories. In other words, they create narratives of their own lives. This type of therapy relies on four major principles: “objective truth” does not exist; reality is a social construct; language can influence how we view reality; and narratives help us organize our personal realities.

Narrative therapy encourages clients to distance themselves from their personal experiences by taking on the role of a narrator and rewriting the script. This can help them change harmful and disruptive thinking patterns, especially those shaped by trauma.

Helen Harris Perlman proposed the problem-solving model in the 1950s specifically for the field of social work. At the time, many social work theories and therapies relied on psychotherapy; Perlman instead argued that social workers could more effectively help clients by focusing on one problem at a time.

Focusing on smaller problems allows clients to develop and follow through with action plans to confront those issues in a manageable way. This method — also called “partializing” — would make therapies more manageable for social workers and clients alike, and professionals still use Perlman’s proposals.

Solution-focused therapy, or solution focused brief therapy, concentrates on an individual’s present and future situations. This therapy involves a departure from psychodynamic-influenced theories that focus on a person’s past and childhood.

Solution-focused therapy proposes immediate, manageable solutions that allow patients to better cope with their problems. A mental health professional or social worker employing this type of therapy might challenge a client to imagine their future life without their problem, or they might help individuals recognize and better harness copy mechanisms that they already use. Social workers might implement solution-focused therapy for adolescents with behavioral problems or families with conflicts, to name a couple of examples.

Task-centered practice shares many principles with the problem-solving model and solution-focused therapy, but it tends to follow an even more focused and quick approach. Task-centered practice usually only lasts 8-12 sessions, and clients concentrate on achieving measurable goals. Clients and social workers create action plans with specific tasks, and then clients carry out those tasks.

Social workers can integrate this type of therapy into many different types of settings. They might work with students with disruptive behavioral issues, soon-to-be-discharged hospital patients, or older clients at nursing homes.

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2.2 Paradigms, theories, and how they shape a researcher’s approach

Learning objectives.

• Define paradigm, and describe the significance of paradigms
• Identify and describe the four predominant paradigms found in the social sciences
• Define theory
• Describe the role that theory plays in social work research

The terms paradigm and theory are often used interchangeably in social science, although social scientists do not always agree whether these are identical or distinct concepts. This text makes a clear distinction between the two ideas because thinking about each concept as analytically distinct provides a useful framework for understanding the connections between research methods and social scientific ways of thinking.

Paradigms in social science

  For our purposes, we’ll define paradigm as a way of viewing the world (or “analytic lens” akin to a set of glasses) and a framework from which to understand the human experience (Kuhn, 1962). It can be difficult to fully grasp the idea of paradigmatic assumptions because we are very ingrained in our own, personal everyday way of thinking. For example, let’s look at people’s views on abortion. To some, abortion is a medical procedure that should be undertaken at the discretion of each individual woman. To others, abortion is murder and members of society should collectively have the right to decide when, if at all, abortion should be undertaken. Chances are, if you have an opinion about this topic, you are pretty certain about the veracity of your perspective. Then again, the person who sits next to you in class may have a very different opinion and yet be equally confident about the truth of their perspective. Who is correct?

You are each operating under a set of assumptions about the way the world does—or at least should—work. Perhaps your assumptions come from your political perspective, which helps shape your view on a variety of social issues, or perhaps your assumptions are based on what you learned from your parents or in church. In any case, there is a paradigm that shapes your stance on the issue. Those paradigms are a set of assumptions. Your classmate might assume that life begins at conception and the fetus’ life should be at the center of moral analysis. Conversely, you may assume that life begins when the fetus is viable outside the womb and that a mother’s choice is more important than a fetus’s life. There is no way to scientifically test when life begins, whose interests are more important, or the value of choice. They are merely philosophical assumptions or beliefs. Thus, a pro-life paradigm may rest in part on a belief in divine morality and fetal rights. A pro-choice paradigm may rest on a mother’s self-determination and a belief that the positive consequences of abortion outweigh the negative ones. These beliefs and assumptions influence how we think about any aspect of the issue.

In Chapter 1, we discussed the various ways that we know what we know. Paradigms are a way of framing what we know, what we can know, and how we can know it. In social science, there are several predominant paradigms, each with its own unique ontological and epistemological perspective. Recall that ontology is the study of what is real, and epistemology is the study of how we come to know what is real. Let’s look at four of the most common social scientific paradigms that might guide you as you begin to think about conducting research.

The first paradigm we’ll consider, called positivism, is the framework that likely comes to mind for many of you when you think of science. Positivism is guided by the principles of objectivity, knowability, and deductive logic. Deductive logic is discussed in more detail in next section of this chapter. The positivist framework operates from the assumption that society can and should be studied empirically and scientifically. Positivism also calls for a value-free science, one in which researchers aim to abandon their biases and values in a quest for objective, empirical, and knowable truth.

Another predominant paradigm in social work is social constructionism . Peter Berger and Thomas Luckman (1966) are credited by many for having developed this perspective in sociology. While positivists seek “the truth,” the social constructionist framework posits that “truth” varies. Truth is different based on who you ask, and people change their definitions of truth all the time based on their interactions with other people. This is because we, according to this paradigm, create reality ourselves (as opposed to it simply existing and us working to discover it) through our interactions and our interpretations of those interactions. Key to the social constructionist perspective is the idea that social context and interaction frame our realities.

Researchers operating within this framework take keen interest in how people come to socially agree, or disagree, about what is real and true. Consideration of how meanings of different hand gestures vary across different regions of the world aptly demonstrates that meanings are constructed socially and collectively. Think about what it means to you when you see a person raise their middle finger. In the United States, people probably understand that person isn’t very happy (nor is the person to whom the finger is being directed). In some societies, it is another gesture, such as the thumbs up gesture, that raises eyebrows. While the thumbs up gesture may have a particular meaning in North American culture, that meaning is not shared across cultures (Wong, 2007). So, what is the “truth” of the middle finger or thumbs up? It depends on what the person giving it intended, how the person receiving it interpreted it, and the social context in which the action occurred.

It would be a mistake to think of the social constructionist perspective as only individualistic. While individuals may construct their own realities, groups—from a small one such as a married couple to large ones such as nations—often agree on notions of what is true and what “is.” In other words, the meanings that we construct have power beyond the individual people who create them. Therefore, the ways that people and communities work to create and change such meanings is of as much interest to social constructionists as how they were created in the first place.

A third paradigm is the critical paradigm. At its core, the critical paradigm is focused on power, inequality, and social change. Although some rather diverse perspectives are included here, the critical paradigm, in general, includes ideas developed by early social theorists, such as Max Horkheimer (Calhoun, Gerteis, Moody, Pfaff, & Virk, 2007), and later works developed by feminist scholars, such as Nancy Fraser (1989). Unlike the positivist paradigm, the critical paradigm posits that social science can never be truly objective or value-free. Further, this paradigm operates from the perspective that scientific investigation should be conducted with the express goal of social change in mind. Researchers in the critical paradigm might start with the knowledge that systems are biased against, for example, women or ethnic minorities. Moreover, their research projects are designed not only to collect data, but also change the participants in the research as well as the systems being studied. The critical paradigm not only studies power imbalances but seeks to change those power imbalances.

Finally, postmodernism is a paradigm that challenges almost every way of knowing that many social scientists take for granted (Best & Kellner, 1991). While positivists claim that there is an objective, knowable truth, postmodernists would say that there is not. While social constructionists may argue that truth is in the eye of the beholder (or in the eye of the group that agrees on it), postmodernists may claim that we can never really know such truth because, in the studying and reporting of others’ truths, the researcher stamps their own truth on the investigation. Finally, while the critical paradigm may argue that power, inequality, and change shape reality and truth, a postmodernist may in turn ask whose power, whose inequality, whose change, whose reality, and whose truth. As you might imagine, the postmodernist paradigm poses quite a challenge for researchers. How do you study something that may or may not be real or that is only real in your current and unique experience of it? This fascinating question is worth pondering as you begin to think about conducting your own research. Part of the value of the postmodern paradigm is its emphasis on the limitations of human knowledge. Table 2.1 summarizes each of the paradigms discussed here.

Let’s work through an example. If we are examining a problem like substance abuse, what would a social scientific investigation look like in each paradigm? A positivist study may focus on precisely measuring substance abuse and finding out the key causes of substance abuse during adolescence. Forgoing the objectivity of precisely measuring substance abuse, social constructionist study might focus on how people who abuse substances understand their lives and relationships with various drugs of abuse. In so doing, it seeks out the subjective truth of each participant in the study. A study from the critical paradigm would investigate how people who have substance abuse problems are an oppressed group in society and seek to liberate them from external sources of oppression, like punitive drug laws, and internal sources of oppression, like internalized fear and shame. A postmodern study may involve one person’s self-reported journey into substance abuse and changes that occurred in their self-perception that accompanied their transition from recreational to problematic drug use. These examples should illustrate how one topic can be investigated across each paradigm.

Social science theories

Much like paradigms, theories provide a way of looking at the world and of understanding human interaction. Paradigms are grounded in big assumptions about the world—what is real, how do we create knowledge—whereas theories describe more specific phenomena. A common definition for theory in social work is “a systematic set of interrelated statements intended to explain some aspect of social life” (Rubin & Babbie, 2017, p. 615). At their core, theories can be used to provide explanations of any number or variety of phenomena. They help us answer the “why” questions we often have about the patterns we observe in social life. Theories also often help us answer our “how” questions. While paradigms may point us in a particular direction with respect to our “why” questions, theories more specifically map out the explanation, or the “how,” behind the “why.”

Introductory social work textbooks introduce students to the major theories in social work—conflict theory, symbolic interactionism, social exchange theory, and systems theory. As social workers study longer, they are introduced to more specific theories in their area of focus, as well as perspectives and models (e.g., the strengths perspective), which provide more practice-focused approaches to understanding social work.

As you may recall from a class on social work theory, systems theorists view all parts of society as interconnected and focus on the relationships, boundaries, and flows of energy between these systems and subsystems (Schriver, 2011). Conflict theorists are interested in questions of power and who wins and who loses based on the way that society is organized. Symbolic interactionists focus on how meaning is created and negotiated through meaningful (i.e., symbolic) interactions. Finally, social exchange theorists examine how human beings base their behavior on a rational calculation of rewards and costs.

Just as researchers might examine the same topic from different levels of inquiry or paradigms, they could also investigate the same topic from different theoretical perspectives. In this case, even their research questions could be the same, but the way they make sense of whatever phenomenon it is they are investigating will be shaped in large part by theory. Table 2.2 summarizes the major points of focus for four major theories and outlines how a researcher might approach the study of the same topic, in this case the study of substance abuse, from each of the perspectives.

Within each area of specialization in social work, there are many other theories that aim to explain more specific types of interactions. For example, within the study of sexual harassment, different theories posit different explanations for why harassment occurs. One theory, first developed by criminologists, is called routine activities theory. It posits that sexual harassment is most likely to occur when a workplace lacks unified groups and when potentially vulnerable targets and motivated offenders are both present (DeCoster, Estes, & Mueller, 1999). Other theories of sexual harassment, called relational theories, suggest that a person’s relationships, such as their marriages or friendships, are the key to understanding why and how workplace sexual harassment occurs and how people will respond to it when it does occur (Morgan, 1999). Relational theories focus on the power that different social relationships provide (e.g., married people who have supportive partners at home might be more likely than those who lack support at home to report sexual harassment when it occurs). Finally, feminist theories of sexual harassment take a different stance. These theories posit that the way our current gender system is organized, where those who are the most masculine have the most power, best explains why and how workplace sexual harassment occurs (MacKinnon, 1979). As you might imagine, which theory a researcher applies to examine the topic of sexual harassment will shape the questions the researcher asks about harassment. It will also shape the explanations the researcher provides for why harassment occurs.

For an undergraduate student beginning their study of a new topic, it may be intimidating to learn that there are so many theories beyond what you’ve learned in your theory classes. What’s worse is that there is no central database of different theories on your topic. However, as you review the literature in your topic area, you will learn more about the theories that scientists have created to explain how your topic works in the real world. In addition to peer-reviewed journal articles, another good source of theories is a book about your topic. Books often contain works of theoretical and philosophical importance that are beyond the scope of an academic journal.

Paradigm and theory in social work

Theories, paradigms, levels of analysis, and the order in which one proceeds in the research process all play an important role in shaping what we ask about the social world, how we ask it, and in some cases, even what we are likely to find. A micro-level study of gangs will look much different than a macro-level study of gangs. In some cases, you could apply multiple levels of analysis to your investigation, but doing so isn’t always practical or feasible. Therefore, understanding the different levels of analysis and being aware of which level you happen to be employing is crucial. One’s theoretical perspective will also shape a study. In particular, the theory invoked will likely shape not only the way a question about a topic is asked but also which topic gets investigated in the first place. Further, if you find yourself especially committed to one theory over another, it may limit the kinds of questions you pose. As a result, you may miss other possible explanations.

The limitations of paradigms and theories do not mean that social science is fundamentally biased. At the same time, we can never claim to be entirely value free. Social constructionists and postmodernists might point out that bias is always a part of research to at least some degree. Our job as researchers is to recognize and address our biases as part of the research process, if an imperfect part. We all use our own approaches, be they theories, levels of analysis, or temporal processes, to frame and conduct our work. Understanding those frames and approaches is crucial not only for successfully embarking upon and completing any research-based investigation, but also for responsibly reading and understanding others’ work.

Spotlight on UTA School of Social Work

Catherine labrenz connects social theory and child welfare research.

When Catherine LaBrenz, an assistant professor at the University of Texas at Arlington’s School of Social Work was a child welfare practitioner, she noticed that several children who had reunified with their biological parents from the foster care system were re-entering care because of continued exposure to child maltreatment. As she observed the challenging behaviors these children often presented, she wondered how the agency might better support families to prevent children from re-entering foster care after permanence. In her doctoral studies, she used her practice experience to form a research project with the goal of better understanding how agencies could better support families post-reunification.

From a critical paradigm, Dr. LaBrenz approached this question with the understanding that families that come into contact with child welfare systems often experience disadvantage and are subjected to unequal power distributions when accessing services, going to court, and participating in case decision-making (LaBrenz & Fong, 2016). Furthermore, the goal of this research was to change some of the aspects of the child welfare system, particularly within the practitioner’s agency, to better support families.

To better understand why some families may be more at-risk for multiple entries into foster care, Dr. LaBrenz began with an extensive literature review that identified diverse theories that explained factors at the child, family, and system- level that could impact post-permanence success. Figure 2.1 displays the micro-, meso-, and macro-level theories that she and her research team identified and decided to explore further.

At the child-level, Attachment theory posits that consistent, stable nurturing during infancy impacts children’s ability to form relationships with others throughout their life (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1969). At the family-level, Family systems theory posits that family interactions impact functioning among all members of a family unit (Broderick 1971). At the macro-level, Critical race theory (Delgado & Stefancic, 2001) can help understand racial disparities in child welfare systems. Moreover, Systems theory (Bronfenbrenner, 1986) can help examine interactions among the micro-, meso- and macro-levels to assess diverse systems that impact families involved in child welfare services.

In the next step of the project, national datasets were used to examine child-, family-, and system- factors that impacted rates of successful reunification, or reunification with no future re-entries into foster care. Then, a systematic review of the literature was conducted to determine what evidence existed for interventions to increase rates of successful reunification. Finally, a different national dataset was used to examine how effective diverse interventions were for specific groups of families, such as those with infants and toddlers.

Figure 2.2 displays the principal findings from the research project and connects each main finding to one of the theoretical frameworks.

The first part of the research project found parents who felt unable to cope with their parental role, and families with previous attachment disruptions, to have higher rates of re-entry into foster care. This connects with Attachment theory, in that families with more instability and inconsistency in caregiving felt less able to fulfill their parental roles, which in turn led to further disruption in the child’s attachment.

With regards to family-level theories, Dr. LaBrenz found that family-level risk and protective factors were more predictive of re-entry to foster care than child- or agency-level factors. The systematic review also found that interventions that targeted parents, such as Family Drug Treatment Courts, led to better outcomes for children and families. This aligns with Family systems theory in that family-centered interventions and targeting the entire family leads to better family functioning and fewer re-entries into foster care.

In parallel, the systematic review concluded that interventions that integrated multiple systems, such as child welfare and substance use, increased the likelihood of successful reunification. This supports Systems theory, in that multiple systems can be engaged to provide ongoing support for families in child welfare systems (Trucco, 2012). Furthermore, the results from the analyses of the national datasets found that rates of re-entry into foster care for African American and Latino families varied significantly by state. Thus, racial and ethnic disparities remained in some, but not all, state child welfare systems.

Overall, the findings from the research project supported Attachment theory, Family systems theory, Systems theory, and Critical race theory as guiding explanations for why some children and families experience foster care re-entry while others do not. Dr. LaBrenz was able to present these findings and connect them to direct implications for practices and policies that could support attachment, multi-system collaborations, and family-centered practices.

Key Takeaways

• Paradigms shape our everyday view of the world.
• Researchers use theory to help frame their research questions and to help them make sense of the answers to those questions.
• Applying the four key theories of social work is a good start, but you will likely have to look for more specific theories about your topic.
• Critical paradigm- a paradigm in social science research focused on power, inequality, and social change
• Paradigm- a way of viewing the world and a framework from which to understand the human experience
• Positivism- a paradigm guided by the principles of objectivity, knowability, and deductive logic
• Postmodernism- a paradigm focused on the historical and contextual embeddedness of scientific knowledge and a skepticism towards certainty and grand explanations in social science
• Social constructionism- a paradigm based on the idea that social context and interaction frame our realities
• Theory- “a systematic set of interrelated statements intended to explain some aspect of social life” (Rubin & Babbie, 2017, p. 615)

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Module 2 Chapter 3: Logic Models and Theory Informed Intervention

In our earlier course you learned about the relationship between theory and research. In this course about understanding social work interventions the relationship between theory and intervention takes center stage. The design of an intervention is typically informed by theory and evidence, and the research about that intervention further develops theory and evidence. Over time, with repetitions of this cycle, social workers have sufficient evidence to inform their practice decisions. The logic model is an approach to systematically defining an intervention and relating the theory and evidence base to its development.

In this chapter, you learn:

• how theory and logic models inform intervention design

The Role of Theory in Intervention Design

The PICO or COPES process helped define the practice problem or question. The next step in the process of designing an intervention is to apply theory in mapping the mechanism of change . Evidence about mechanisms of change answers questions of how change occurs or is facilitated rather than restricting focus on what changes occur. In other words, mechanisms of change research is about change processes, not just change outcomes. For example, a body of literature suggests that

In our earlier course you learned to understand social work problems and social phenomena, as they occur across diverse populations, in terms of theory and evidence. This is the change theory and evidence applied by intervention planners. Theory helps planners identify “targets for change”—leverage points where it makes the most sense to intervene and how intervening at those points might lead to the desired change outcomes (Fraser, Richman, Galinsky, & Day, 2009). Practical targets for change are limited to factors that can be modified through intervention; it is impractical to target phenomena that cannot be modified through intervention (e.g., exposure to past events cannot be undone, but reactions/responses to them might be modifiable). In the empirical literature, these factors are often identified as  mediators .

This diagram shows the rationale involved: the outcome ( y ) is considered a direct effect of the problem ( x ), but the relationship between them is influenced or controlled by a mediating process ( z ). This mediator becomes a prime target for change—by changing it ( z ), the problem ( x ) might have a different impact or outcome ( y ).

For example, empirical evidence tells us that a specific biological process in the brain (accumulation of amyloid plaques) is a direct cause of Alzheimer’s disease. The problem (x) in this case is amyloid plaque formation in the hippocampus and thalamus regions and causes—or at least heavily influences—the outcome, which is Alzheimer’s Disease ( y ). Recent evidence identified a mediator of this relationship ( z )—lack of sleep causes an accumulation of beta-amyloid proteins that “clump” together forming plaques in the human brain (Shokri-Kojori et al., 2018). While we are not able to change the neurobiology whereby plaque formation ( x ) causes Alzheimer’s Disease ( y ), we might intervene around the mediator, lack of sleep ( z ) to help prevent or delay the onset of Alzheimer’s disease due to beta-amyloid plaque formation. Evidence about lack of sleep as a mediator points to a potentially modifiable intervention target: interventions to promote good “sleep hygiene” practices. This is suggested because beta-amyloid increased by about 5% with study participants losing one night’s sleep—it is a cellular waste product that clears away during sleep. It is unknown whether or to what extent a night of rest can reverse the increase in beta-amyloid that accumulated during the sleep deprivation period (NIAAA, 2018).

Ideally, intervention plans are shaped by causal evidence, not merely correlational evidence. Systematic intervention planning and design proceed from this phase to the creation of a logic model.

Logic Models Explained

A logic model  is a conceptual map for a planned intervention, one that shows the logical connections between inputs  and outputs  in the intervention process and the theory of change (mechanisms of change) underlying the intervention plan (Fraser et al., 2009; Harris, 2010). Inputs are those core elements and resources necessary for implementing the planned intervention. These inputs include personnel, time/effort, space, finances, supervisory, technology, materials, and other resources necessary to deliver the intervention (Harris, 2010). Outputs, on the other hand, are the changes anticipated to result from the planned intervention. The outputs include initial/immediate products or outcomes ( proximal outcomes), intermediate impacts or outcomes, and long-range/final outcomes ( distal  outcomes) associated with the planned intervention (Kapp & Anderson, 2010). The logic model serves the following purposes (adapted from Harris, 2010, p. 56):

• mapping an intervention during planning and evaluation phases;
• documenting the reasoning behind the intervention activities;
• “a tool to facilitate stakeholder insight and reflection”;
• “a tool to inform monitoring and the development of benchmarks” for evaluating the intervention.

Here is a sample template for an intervention or program logic model. Inputs and Outputs/Outcomes were previously described. Activities are those change-producing processes involved—the crucial intervention components informed by evidence. Activities and processes might be separated into “staff activities” and “program processes” to distinguish between what is delivered (staff activities) and what clients do (program processes) for a more nuanced logic model (Kapp & Anderson, 2010). Note that a separate logic model should be developed for each intervention goal if multiple goals are targets of a single intervention, program, or policy.

Here is an example of a completed logic model from the HOME intervention (Home Ownership Mobilization Effort) in the United Kingdom, an intervention to improve communities through increased home ownership (retrieved from https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/logic-model-development/example).

Stop and Think

Scenario: A county wishes to intervene to reduce severe health disparities between its urban and suburban populations. Their search for evidence led them to an intervention plan that increases safe, appealing spaces and opportunities for physical activity and provides affordable, appealing access to healthful food. Thinking about how their logic model might be constructed, answer the following multiple-choice questions.

Chapter Summary

In this brief chapter you were introduced to the logic model for planning and evaluating interventions. This is an approach that clearly identifies the logic in designing an intervention to achieve specified outcomes based on the intervention “inputs,” activities, and processes. A logic model is founded on theory and evidence informing the choices of inputs, activities, and processes, as well as determining the likely short- and long-range impacts of the intervention. In our next chapter, we consider approaches to locating that evidence.

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Article contents

Social work practice: history and evolution.

• John G. McNutt John G. McNutt University of Delaware
• https://doi.org/10.1093/acrefore/9780199975839.013.620
• Published online: 11 June 2013
• This version: 03 September 2013
• Previous version

Social work is a profession that began its life as a call to help the poor, the destitute and the disenfranchised of a rapidly changing social order. It continues today still pursuing that quest, perhaps with some occasional deviations of direction from the original spirit.

Social work practice is the primary means of achieving the profession's ends. It is impossible to overstate the centrality or the importance of social work practice to the profession of social work. Much of what is important about the history of the profession is the history of social work practice.

We must consider both social work practice per se (the knowledge base, practice theories and techniques) and the context for social work practice. The context of practice includes the agency setting, the policy framework and the large social system in which practice takes place.

Social work practice is created within a political, social, cultural and economic matrix that shapes the assumptions of practice, the problems that practice must deal with and the preferred outcomes of practice. Over time, the base forces that create practice and create the context for practice, change. Midgley (1981) correctly notes that practice created in one social order is often inappropriate for work in another social order. Since the social order changes over time, practice created at one point in time may no longer be appropriate in the future.

• social work history
• social work practice
• social work profession
• social work organizations

Updated in this version

Bibliography expanded and updated to reflect recent research.

The Profession Develops

Social work, in the United States, is largely a product of the same industrial revolution that created the welfare state and industrial society. As Garvin and Cox ( 2001 ) note, industrialization led to the factory system, with its need for large numbers of concentrated workers, and subsequently created mass immigration, urbanization, and a host of consequent problems. Social work was a response to many urban problems such as mass poverty, disease, illiteracy, starvation, and mental health challenges.

Both the Charities Organization Society and the Settlement House Movement were responses to these problems. Both movements were imported from Great Britain and supplemented the efforts of religious groups and other associations, as well local and state governments in dealing with the problems of urbanization and industrialization. The Charities Organization Society and the Settlement Houses were important forces in shaping the development of American social work practice and the professionalization of social work.

The Charities Organization Society ( COS ) represented the cause of scientific charity, which sought to introduce more rational methods to charity and philanthropy (Trattner, 2004 ). The direct services component consisted of paid investigators, who worked for the COS, and “Friendly Visitors,” who were volunteers that visited the clients. There were also Councils of Social Agencies, which coordinated the efforts of social services agencies. It can be argued that the paid investigators were probably the precursors of caseworkers while the Councils of Social Agencies gave rise to social planning in community practice. The United Way Movement, which credits its founding to the Denver COS, was another product of this group. Richmond's ( 1917 ) very important contribution was Social Diagnosis , which presented her observations on the nature of social casework. Perhaps the final contribution made to social work practice by the COS was the mark it made on social work education through its role in creation of the New York School of Philanthropy. As Austin ( 1986 ) notes, the scholar practitioner model, where faculty come from a social work practice (as opposed to a traditional academic model), is our prevailing mode of preparing social workers today.

The Settlement House Movement aimed at the innercity and created houses as community centers in urban area. This was a completely different approach from that used by the COS. The settlement house workers used social group work to help socialize new immigrants to the city. They offered adult education for their urban neighbors and provided help and advice. They worked on community problems together with the other residents of poor urban neighborhoods. The Settlement House Movement is often most thought of for its social action efforts (Trattner, 2004 ). Working in conjunction with organized labor and other community activists, the settlement house workers were instrumental in the creation of the juvenile court, mother's pensions, child labor laws, and workplace protections. This is often seen as the touchstone of social work's involvement in social action and policy practice. Jane Addams was well known in this regard. Because many of the Settlement house workers were social scientists who worked in conjunction with university-based academic social scientists, they began important research into urban problems.

Between these two movements lies the foundation of much of the practice we see today, accounting for casework, social group work, community development, social planning, and social action. The beginning of research supporting social policy is also here.

The development of fields of practice began to occur with the emergence of psychiatric social work and medical social work (Dolgoff & Feldstein, 1980 ; Lubove, 1969 ). These new specialties allowed the creation of practice methodology refined for certain populations and many other practices specialties emerged.

All of this occurred during the process of professionalization described by Lubove ( 1969 ). This included the creation of professional organizations, a code of ethics, professional agencies, and the creation of professional schools and a knowledge base.

In 1915 Abraham Flexner questioned whether social work was actually a profession because of what he saw as the lack of a scientific knowledge base. This created an underlying theme in the profession that has occasionally led to unfortunate results (Austin, 1983 ; Eherenreich, 1985 ). Social workers, in response to this criticism, worked to find a knowledge base that would satisfy Flexner's critique. This quest continues to this day.

As the profession developed and changed, so did society. As America became more conservative, social action activities decreased. This was especially true during the first three decades of the 20th century. Eherenreich ( 1985 ) observes that the rediscovery of poverty and the changing national mood toward social programs created a crisis for the profession. It did not, on balance, lead to much in the way of changes in social work practice.

Freud and psychoanalysis became very influential in social work from the early part of the 20th century until the sixties. This period, often called the Psychoanalytical Deluge, saw social workers eagerly adopting psychoanalysis as a means to solve several of the profession's needs. While social work created its own variants that brought more social factors into the mix (ego psychology and psychosocial treatment), psychodynamic treatment became fashionable. Psychoanalysis was popular with psychiatrists, which facilitated the creation of strong bonds with the medical profession and the emerging mental health movement (see Eherenreich, 1985 ). Although, it is not completely clear whether the profession as a whole endorsed Freud or just its leadership (see Alexander, 1972 ). The impact of psychoanalysis cannot be discounted. The individually centered nature of psychodynamic theory also served to push the profession further from social action. Although one can debate whether psychoanalysis was the cause or consequence of a disengagement from social action and the poor, it is clear that this extraordinarily individualistic practice method closed off many avenues of engagement. Casework was the dominant practice method, a trend that can be seen throughout the history of the professional, and this was, perhaps, its most individualistic form.

The Milford Conference ( 1923–1929 ) came to an agreement on the importance of casework to the profession (Eherenreich, 1985 ). The Lane Report in 1939 argued that community organizers deserved equal status to caseworkers and social groupworkers (Dolgoff & Feldstein, 1980 ).

There were dissenting voices in direct practice however. A group of social workers formed the Functionalist School, providing a challenge to psychoanalysis. Functionalist theory, based on the work of Otto Rank, advocated an agency-based view of practice, which was different from the psychodynamically based diagnostic school. The Functional-Diagnostic Debate continued, with the more psychodynamically based diagnostic school maintaining the upper hand.

There were also social workers who bucked both the more conservative national mood and the conservative orientation of the social work profession and engaged in social action. Perhaps the best known were Bertha Capen Reynolds and Mary Van Kleek who led a group called the Rank and File Movement during the Depression years. They advocated more progressive politics and a movement away from casework (Eherenreich, 1985 ). The response of the profession was less than positive and the conservative mood that characterized social work reflected a conservative political mood.

Until the end of the 1950s, social work was a far more unified profession. Disagreements had been worked out and the profession presented a singular face to the world. That was about to change as the nation and the profession encountered the 1960s.

The Profession Changes in the Sixties

The sixties changed the social policy, and the forces changing the context of practice changed the nature of professional social work practice and ultimately the profession. The politically and culturally conservative fifties gave way to a new national mood and a series of social movements that changed the political agenda for a nation. Poverty was part of the national debate in a way that it had not been since the Depression. This time, the results were different for social work and social work practice.

There were major changes in social work practice during the 1960s. Those changes continued at least for the next four decades and will likely continue into the future. The most momentous change was the erosion of the psychodynamic influence in social casework. There are many possible explanations for this situation, but it is important to note this as a major change in the profession's view of practices. This does not mean that social workers no longer do psychodynamic practice, nor does it mean that social work schools no longer teach psychodynamic practice theory. The hold that Freudian and neo-Freudian approach had on social casework was, however, broken.

In the macro area, politically oriented community action reemerged. Certainly the War on Poverty and the Ford Foundation's Gray Areas project helped this to occur. Involvement in social planning was facilitated by the Model Cities Program and the regional planning agencies such as the Appalachian Regional Commission. Rothman's ( 1969 ) influential approach to community organization theory helped define and organize the field. This was less than 10 years before the Lurie, writing in the Boehm Report, had questioned the lack of integration in the field.

It is fair to say that the 1960s began a pattern of fundamental change in the profession and within social work practice. This change continues even today.

The Changing Face of Social Work Practice

In the three decades that followed the 1960s there were a great many changes in the way that social work practice was described, conducted, and taught. This reflected an adaptation to changes in the context of practice, as well as the efforts of social workers to move beyond the older agreement.

Micro practice has taken advantage of models and approaches from the social sciences and from other helping groups. While some practitioners still use psychodynamic approaches, social workers also use behavioral and phenomenological approaches. Theories such as task-centered treatment, cognitive behavioral approaches, reality therapy, and so forth provide options for the social work micro practitioner. New approaches that look at social networks and other sets of relationships are also used and will continue to become more important as our knowledge of social networks evolves (Christakis & Fowler, 2009 ). Turner ( 1996 ) and Payne ( 2005 ) describe a vast variety of clinical approaches that move beyond the single theory approach of the profession prior to 1960 .

Macro practice has matured since the 1960s and will continue to develop as time goes forth. Community practice has developed new approaches that encompass a wide variety of strategies and techniques. Political organizing, locality development, and social planning have matured and developed. Administration (frequently referred to as Social Administration) once had an unclear place in social work practice, but is now clearly established as a method of social work practice. This began with a series of reports and projects in the 1970s and evolved into eventual recognition of the approach. Recognition of policy practice as a practice field is also established in most of the profession. This brings in policy analysis and policy change (advocacy, lobbying, and so forth) together in a single social work role. These are developments that would have been unthinkable in the past but, in many ways, the profession still lags behind other fields in the training of practitioners for macro practice.

Going beyond the macro–micro divisions, the growth of generalist practice theory is noteworthy. Generalist social work means using an essentially constant set of approaches at multiple levels. Generalist practice has developed a robust set of theories and approaches to inform this perspective.

Ecological systems theory and the Life Model, the Strengths Perspective and Empowerment practice, as well as Feminist Social Work Practice Theory, provide explanations at multiple levels that can encompass several types of techniques. These are, in many ways, recognition of the limitations of earlier approaches.

Evidence-based practice (O'Hare, 2005 ) is a likely paradigm shift in social work, judging from the impact of evidence-based approaches on medicine, public health, and nursing. The use of research findings to guide practice is an attractive theory and one that promises further improvement in the quality of practice.

Also important are the developments in technology-based practice, including e-therapy, telemedicine, electronic advocacy, and other techniques that use high technology. These have grown in importance as the technology evolves, the online environment become more important and experience and research push the development of practice toward further refinement.

What Is Next?

The world is now in midst of a new economic and social transition, one that began in the 1970s and continues today. This transition will create an information economy that will be as different from our industrial economy as it was from the agricultural society that preceded it. It is already changing the nature of society in many profound ways and changing the environment of practice. Friedman ( 2005 ) identifies major changes in the political economy of the near future, including global competition, outsourcing, more technology, and so forth. This will have major impacts on policies, agencies, and clients. Also important will be the destruction of the physical environment and the rise of globalization as drivers of social policy decision-making. The profession will have to adapt, much in the way that social workers in the 1800s adapted.

The History of Social Work Practice Considered

There are a number of lessons that can be gleaned from this discussion of social work practice. It is undeniable that direct services/casework is the primary practice orientation in social work. The orientation of social work practice often conflicts with its concerns for social justice and systems change. When Specht and Courtney ( 1994 ) called social workers “Unfaithful Angels,” there was significant evidence to back up that charge. Social work has evolved into a conservative profession that has a hard time resolving the conflict between its social justice values and its choice of primary practice methodologies. It often seems that whatever the problem is, casework or psychotherapy is often our primary answer. That does not mean that it is the correct answer.

Social work practice will face a number of challenges in the future. The change in political economy, coupled with other developments in culture, the environment and social organization, will create the need for new practice methods and make others less viable. The development of new knowledge will also create new practice theories and techniques. Social workers must resist the temptation to hold on to the past when the future is at our door.

• Alexander, L. B. (1972). Social work's Freudian deluge: Myth or reality? Social Service Review , 46, 517–538.
• Austin, D. M. (1983). The Flexner Myth and the History of Social Work. Social Service Review , 57, 357–377.
• Austin, D. M. (1986). A History of social work education (Monograph No. 1). Austin: University of Texas School of Social Work.
• Christakis, N. A. , & Fowler, J. H. (2009). Connected: The surprising power of our social networks and how they shape our lives. New York, NY: Little, Brown, and Company.
• Dolgoff, R. , & Feldstein, D. (1980). Understanding social welfare. New York: Harper & Row.
• Eherenreich, P. (1985). Altruistic imagination: A history of social work and social policy in the United States. Ithaca, NY: Cornell.
• Flexner, A. (1915). Is social work a profession? In National Conference of Charities and Corrections, Proceedings of the National Conference of Charities and Corrections at the 42nd Annual Session, Baltimore, Maryland, May 12–19. Chicago: Hildmann, pp. 581, 584–588, 590.
• Friedman, T. L. (2005). The world is flat: A brief history of the twenty-first century. New York: Farrar, Straus and Giroux.
• Garvin, C. , & Cox, F. (2001). A history of community organization since the Civil War with special reference to oppressed communities. In J. Rothman , J. Erlich , & J. Tropman (Eds.), Strategies of community intervention (pp. 65–100). Itasca, MN: Peacock.
• Lubove, R. (1969). Professional altruist: The emergence of social work as a career 1880–1930. New York: Macmillian.
• Midgley, J. (1981). Professional imperialism: Social work in the third world. London: Heinemann.
• O'Hare, T. (2005). Evidence-based practices for social workers: An interdisciplinary approach. Chicago: Lyceum Books.
• Payne, M. (2005). Modern social work theory (3rd ed.). Chicago: Lyceum Books.
• Richmond, M. (1917). Social diagnosis. New York: Russell Sage Foundation.
• Rothman, J. (1969). Three models of community organization practice. In Social work practice 1968 (pp. 16–47). New York: Columbia University Press.
• Specht, H. , & Courtney, M. (1994). Unfaithful angels: How social work has abandoned its mission. New York: Free Press.
• Trattner, W. J. (2004). From poor law to welfare state: A history of social welfare in America (6th ed.). New York: The Free Press.
• Turner, F. J. (Ed.). (1996). Social work treatment: Interlocking theoretical approaches (4th ed.). New York: The Free Press.

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Home / Social Work Resources / Theories & Practice Models Used in Social Work

Theories & Practice Models Used in Social Work

Private practices. Mental health clinics. Child welfare service agencies.  Occupying a variety of professional settings, social workers are united by a shared mission: helping others live better lives.

In order to do that, they must first understand what makes their clients tick. As a social worker, studying different social work theories and social work practice models can help to bring you closer to your clients — equipping you with actionable insights that inform empathetic, evidence-based service.

Inspired by the scientific method, social work theories uncover the why of human behavior, while social work practice models reveal how you can effect change for individuals, couples, families, and communities at large.

If you’re looking for Social Work Practice Models, jump down here.

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University of Denver

The University of Denver’s Online MSW Program is delivered by its top-ranked school of social work and offers two programs. Students can earn their degree in as few as 12 months for the Online Advanced-Standing MSW or 27 months for the Online MSW.

• Complete the Online Advanced-Standing MSW in as few as 12 months if you have a BSW; if you do not have a BSW, the Online MSW Program may be completed in as few as 27 months.
• No GRE Required
• Customizable pathway options include Mental Health and Trauma or Health, Equity and Wellness concentrations

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List of Theories Used in Social Work

As a social worker, more knowledge can lead to a more informed approach, and more effective client interactions. Here, we’ll dig into decades of research to share a comprehensive set of social work theories and practice models, including:

Systems Theory

Behaviorism and social learning theory, psychodynamic theory, developmental perspective, rational choice perspective, conflict theory, ecological systems theory, family systems theory, contingency theory.

The 1950s were a decade of global innovation. From barcodes to credit cards, commercial computers to video cassette records, cutting-edge inventions were taking the stage. Around the same time, a new social work development was making its debut: systems theory.

Inspired by major advancements in the fields of psychology, communication, and psychiatry,  systems theory is based on the belief that individuals don’t operate in isolation . Rather, the theory positions people as products of complex systems: influenced by a variety of external factors, including other individuals, families, communities, and organizations.

Learn more about System Theory in Social Work.

Developed by the  American psychologist Urie Bronfenbrenner , ecological systems theory emphasizes the importance of observing people in multiple environments, or systems, to fully understand their behavior. In his theory, Bronfenbrenner outlines five distinct systems:

• The  microsystem  is someone’s small, immediate environment. For a child, this usually includes direct family, teachers, peers, and caregivers. Relationships in the microsystem are bi-directional—for instance, a parent treating a child with kindness will likely affect how the child treats the parent in return. For this reason, some consider the microsystem to be the most influential level of the ecological systems theory.
• The  mesosystem  consists of interactions between the different parts of a person’s microsystem. For instance, between a child’s parent and teacher. A social worker using this theory in everyday practice might ask themselves: “Are the different parts of my client’s microsystem working together towards a positive impact or working against each other?”
• The  exosystem  is an individual’s indirect environment. Consider a child whose father is an active duty soldier. Though the military isn’t a part of that child’s direct environment, it still influences them mentally and emotionally, and can impact their thoughts, relationships, and behavior.
• The  macrosystem  is a society’s overarching set of beliefs, values, and norms. This system often has a cascading effect on behavior in all the other systems, serving as a filter through which an individual interprets their experiences. For instance, a child might grow up thinking their socioeconomic status is a limiting factor in life. This macrosystem-level belief may cause them to behave differently in school — for positive or for negative, depending on the individual.
• The  chronosystem  includes major changes that influence an individual’s development overtime. This could include changes in family structure, employment status, or address, as well as large societal changes like wars, civil rights movements, or economic flux.

Family systems theory was developed in the mid-1950s, while  American psychiatrist Murray Bowen was working at the National Institute of Mental Health . Based on his knowledge of family patterns and systems theory, Bowen believed that the personalities, emotions, and behaviors of grown individuals could be traced back to their family interactions. The family, he suggested, is an emotional unit and can therefore play a formative role in development.

Within social work, professionals may enable families to try out different ways of doing things, such as teaching a parent on how to maintain appropriate boundaries with their child. The family is identified as a social system and therapy engages that concept to support the growth of clients.

Contingency theory explains that individual outcomes are contingent on a variety of specific situational factors. In the realm of social work, contingency theory can inspire you to seek understanding by considering all of the internal and external influences that are contributing to a client’s problem.

Systems Theory Related Resources

• American Academy of Child and Adolescent Psychiatry (AACAP) – Systems-Based Practice
• Bronfenbrenner Center for Translational Research
• The Bowen Center
• The Ecology of Human Development by Urie Bronfenbrenner
• Effective Social Work with Children, Young People and Families: Putting Systems Theory into Practice
• GoodTherapy – Systems Theory/Therapy
• New England Association for Family and Systemic Therapy (NEAFAST) – What is Systems Theory?
• Psychology Today – Family Systems Theory
• Systems Theory in Social Work

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• Behaviorism
• Cognitive Theory

What drives human behavior?  It’s a question that’s been asked for decades on end — and one that’s particularly relevant to the field of social work. Both behaviorism and social learning theory provide social workers with a useful framework for understanding clients.

By learning how past experiences influence present-day behavior, you can develop a research-backed approach to providing targeted care.

Social learning theory was developed by the influential Stanford University psychologist Albert Bandura. In 1961, Bandura conducted his most widely known experiment: the  Bobo doll study . In this experiment, children watched an adult shout at and beat a Bobo doll on television.

Later that same day, the children were left to play in a room containing a Bobo doll — and those who’d seen the film were more likely to torment the doll, imitating the behavior they’d been exposed to earlier. As a result, social learning theory posits that learning occurs through observation and imitation.

Learn more about  Social Learning Theory in Social Work.

Behaviorism and Behavioral Theory

According to behaviorism, all behaviors are acquired through conditioning. By adding in a conditioned stimulus before an unconditioned stimulus that leads to an unconditioned response, the conditioned stimulus will lead to a new conditioned response. In his famous experiment,  Russian psychologist Ivan Pavlov  conditioned dogs to produce saliva at the sound of a metronome. By consistently introducing the metronome before feeding time, he found that the sound alone would lead to salivation — in anticipation of feeding time.

Similarly, humans can be conditioned to respond to specific stimuli. For instance, a child may work harder in school if they are promised a reward for receiving good grades.

Cognitive Theory in Social Work

Cognitive theory  uncovers how a person’s thinking influences behavior. This theory places emphasis on dysfunctional thought patterns that influence problematic behaviors — what we tell ourselves after an event. Social works may utilize this approach in therapy sessions to link dysfunctional thoughts that occur after and before behaviors.

Behaviorism and Social Learning Theory Related Resources

• American Psychological Association (APA) – “Albert Bandura to receive National Medal of Science”
• Association for Psychological Science (APS) – What Happened to Behaviorism
• Berkeley Graduate Division: Graduate Student Instructor Teaching & Resource Center – Behaviorism
• BMC Medical Education – Using Social Learning Theory to Explore the Process of Learning from Role Models in Clinical Settings
• Psychology Today – Behaviorism
• Psychology Today – Social Learning Theory
• Stanford Encyclopedia of Philosophy – Behaviorism
• Social Learning Theory – By Albert Bandura
• Social Learning Theory in Social Work
• Youtube Video from The Curious Classroom – Bandura and Social Learning Theory

Drive Theory

Ego psychology, object relations theory, self psychology.

Originally introduced by Sigmund Freud,  psychodynamic theory  has a storied history within social work. This theory is based on Freud’s belief that humans are intra-psychologically driven to seek gratification and that these impulses largely influence our everyday behavior. Psychodynamic theory has four major schools of thought: drive theory, ego psychology, object relations theory and self-psychology.

This psychodynamic theory is based on Freud’s belief that humans are biologically driven to seek gratification of their endogenous drive — and that these impulses largely influence our everyday behavior. Per Freud, these primary drives include sex, self-preservation, and aggression. Impositions on these drives may be external or internal via superego and ego; psychic structures introduced by Freud. Social workers who approach clients with theoretical orientation on drive may posit that a client’s actions are based on an innate suppression of, otherwise, socially unacceptable actions.

According to the American Psychological Association (APA),  ego psychology  is an approach that emphasizes the functions of the ego in controlling impulses, planning, and dealing with the external environment. Freud believed that the ego is weak in relation to one’s id. Ego psychology combines biological and psychological views of development by understanding the influences of socio cultural impacts on function.

Object-relations theory is a branch of psychodynamic thought that suggests relationships are more critical to personality development than individual drives and abilities. Accordingly, social workers may want to study the interactions between a client and the people who played a significant role in their life in early childhood.

Self psychology was introduced by Austrian psychoanalyst Heinz Kohut in the early 1970s and has since become one of social work’s most significant analytic theories. According to self psychology, humans have a distinct set of development needs and transferences: mirroring, idealizing, and alter ego. If a parent fails to meet those needs in childhood, an individual may wind up unable to regulate self-esteem — and therefore, may be overly dependent on others to provide those functions. In the realm of social work, this calls for a careful understanding of early occurrences and shortcomings.

Psychodynamic Related Resources

• PsychCentral – Psychodynamic Therapy
• Psychodynamic Theory – By Kathleen Holtz Deal
• Psychology Today – Psychodynamic Therapy
• SAMSHA/CSAT Treatment Improvement Protocols – Brief Interventions and Brief Therapies for Substance Abuse – Brief Psychodynamic Therapy
• Psychosocial Development Theory

Transpersonal Theory

Growth. Change. Consistency.  By adopting a developmental perspective, social workers can start uncovering the patterns of a person’s life. A large portion of developmental theories focus on childhood, since this is such a formative time.

Psychosocial Developmental Theory

Inspired by the earlier work of Sigmund Freud, German psychoanalyst Erik Erikson developed an eight-stage theory of identity and psychosocial development. According to Erikson, everyone must pass through eight stages of development throughout their life cycle: hope, will, purpose, competence, fidelity, love, care, and wisdom. As a social worker, you may find it useful to identify a client’s current stage to pinpoint what challenges they’re currently facing.

Transpersonal theory  suggests the existence of stages beyond the adult ego. These stages contribute to creativity, wisdom, and altruism in healthy individuals—but can lead to psychosis in those lacking healthy ego development. In social work, transpersonal theory may be used to treat anxiety, depression, addiction and other mental health concerns. Typically spiritual approaches as used such as meditation, guided visualization, hypnotherapy and more.

Developmental Perspective Related Resources

• A Lifespan Developmental Perspective on Psychosocial Development in Midlife – By Tara L. Kuther and Kaitlyn Burnell
• Liberty University – Theories of Psychosocial Development
• Midlife Eriksonian Psychosocial Development: Setting the Stage for Cognitive and Emotional Health in Late Life – By Johanna C. Malone, Sabrina R. Liu, George E. Vaillant, Dorene M. Rentz, and Robert J. Waldinger
• Psychosocial Theory: Erikson – By Doug Davis and Alan Clifton
• Psychology Today – Our Hierarchy of Needs
• Psychology Today – Transpersonal Therapy
• A Review of Transpersonal Theory and Its Application to the Practice of Psychotherapy – By Mark C. Kasprow, M.D. and Bryce W. Scotton, M.D.
• Social Work and Social Development – Edited By James Midgley and Amy Conley

Social Exchange Theory

Social constructionism, symbolic interactionism.

Rational choice perspective is based on the idea that people calculate risks and benefits before making any decision, since all actions are fundamentally rational in character. Studying this theory can help social workers better understand client behavior. For instance, an action that seems objectively irrational to some, may make more sense upon closer examination of the individual’s context.

Social exchange theory  dates back to 1958, when American sociologist George Homans published the paper “Social Behavior as Exchange.” According to Homans, any two-person relationship can be viewed in terms of cost-benefit analysis— what am I giving, and what am I getting in return?  The  APA defines social exchange theory  as a concern of social interactions in exchanges where all participants seek to maximize their benefits. Within social work, professionals may utilize their theory to better understand interactions with their client and others around them — diving into the intrinsic rewards they may receive.

True. False. Good. Bad. Right. Wrong.  In social constructionism, these are all relative concepts, entirely dependent on the person who is interpreting them. This concept abandons the idea that one’s mind represents a mirror of reality—rather, it suggests that each of us creates our own world from our individual perceptions and interactions with others in the community.

Symbolic interactionism positions communication as the central way in which people make sense of their social worlds. American psychologist Herbert Blumer introduced three premises of symbolic interactionism:

• Humans interact with objects, institutions, and other individuals based on ascribed meanings.
• These ascribed meanings are inspired by our interactions with others and society.
• The meanings are interpreted by individuals in specific circumstances.

Imagine, for example, that your client professes a love for baking. Adopting a lens of symbolic interactionism, you may dig deeper into the ascribed meaning behind this act. Perhaps your client makes meringues because they used to help their mother do so in childhood — and for them, escaping to the kitchen is an act of comfort and safety.

Rational Choice Perspective Related Resources

• Association for Behavior Analysis International (ABAI) – Behavior Analysis and Social Constructionism: Some Points of Contact and Departure by Bryan Roche and Dermot Barnes-Holmes
• Cornell University ILR School – Social Exchange Theory of Emotions by Edward J. Lawler and Shane R. Thye
• Iowa State University – Social Exchange Theory by Mark V. Redmond
• Ontario Ministry of Children, Community and Social Services – Rational Choice and Routine Activities Theory
• Rational Choice Theory: Advocacy and Critique – Edited by James S. Coleman and Thomas J. Fararo
• What is Social Constructionism? – By Tom Andrews

Conflict theory explains how different power structures impact people’s lives. In this theory, life is characterized by conflict—whether that’s oppression, discrimination, power struggles, or structural inequality. In addressing these asymmetrical power relationships, social workers can strive to reduce tensions between different groups.

Practice Models Used in Social Work

Problem solving model.

• Task Centered Practice
• Solution Focused Therapy

Narrative Therapy

Cognitive-behavioral therapy, crisis intervention model.

Read on to discover how these practice models are used by social workers in a variety of settings.

Proposed by Helen Harris Perlman in her book Social Casework: A Problem-solving Process, the problem solving model. Ms. Perlman posited that “success could be achieved by partializing – or separating into manageable segments – a client’s intertwined problems and focusing on one specific issue the client and social worker agreed needed to be resolved at a given time”, according to  The University of Chicago School of Social Service Administration . Utilizing this model, social workers are employed to address one concern of a client as to be resolved, at any given time. This allows for therapy for clients to be more manageable.

Task-Centered Practice

Beginning at the University of Chicago’s School of Social Service Administration,  task-centered practice (TCP)  is a four step process that trains social workers to work with clients in establishing specific and achievable goals based upon their concern for therapy. Through this model, social workers empower clients to drive their therapy by asking what they most want to work on to address their problems.

Solution-Focused Therapy

Solution-focused therapy  was developed out of necessity, as a brief theory, in an inner city outpatient mental health setting bySteve de Shazer, Insoo Kim Berg and their colleagues. This approach focuses on finding solutions in the from the past, for the present — in hopes of achieving quicker problem resolution. Social workers may use this theory when focusing more on the present and future, asking questions like “What would you be doing this weekend that supports your therapy goals?”.

Narrative therapy can be an effective way of separating a client from their problems. By examining a person’s life story, this social work practice model externalizes struggles, allowing individuals to adopt a new perspective and see the bigger picture. From a distance, they may be able to reframe their situation—recognizing that their self-worth and purpose are separate from their problems. When told from a third-person perspective, a story of hardship may transform into a story of resilience.

Cognitive-behavioral therapy is one of the leading treatments for many mental health conditions. This social work practice model focuses on the relationship between thoughts, feelings, and behaviors—encouraging clients to identify patterns of irrational and self-destructive thoughts and behaviors that impact emotions.

Crisis intervention includes seven stages: assess safety and lethality, rapport building, problem identification, address feelings, generate alternatives, develop a plan of action, and follow up. This social work practice model is used when someone is experiencing an acute crisis — and is commonly used with clients who are expressing suicidal intent.

If you would like to become a social worker, but are not sure what degree options are available for you, explore our list of  accredited masters in social worker online programs .

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Online MSW Programs / Social Work / 6 Important Theories in Social Work

Six important theories in social work

Social work theories attempt to describe, explain and predict social events based on scientific evidence, studies and research. Social work perspectives draw from psychology, philosophy, economics, education and other fields to attempt to explain what drives and motivates people at various stages of life.

Some social work students studying for a  bachelor’s degree in social work  or  master of social work  may wonder, “Why is theory important in social work?” Studying theory ensures that aspiring professionals are both competent and confident when the time comes to apply social work theories to practice.

Why is theory important in social work?

Social work theories help social workers analyze cases, understand clients, create interventions, predict intervention results, and evaluate outcomes. While the theories are constantly evolving as new evidence is produced, referencing social work theories that have been used over time enables social workers to explore causes of behavior and identify potential solutions.

A crucial objective of learning social work theories is to train and encourage social workers to set aside personal assumptions and beliefs when engaging in social work practice. Social workers should use evidence-based theories to investigate issues and drive their decision making.

University of Denver

Graduate school of social work, master of social work (msw).

The University of Denver’s Online MSW Program is delivered by its top-ranked school of social work and offers two programs. Students can earn their degree in as few as 12 months for the Online Advanced-Standing MSW or 27 months for the Online MSW.

• Complete the Online Advanced-Standing MSW in as few as 12 months if you have a BSW; if you do not have a BSW, the Online MSW Program may be completed in as few as 27 months.
• No GRE Required
• Customizable pathway options include Mental Health and Trauma or Health, Equity and Wellness concentrations

Fordham University

Graduate school of social service.

Fordham’s skills-based, online MSW program integrates advanced relevant social work competencies, preparing students to serve individuals and communities while moving the profession forward. This program includes advanced standing and traditional MSW options.

•  Traditional and advanced standing online MSW options are available.
• There are four areas of focus: Individuals and Families, Organizations and Community, Evaluation, and Policy Practice and Advocacy.
• Pursue the degree on a full-time or part-time track.

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Applying social work theory to practice

Social work theory provides a starting point for social workers to address client problems through a research-based lens.

The theories help social workers better understand complex human behaviors and social environments, which influence their clients lives and the challenges they face. A good grasp of theory that is backed by research-based scientific evidence helps guide social workers by providing them with a sense of direction and purpose.

One challenge when applying social work theories to practice is choosing the right theory for the situation. It can be difficult to assign a single theory to complex client issues. Often, it’s more practical to draw upon the knowledge of multiple theories and use that understanding to design multifaceted interventions.

List of important social work theories

The following list of social work theories includes some of the most widely referenced theories used in social work.

1. Social learning theory

Social learning theory , which is also known as social cognitive theory , was developed by psychologist Albert Bandura. This theory posits that learning occurs by observing others and modeling their behavior.

In order for social learning to occur, a person must want to emulate the person they’re watching. The individual pays close attention to the action and retains the action in memory. Then, the individual must experience a situation where the behavior can be repeated and must be motivated to repeat the behavior.

Social workers can use this theory to better understand how role models affect the behaviors and emotions of their clients. Social learning theory can also help social workers form intervention strategies that use positive modeling and reinforcement to encourage their clients to engage in new positive behaviors.

2. Systems theory

Systems theory proposes that people are products of complex systems, rather than individuals who act in isolation. According to this theory, behavior is influenced by a variety of factors that work together as a system. These factors include family, friends, social settings, religious structure, economic class, and home environment.

Systems theory can be used to treat issues like eating disorders, depression, bipolar disorder, anxiety, school trauma, and risky behavior. In ecological systems theory, individuals are observed in multiple environments so that behavior is fully understood. Family systems theory examines the family as a social system influencing behavior and thoughts.

Social workers using systems theory will work to understand how their clients are influenced by the systems they’re a part of. Social workers then identify where systemic breakdowns are affecting behavior.

3. Psychosocial development theory

Psychosocial development theory  was introduced by German psychoanalyst Erik Erikson, who believed personality develops in a series of stages. Erikson created an  eight-stage theory of psychosocial development . According to the theory, the eight stages of development that people pass through in life are:

• Trust versus mistrust
• Autonomy versus shame and doubt
• Initiative versus guilt
• Industry versus inferiority
• Identity versus confusion
• Intimacy versus isolation
• Generativity versus stagnation
• Integrity versus despair

Psychosocial development theory explains that humans pass through these stages as they age. By identifying which stage of development their clients are experiencing, social workers can better understand the challenges their clients face.

4. Psychodynamic theory

Psychodynamic theory  was introduced by the founder of psychoanalysis, Sigmund Freud. This theory is founded on the idea that humans are biologically driven to seek gratification. The theory states that people do this based on processes that have developed outside of conscious awareness, with origins in childhood experiences. This drive influences everyday behavior, leading to actions like aggression, sex and self-preservation.

In social work, psychodynamic theory can help to explain the internal processes individuals use to guide their behavior , some of which may be unconsciously motivated. Social workers may also examine how early childhood experiences have played a role in influencing their clients’ current behavior.

5. Social exchange theory

Social exchange theory suggests that relationships are based on cost-benefit analysis. Each person seeks to maximize their benefits and is expected to reciprocate for the benefits they’ve received. When risks outweigh potential rewards, relationships may be abandoned. When one person in a relationship has greater personal resources than another, that person is predicted to have greater power as well.

Social workers can use social exchange theory to understand their clients’ relationships,  including why they continue to maintain certain relationships or abandon them.

Social exchange theory can also be applied to the techniques social workers use to connect with their clients. This theory can influence how social workers position the social worker-client relationship as one that benefits their clients.

6. Rational choice theory

Rational choice theory helps explain why people make the choices they do, by weighing risks, costs and benefits. This theory suggests that all choices are rational because people calculate the costs and benefits before making a decision. Even when a choice seems irrational, there is reasoning behind it.

This theory can help social workers understand the decision-making processes and motivations of their clients.

Six practice models in social work

Social work practice models enable social workers to implement theories in their day-to-day work. Just like a social worker may use various theories to guide their interventions, social workers may also use various practice models depending on the problems their clients encounter.

1. Cognitive behavioral therapy

Cognitive behavioral therapy focuses on how thoughts and feelings influence behaviors, which can sometimes lead to psychological problems. Social workers using cognitive behavioral therapy methods help clients identify self-destructive thoughts that influence negative emotions and behaviors.

Cognitive behavioral therapy is often used for individuals who are experiencing mental health issues, mental illness or depression resulting from crisis or trauma. Social workers using cognitive behavioral therapy help their clients eliminate negative thoughts to prevent destructive behaviors and adverse outcomes.

2. Crisis intervention model

The crisis intervention model is used for clients who are experiencing crisis and trauma, such as victims of domestic violence, and for clients who require intervention to prevent physical harm or suicide. Albert R. Roberts, PhD, and Allen J. Ottens, PhD, developed a  seven-stage crisis intervention model :

• Take a psychosocial and lethality assessment.
• Rapidly establish rapport.
• Identify the major crisis cause(s).
• Enable the client to express their feelings and emotions.
• Generate and explore safe alternatives for coping.
• Create an action plan.
• Follow up after the intervention.

This social work model can be used for clients who are experiencing thoughts of suicide or self-harm or who have undergone an acute crisis, like rape or violence.

3. Narrative therapy

Narrative therapy is the process of helping the individual recognize that they have the power to change their life story, also known as the narrative. Narrative therapy helps individuals realize that they are separate from their problems and can fix them when they view the narrative from an outside perspective.

Using narrative therapy, a social worker can help an individual create a new narrative with different positive actions. The social worker enables the individual to understand how the broader context is contributing to their narrative, so that they can be aware of pitfalls to avoid and can utilize various strategies to tackle their problems.

4. Problem-solving model

The problem-solving model was created by Helen Harris Perlman , a social worker and author of “Social Casework: A Problem-solving Process.” Using the problem-solving model, a social worker helps an individual identify a problem, create an action plan to solve it, and implement the solution. Together, the social worker and individual discuss the effectiveness of the problem-solving strategy and adjust it as necessary. The problem-solving model enables the social worker and individual to focus on one concrete problem at a time.

5. Solution-focused therapy

Solution-focused therapy involves the social worker and client identifying a problem and creating a solution based on the individual’s strengths. It’s a short-term practice model that focuses on helping clients cope with challenges using specific behaviors. Instead of focusing on changing who a client is, solution-focused therapy attempts to change a client’s actions in certain situations to achieve more favorable outcomes.

Collaborating to create solutions allows the client to play an active role in implementing necessary actions and achieving positive change.

6. Task-centered practice

Using task-centered practice, a social worker breaks down a problem into manageable tasks. The individual has deadlines to complete the tasks and agrees to meet them. Task-centered practice is a goal-setting form of social work that helps individuals make consistent steps toward improving their lives.

Instead of focusing on the past, this type of practice encourages clients to live in the present and think about how completing certain tasks will positively impact their future.

Resources to explore social work theories

Social work theories have been practiced over decades and continually evolve when new research is completed. Learn more about social work theories by exploring the resources below.

• Journal of Evidence-Based Social Work : This journal features research on evidence-based practice in social work and evaluates social work theory, techniques, and strategies.
• Journal of Social Work Practice : This journal focuses on psychodynamic and systemic social work perspectives. It features research on theory and practice and includes articles offering critical analysis of systemic and psychodynamic theory.
• Journal of Social Work : This journal includes social work research and short “think pieces” on social work theoretical understanding, policy, and practice.
• Social Work:  This journal is the official journal of the National Association of Social Workers and features articles on social work and social welfare, including new techniques and research.
• Clinical Social Work Journal:  This journal features peer-reviewed articles on clinical social work practice with individuals, groups, families, and couples. It also has articles on theory developments, practice and evidence-based clinical research.

Introductory books

• “A Brief Introduction to Social Work Theory” : This textbook by David Howe explains how social work practice is influenced by various social work theories and shows how social work theories have evolved over time.
• “An Introduction to Applying Social Work Theories and Methods”:    This book by Barbra Teater explains the most prominent social work theories and how those approaches can be used in practice.
• “Social Work Theory and Practice”:  This book by Lesley Deacon and Stephen J. Macdonald explains how social work theory informs practice for various individuals and contexts.
• “Modern Social Work Theory”:  This book by Malcolm Payne introduces the major social work practice theories and explains how to apply theory to practice.
• “An Introduction to Using Theory in Social Work Practice”:  This book by James A. Forte covers 14 social work theories and explains how to use them from engagement through evaluation.

Note: the links in this section on Social Work Theory all go to Google Books and are solely provided for your information. edX does not receive any form of compensation for these links.

Other online resources

• NASW Clinical Social Work : This section of the National Association of Social Workers website covers clinical social work practice. It features content, publications, and related resources for clinical social workers, like the “ NASW Standards for Clinical Social Work in Social Work Practice (PDF, 135 KB) .”
• Encyclopedia of Social Work:  The Encyclopedia of Social Work by the National Association of Social Workers Press and Oxford University Press features tools for applying social work theory to practice. These resources include scholarly articles and bibliographies.
• Social Work Today :  This publication features articles on current social work trends in categories like behavioral health, addictions, children and family, aging and professional practice.

Science-based social work theory helps social workers and their clients succeed

Social work theory helps professionals in the field identify and implement effective interventions for clients. An understanding of the most prominent social work theories gives social workers the tools they need to provide evidence-based treatment and help their clients overcome their problems. As social work theories continue to evolve and emerge, social workers can apply their multifaceted knowledge to unique situations and clients.

Are you considering a career in social work? Read more about the field of social work and the steps to becoming a social worker , which can vary by location. 

Last updated: November 2023

• Open access
• Published: 01 May 2024

Healthcare social network research and the ECHO model™: Exploring a community of practice to support cultural brokers and transfer cultural knowledge

• Phil Nixon   ORCID: orcid.org/0000-0002-3156-4592 1 ,
• Chiara Broccatelli   ORCID: orcid.org/0000-0002-1289-174X 3   nAff2 ,
• Perrin Moss   ORCID: orcid.org/0000-0002-4396-8105 4   nAff1 ,
• Sarah Baggio 1 ,
• Angela Young 1 &
• Dana Newcomb 5   nAff1  

BMC Health Services Research volume  24 , Article number:  558 ( 2024 ) Cite this article

Metrics details

Project ECHO ® networks at Children’s Health Queensland Hospital and Health Service (CHQHHS) are communities of practice designed to mitigate services and systems fragmentation by building collaborative partnerships addressing priority child and youth health needs. Aboriginal and Torres Strait Islander people experience the negative impacts of fragmentation in addition to historical challenges of absent or culturally inappropriate health services. Access to culturally safe and responsive services can be improved by engaging Aboriginal and Torres Strait Islander Health Workers and similar roles in an online community of practice, supporting the integration of cultural and clinical knowledge and self-determination of Aboriginal and Torres Strait Islander consumers in decisions affecting their health.

Analysing professional support networks and knowledge sharing patterns helps identify enablers and barriers to partnerships. Using social network research, the multilevel network inclusive of ECHO network members and their colleagues was studied to identify interdisciplinary and cross-sector advice exchange patterns, explore the position of cultural brokers and identify common relational tendencies.

Social network theories and methods informed the collection of network data and analysis of advice-seeking relationships among ECHO network members and their nominees. Registered members from two ECHO networks were invited to complete the Qualtrics survey. Networks analysed comprised 398 professionals from mainstream health, Aboriginal and Torres Strait Islander Community Controlled Health Organisation, education, disability and child safety service settings.

Brokers were well represented, both those who hold knowledge brokerage positions as well as cultural brokers who incorporate clinical and cultural knowledge enabling holistic care for Aboriginal and Torres Strait Islander patients (38 individuals, 17% of network). Professionals who occupy brokerage positions outside the ECHO network tend to be more connected with co-members within the network.

Conclusions

This study is the first application of contemporary social network theories and methods to investigate an ECHO network. The findings highlight the connectivity afforded by brokers, enabling the coordination and collaboration necessary for effective care integration. Inclusion of cultural brokers in an ECHO network provides sustained peer group support while also cultivating relationships that facilitate the integration of cultural and clinical knowledge.

Peer Review reports

The ECHO model™ was developed at the University of New Mexico to address inequities in access to specialty care [ 1 , 2 ]. In each ECHO network, regular multipoint videoconference sessions combine de-identified case discussions with brief presentations. Problem-based case discussions elicit valuable information from the perspectives of ECHO participants and panel members, to build collective knowledge of clinical conditions, system and sector navigation, and culturally appropriate service provision, as well as to facilitate connections and enhanced coordination between providers. The model is inherently learner-centric, as panels are attentive to emergent participant learning needs and design future content to address group priorities. To provide clarity on terminology used in relation to the ECHO model, social network research and Aboriginal and Torres Strait Islander healthcare, please refer to Table  1 .

ECHO networks addressing a multitude of health focus areas have demonstrated positive impacts on health care provider knowledge, self-efficacy, and professional isolation [ 6 , 7 , 8 , 9 , 10 ]. A small number of studies have demonstrated changes in care practice and patient-level health outcomes [ 11 ]. In addition to the need for further research on patient and community health outcomes, there is a need to understand knowledge translation patterns, including how advice is sought, gained, and applied to patient care. Anecdotal evidence from ECHO participants and panel members at Children’s Health Queensland Hospital and Health Service (CHQHHS) indicates new and strengthened socio-professional connections between providers from diverse geographical regions, services and sectors. Positive outcomes based on these connections have included new organisational partnerships to progress shared priorities, primary and tertiary team collaboration to streamline both continuity and coordination of care, and the adoption of new models of care in regional hospitals and schools. Despite the benefits identified to date, analysis of the impact of ECHO on professional support networks and care integration has not occurred.

Recognising the challenges of fragmentation affecting the state-wide delivery of specialist paediatric care, CHQHHS introduced the ECHO model in 2017 [ 12 , 13 ]. To improve child and youth health outcomes, a need for effective partnerships was identified across primary, secondary and tertiary healthcare and with non-medical institutions such as those within education, child safety, youth justice, and disability sectors. The ECHO model operationalises the 2018 CHQHHS Integrated Care Strategy [ 14 ] by providing a platform for bi-directional knowledge sharing between participants and panel members, in an environment that fosters interprofessional collegiality, empowerment of frontline providers, and communication between providers and services. The impacts of services and systems fragmentation compound the effects of other challenges to health equity, such as culturally inappropriate health services for Aboriginal and Torres Strait Islander people.

Health and wellbeing of Aboriginal and Torres Strait Islander children and youth

A sense of cultural identity and nurturing family networks are among the resilience factors in the lives of many Aboriginal and Torres Strait Islander children and youth [ 15 , 16 , 17 ]. More than 6 in 10 (61%) Aboriginal and Torres Strait Islander people aged 10–24 recognised their traditional homelands or country, and over two-thirds (69%) were involved in cultural events [ 18 ]. Most young Indigenous people were connected to family and friends, describing as extremely or very important family relationships (74%) and friendships (67%) [ 18 ].

However, the effects of intergenerational trauma, racial discrimination, and socioeconomic disadvantage often disproportionately impact the health and wellbeing of Aboriginal and Torres Strait Islander young people. The child mortality rate for Aboriginal and Torres Strait Islander children was 141 per 100,000 in 2018 – more than twice the rate for non-Indigenous children comparatively (67 per 100,000) [ 19 ]. Potentially preventable hospitalisations are nearly twice as common in this cohort, at 21 per 1,000 compared to 11 per 100,000 for their non-Indigenous counterparts [ 18 ]. High to very high levels of psychological distress in the previous month have been reported by 33% of Aboriginal and Torres Strait Islander young people aged 15–24 years [ 20 ], associated with suicide and self-harm (13%), anxiety disorders (8%), alcohol use disorders (7%), and depressive disorders (7%) [ 20 ]. Currently, Aboriginal and Torres Strait Islander young people are over-represented in the youth justice system, at 26 times more likely to be in detention than their non-Indigenous counterparts and accounting for 56% (461 of 818) of young people in detention on an average night in the June 2022 quarter [ 21 ].

Appropriate service provision and cultural brokerage

The holistic concept of health held by Aboriginal and Torres Strait Islander people considers not only the physical well-being of an individual, but refers to the “social, emotional and cultural well-being of the whole community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total well-being of their community” [ 22 ]. Western medical models do not align with this definition and are therefore not appropriately designed to meet the needs of Aboriginal and Torres Strait Islander people. This can lead to challenges with health system engagement, such as feelings of intimidation due to unfamiliarity with the Western medical model, mistrust informed by current and/or historical experiences, varied experiences of safety in the physical environment, and interactions with staff not marked by openness, respect and culturally aware communication [ 23 , 24 ].

A recent study found that one third of Aboriginal and Torres Strait Islander people who needed to see a health provider on at least one occasion in the previous 12 months were unable to attend the appointment [ 25 ]. Reasons provided included: high cost (34%) and wait times too long or service unavailable at the time required (33%).

A well-integrated Aboriginal and Torres Strait Islander workforce is crucial to the provision of health care for First Nations populations, and to the engagement of Aboriginal and Torres Strait Islander people in their own health [ 26 , 27 ]. Aboriginal and Torres Strait Islander Health Worker and similar roles are multifaceted, with distinct but intersecting functions that include health promotion, clinical service provision, and cultural brokerage [ 28 ]. The concept of cultural brokerage encompasses both tangible and intangible approaches to health and wellbeing work, incorporating Aboriginal and Torres Strait Islander knowledges for the benefit of the client and service delivery systems [ 28 , 29 ]. In this paper, the terms ‘cultural brokerage’ and ‘cultural broker’ encompass the unique mix of clinical and cultural skills that incorporate Aboriginal and Torres Strait Islander knowledges to promote the provision of more holistic care. Cultural knowledge nuanced in a clinical environment is an important enabler of the understanding, trust, and quality communication critical to culturally safe services [ 5 , 28 , 29 ]. Cultural brokerage is gaining traction in a variety of jurisdictions including North America, where there has also been historical disadvantage experienced by First Nations communities [ 30 , 31 ].

To strengthen engagement of Aboriginal and Torres Strait Islander children and youth in their health care, strategies to support and sustain Aboriginal and Torres Strait Islander providers in the workforce are needed. Research indicates that Aboriginal and Torres Strait Islander Health Workers may improve attendance at appointments, acceptability of assessment and treatment recommendations, and enhance patient follow-up including referrals [ 32 ]. Roles that must be occupied by an Aboriginal and/or Torres Strait Islander person (identified roles) are under-represented in the health workforce. This may place unwelcome pressure on those working in these roles, and limit health services from improving responses to the needs within this population [ 25 ]. In 2019–2020, consultation with Aboriginal and Torres Strait Islander Health Workers in Queensland indicated several other concerns regarding these roles, including lack of awareness of role and scope, inconsistencies of practice, and a need for better access to peer and professional senior supports [ 33 ].

Following the establishment of a CHQHHS health equity strategy, the Aboriginal and Torres Strait Islander Kids ECHO network was launched in November 2021 with the objective of improving health system engagement with Aboriginal and Torres Strait Islander families through increased workforce capability for culturally responsive care. To provide culturally appropriate leadership and governance, a project steering committee was formed under the executive sponsorship of CHQHHS Executive Director of Aboriginal and Torres Strait Islander Engagement (co-author #5, a Kullali/Koa woman). Steering committee members were invited from state-wide leadership roles to provide advice to support the design, stakeholder engagement and implementation of an initial learning needs assessment, as well as initial promotion of the new ECHO network.

• Social network research

In this study, social network theories and methods are applied to provide an understanding of the connections occurring in an ECHO network. Social network research comprises a set of network concepts and theories as well as analytical methods used to systematically study relationships that exist between people, groups and organisations [ 34 , 35 ]. In recent years, social network research has provided an innovative paradigm for health services research, contributing to a better understanding of contemporary health system problems including professional isolation, working in silos, barriers to adopting new practices, and team communication [ 36 , 37 , 38 ]. To date, there is one study that draws from network concepts to evaluate Project ECHO [ 39 ].

The overarching study aim is to investigate the knowledge sharing that occurs in the context of an ECHO network. Knowledge sharing can occur via formal relationships such as those arising between internal or inter-organisational colleagues with a shared objective (e.g. a health professional and their mentor), as well as via informal relationships that arise among colleagues who are also friends or family members. Informal relationships can also occur based on interactions in a workplace not necessarily involving a shared team or shared organisational objectives [ 40 ]. To capture knowledge sharing though formal and informal relationships the overall sharing of advice between colleagues was studied, as advice ties allow the circulation of ideas, problem-solving solutions and social support [ 41 ].

Formal and informal advice ties are equally important for sharing patient care knowledge and can be simultaneously present. The purpose of this investigation is to understand whether Project ECHO networks supported improved care integration via facilitation of advice exchange, in particular for Aboriginal and Torres Strait Islander children and young people. The following research questions are addressed:

What are the patterns of advice exchange within the ECHO network and across the broader network of providers?

Cross-organisation relationships can foster integration at a systems level, associated with integration between individual care providers and resulting in improved health and wellbeing outcomes. Boosting connectivity is an important mandate of CHQHHS. As such it is hypothesised that previous efforts in care integration will appear in network mapping.

Hypothesis: Networks show well-connected areas, particularly between disciplines and sectors engaged in the ECHO network.

What is the position of cultural brokers in the ECHO network as well as in the broader network of providers?

Cultural brokers incorporate Aboriginal and Torres Strait Islander knowledges into health care practices, for the benefit of the client and service delivery systems. Cultural brokers are a scarce knowledge resource in the health care environment in Australia.

Hypothesis: Cultural brokers occupy strategic positions within the ECHO network and broader network.

What are the most common relational tendencies that underpin knowledge exchange among professionals within the ECHO network as well as in the broader network of providers?

Social network analytical methods provide a way to systematically study the complex relationships that support the shared provision of care by individuals across discipline, service, sector and system boundaries. Note that the different relational tendencies studied will be outlined in the analytical method, below.

Exploratory hypothesis: Identify the prevalent relational tendencies, providing guidance for future ECHO network interventions as well as broader CHQHHS care integration initiatives.

This paper focuses on the implications of findings from the Aboriginal and Torres Strait Islander Kids ECHO network. A separate manuscript in development compares the results for both ECHO networks studied, and discusses in detail the multilevel analytical approach to healthcare social network research.

Studies have indicated that ECHO networks can create a CoP [ 42 , 43 , 44 , 45 , 46 , 47 ]. A CoP refers to a group with a shared interest in a real-life problem, who choose to interact regularly to learn from and with each other [ 3 ]. CHQHHS ECHO networks seek to align with the principles and values of a community of practice (CoP), therefore in this manuscript the terms ECHO network and ECHO CoP are used interchangeably.

Seeking advice from a colleague was selected as the most appropriate relationship definition to capture the interactions that occur in interdisciplinary and cross-sector care, and to avoid the ambiguous nature of other relationship definitions such as communication frequency and collaboration [ 48 ]. A description of a relationship that involves advice-seeking was provided to respondents including examples for consideration of both formal and informal relationships that are of value in the provision of care to children and families.

Role and sector categorisation for all survey respondents and their nominees was completed by ECHO Network Coordinators (co-authors #1,4) based on the individual’s reported job title and organisation. This was done to facilitate analysis of relationships at both an interprofessional and cross-sector level. Individuals were assigned to one of the following categories for role: allied health, child safety, community elder, cultural brokerage, director/program lead, disability, education, medical, nursing, partnerships, project officer, youth worker, or other/unknown. For sector categorisation, individuals were assigned according to their organisation’s primary alignment with one of the following: primary health/community care, secondary/tertiary health, child safety/youth justice, disability, education, or other/unknown.

Individuals categorised as a cultural broker included the following identified and non-identified roles: Aboriginal Health Worker, Advanced Aboriginal Health Worker, Aboriginal Mental Health Worker, Cultural Officer, Indigenous Health Worker, Cultural Support Worker, Indigenous Liaison Officer, Indigenous Health Liaison Officer, and Indigenous Education Liaison Officer. Cultural brokerage is sometimes expected of Aboriginal and Torres Strait Islander staff members regardless of whether this is included in their role description, often without remuneration. Therefore, professionals occupying medical, nursing, allied health and other roles who identify as Aboriginal and/or Torres Strait Islander and may incorporate cultural and cultural knowledge in their delivery of holistic care were not categorised as a cultural broker.

Research team

The first two authors served as principal investigators for the study, forming a health services research partnership between CHQHHS and the Institute for Social Sciences Research at The University of Queensland. Co-authors from the Project ECHO Hub at CHQHHS (co-authors #3,4 and 6) contributed expertise implementing and evaluating ECHO CoPs addressing child and youth health priorities. Co-author #5 identifies as Aboriginal and/or Torres Strait Islander. Through their dual role as project steering committee lead and facilitator of the Aboriginal and Torres Strait Islander Kids ECHO CoP, they contributed executive governance and sponsorship, cultural insight and advice, as well as recommendations for stakeholder engagement.

Data collection and participant engagement

The network boundary included professionals residing in the state of Queensland who registered as ECHO participants, as well as ECHO panel members. ECHO CoP members were eligible for the study if they attended at least one session during the survey development period (January-May 2022). Network data were collected in two ECHO CoP: network 1 ( Aboriginal and Torres Strait Islander Kids ECHO), and network 2 ( Navigating Paediatric Disability ECHO ) . The latter has been operational since 2020, and was selected for comparison purposes. During a routine ECHO session participants were invited to voluntarily take part in the study. Study information was provided to all participants by email, with link to the Qualtrics survey (see Additional file 1 ).

Network 1 participants were from varied geographic locations in Queensland. Participants occupied diverse roles including medical, nursing, allied health, education and social service roles. Organisational settings included mainstream health, education, child safety and disability organisations as well as non-government, community controlled and private organisations. ECHO network participants were asked to nominate the people they seek advice from both within and outside the ECHO group. They were also asked to indicate the potential for information exchange between their external nominees. For further information regarding the data collection process, see Fig.  1 .

Data collection process flow chart

Analytical method

Social network research is the investigation of social structures using network and graph theory, and for this study examined formal and informal advice-seeking relationships. In social network visualisations, a ‘node’ refers to an individual within a network. Nodes are connected by ties, representing the relationships between them. In this study ties are considered undirected, since the connection through which knowledge and advice is obtained opens the possibility for reciprocity. Patterns of advice tie formation tend to be highly generalisable. Relational tendencies such as density, transitivity, homophily and activity can explain why ties arise in almost all advice exchange networks. In the context of professional roles, the baseline tendency to seek advice ( density ) tends not to be reciprocal, mainly due to hierarchical differences [ 49 ]. Transitivity measures the tendency for an individual to seek advice from those who provide advice to someone’s advisor, creating a triad pattern of connectivity. Transitivity tends to reinforce the presence of hierarchical dynamics [ 50 ] and shared advisors [ 51 ]. Another important mechanism, activity , is the tendency to actively reach out for advice. The more there are active nodes, the more the network can be centralised suggesting the presence of consultative mentors and leaders. Studies have demonstrated that in work-related advice networks, some people are generally more trusted than others and more frequently act as advisors [ 52 ]. Homophily , based on individual attributes rather than ties, is the tendency to seek advice from those with a shared attribute. Homophily indicates the presence of bridges that incentivise information flow among individuals with similar types of knowledge and background, due to working in the same sector or having the same role. The presence (or absence) of these relational tendencies can be used to examine, in each network, the overall level of segregation, clustering, integration and connectivity, as well as governance, efficiency, and trust.

Statistical models called Exponential Random Graph Models (ERGMs) allow examination of relational tendencies that are not possible to analyse with conventional statistical methods. Using the extension of these models for multilevel networks, it is possible to investigate how relational processes occur within and across overlapping networks, and how these relate to tie formation while considering interdependency of network observations on multiple levels [ 53 , 54 ]. A Multilevel Exponential Random Graph Model (MERGM) was completed separately for each ECHO CoP. Each network considers respondents and nominees at different levels. Figure  2 depicts a schematic visual representation of the three level networks – A, B and X – for each ECHO CoP.

Schematic view of the multilevel advice-seeking relationships among ECHO CoP members and their nominated advisors

Network 1 comprised N  = 44 individuals at level A, including ECHO CoP members and their nominees who were also ECHO CoP members. At level B there were N  = 179 individuals, these were the advisors nominated outside ECHO. There were three different sets of undirected ties: at level A the advice-seeking ties within ECHO CoP members, at level B the ties among external nominees and at level X the cross-level bridging relationships between ECHO CoP members and their nominated individuals. Network 1 comprised N  = 96 ties at level A, N  = 229 ties at level B, and N  = 239 across levels (level X).

MERGMs consider how ties occurring at level A are interrelated with those occurring at level B, recognising that some relational tendencies are occurring uniquely within each level, and some across levels. In addition to the study of relational tendencies based on shared role and sector (density, transitivity, activity and homophily), several other network mechanisms are of interest. In particular, the likelihood of seeking advice from an advisor’s advisor, creating small clusters and three-person subsystems (i.e., triangles) of advice exchange. Moreover, ECHO CoP member advice-seeking patterns with those outside the CoP with similar patterns of connections, as well as whether professionals tend to assume a brokerage position by actively linking professionals within and outside ECHO (i.e., across levels A and B).

Sample characteristics

The survey was completed by 37 out of 53 (69.81%) eligible participants from network 1, and 31 out of 66 (46.96%) eligible participants from network 2. On average, respondents participated in 2.03 different ECHO networks. There were 8 respondents who participated in both ECHO networks. The following results and discussion are relevant to the findings from network 1.

The sample of 37 network 1 participants included 12 (32.43%) Aboriginal and/or Torres Strait Islander people. Respondents predominantly supported children and/or youth in a major region (70.27%), remote (21.62%) or rural (8.11%) area.

Research question 1 – Advice exchange patterns

Among ECHO CoP members studied a positive and significant tendency for transitivity was noted, that is, the presence of small clusters of advice ties (Fig.  3 , transitivity closure parameter, level A). The analysis of dyads, or pairs of individuals who have a direct relationship, indicated that knowledge-sharing may be incentivised by shared role and sector. There was a tendency for ECHO CoP members studied to exchange advice with co-members of the same role (homophily [same role], level A). Similarly, advice exchange ties within the CoP were more likely to occur between co-members from the same sector (homophily [same sector], level A). The tendency to form advice exchange ties with those outside the ECHO network was non-significant for role (heterophily [different role] & activity, level X) and sector (homophily [same sector] & activity, level X).

MERGM results and visualisations for advice exchange relational tendencies. Parameters with an asterisk (*) are significant, indicating that they are either more commonly (positive parameters) or less commonly (negative parameters) observed than that would have been found by chance

Diffuse organisational links were present, based on the advice-seeking relationships that exist between ECHO CoP members and their nominees. The strength of organisational links was determined based on the number of advice-seeking ties between individuals affiliated with any two organisations. Individuals were affiliated with 28 organisations from health, education and community-controlled sectors, and from 20 postcodes across Queensland. Relational ties supported by the ECHO CoP serve as advice-exchange links between 7 Hospital and Health Services, 10 Aboriginal and Torres Strait Islander Community Controlled Health Organisations, 3 Department of Education regions, 2 Primary Health Networks, and several other advisory or frontline organisations.

Research question 2 – Position of cultural brokers

The advice exchange connections between individuals were displayed in network maps (Figs.  4 and 5 ). Individuals were represented by nodes or dots, and undirected advice exchange ties represented by the lines between them. Nodes were categorised by role (Fig.  4 ), and by sector (Fig.  5 ).

Advice-seeking relationships among ECHO CoP members and their nominees; nodes categorised by role

Advice-seeking relationships among ECHO CoP members and their nominees; nodes categorised by sector

The 223 individuals in network 1 (levels A and B) included 38 individuals with cultural brokerage as a primary function of their role, working within the secondary/tertiary health sector (9% of total cohort), primary health/community care (5%), child safety/youth justice (3%), and education (1%).

Mapping by sector demonstrates the broader community within which the cultural brokers fulfil their role, comprising individuals from secondary/tertiary health sector (52%), primary health/community care (23%), child safety/youth justice (12%), education (8%) and other/unknown (5%).

Research question 3 – Exploratory analysis of relational mechanisms

ECHO CoP members studied held advice exchange ties with multiple colleagues beyond the ECHO network (Fig.  3 , activity spread for node type A, level AxB). MERGM analysis indicated that the presence of brokerage tendencies across levels was positive and significant (Fig.  3 , brokerage and activity spread). Level B colleagues were intermediaries for the flow of information from ECHO network sessions to the broader community of providers. In social network research, the term brokerage refers to the position of an individual that connects two nodes that are otherwise unlinked [ 55 ]. Brokers occupy “structural holes” between nodes or clusters [ 55 ]. Being a broker means being in a privileged position to pass on information and, with it, to reduce network fragmentation. In this sample, those who occupied a brokerage position were also those with a high number of advice exchange relationships (Fig.  3 , brokerage and activity spread, level A, B and X). Specifically, those who occupied a brokering position outside the ECHO CoP (across levels A and B) tended to also be more connected with other professionals within the CoP.

Although the MERGM analysis did not reveal brokerage tendencies unique to cultural brokers, this may be attributed to the limited number of individuals fulfilling the role or possibly due to challenges parameterising this particular tendency.

This study examined the formal and informal advice-exchange relationships occurring in the context of the Aboriginal and Torres Strait Islander Kids ECHO CoP and allied providers. Though the findings pertain to the specific ECHO CoP studied, they are of relevance to ECHO CoP and healthcare teams globally that seek to integrate clinical and cultural knowledge for more holistic patient care. The manuscript focuses on advice exchange patterns, cultural brokers, and dual activity/brokerage relational tendencies. Since the research literature discussed in this section includes a mix of domestic and international studies and no studies that have been Aboriginal and Torres Strait Islander led, relevance of literature to the Aboriginal and Torres Strait Islander context will need to be considered carefully.

Brokers, both those who hold general knowledge sharing brokerage positions as well as those in roles dedicated to cultural brokerage, are well represented in this sample. Unique functions of brokers include facilitating flow of information and resources, supporting knowledge exchange, and coordinating contributions across the network [ 56 ]. Moreover, brokers who connect individuals across disparate groups (boundary spanners) are of value to a network in their ability to engage with perspectives outside their own profession, culture and mindset, contributing to the development of trust and reciprocity [ 57 , 58 ].

The findings align with recent literature recognising the value of distributed brokerage in cross-level networks, for the delivery of integrated services [ 59 , 60 ]. The unique role played by those who bridge a gap between individuals and are themselves connected to many, referred to by Fujimoto and colleagues [ 60 ] as brokerage-centrality conjugates , contributes to collaborations at an inter-organisational level. The distributed brokerage-centrality conjugates in two functionally distinct groups (level A and B networks) have a privileged position in improving knowledge exchange and coordination supporting professional engagement across traditional boundaries for the delivery of coordinated, collaborative and person-centred care.

The function of knowledge brokers in the context of ECHO CoP has not been studied in-depth. One study from an HIV clinical care ECHO included staff who did not participate in ECHO but were colleagues with a provider who did [ 61 ]. A statistically significant improvement in viral load suppression was demonstrated in patients treated by a provider co-located with an ECHO participant, compared to the control group of providers not participating and not co-located with an ECHO participant [ 61 ]. The present study builds on these findings, recognising the value of participants who become brokers and are well-placed to facilitate diffusion of knowledge and resources within their local environment. The increase in connectivity afforded by brokers facilitates the coordination and collaboration necessary for effective care integration.

The experience of burden due to others’ over-reliance on them may be a risk to the broker [ 56 ]. In the case of cultural brokers, the multiple roles and responsibilities held towards their communities as well as their workplaces can sometimes overlap causing an additional challenge [ 5 , 62 , 63 , 64 , 65 ].

Knowledge afforded by cultural brokers can contribute significant value in the development of collaborative solutions addressing gaps in service delivery and care. All professionals have a responsibility to make necessary adjustments to routine care to best meet cultural needs, regardless of whether their role requires specific or incidental cultural service provision. One-to-many knowledge sharing relationships such as those that exist in an ECHO CoP offer an opportunity to support professionals to make these adjustments, enabling providers from diverse disciplines, sectors, and locations to engage in a culturally nuanced way with health consumers. The prioritisation of psychological safety in an ECHO CoP permits open-handed sharing of rich contextual and experiential knowledge.

In view of the unique contribution of cultural brokers to enhanced service delivery as well as the challenges they face, CoPs offer a sustained peer support mechanism contributing to sense of belonging, increased confidence in problem-solving, and strengthened sense of professional identity [ 3 ]. Mentorship and mutual support networks have already been advocated for as necessary supports for cultural brokers in the literature [ 32 , 62 , 64 , 66 , 67 ].

Network intervention

To increase awareness and nurture the connections and collaboration occurring between ECHO CoP members and their colleagues, a network intervention was completed in the form of a digital booklet disseminated to CoP members and other stakeholders (see Additional file 2 ). Artwork inspired by the relationships occurring in an ECHO CoP was created by a contemporary Aboriginal artist and incorporated into the design of the booklet. The booklet highlighted the value of connections in everyday work objectives and based on common trends, identified strategies to foster integration between providers, services and systems. Two key recommendations were provided: 1) share knowledge gained at ECHO with like-disciplines colleagues or invite them to join an upcoming session, and 2) schedule a regular day to become a knowledge broker by connecting colleagues who don't know each other and exploring opportunities for their collaboration. Since ECHO networks are learner driven, they continuously evolve in response to participant engagement and the learning agenda. Recognising the importance of relationships and the role of brokers for knowledge sharing contributes to the future reach and influence of the CoP.

Limitations and future directions

Engagement with study respondents in a state-wide virtual CoP was challenging. Although twice-weekly virtual drop-in sessions were offered to assist with survey completion, uptake of these was low. It is recommended that future social network studies investigating virtual CoP prioritise planning for stakeholder engagement, employing follow-up aids to survey completion and face-to-face interaction wherever possible. Efforts were made to explain informal and formal advice-seeking relationships, however the possibility that study respondents did not have a common understanding of these terms cannot be excluded. Privacy and confidentiality are a particular sensitivity for professionals included in this sample, and one participant reported discomfort providing the name of role of colleagues without their permission. Enhanced engagement in virtual drop-in and follow-up sessions would help to mitigate the impact of these concerns on survey completion. The recruitment of pre-registered ECHO participants to the study presents a source of sample and volunteer bias, with respondents more likely to understand the value of interdisciplinary and cross-sector connection. Lastly, respondent report of those they seek advice from was dependent on recall, and some contacts may have been missed.

Since there was insufficient data to study the relational tendencies of cultural brokers, additional research is indicated to further describe this cohort. Cultural brokers’ perceptions of the impact of ECHO CoP on their work, and co-participant integration of cultural care practices are additional questions for further research.

Social network theories and methods revealed the advice exchange patterns present in an ECHO CoP and across the broader network of providers linked to members of the CoP. Brokers who bridge the gap between the CoP and the broader network of providers are positioned to advance the knowledge diffusion objectives inherent to any ECHO CoP. The findings of this study highlight the connectivity afforded by brokers, enabling the coordination and collaboration necessary for effective care integration. Inclusion of cultural brokers in an ECHO CoP provides them with peer group support and mentorship, while concurrently cultivating relationships that facilitate diffuse integration of cultural and clinical knowledge.

Availability of data and materials

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Aboriginal and Torres Strait Islander Community Controlled Health Organisation

Children’s Health Queensland Hospital and Health Service

• Community of Practice

Extension for Community Healthcare Outcomes

Exponential Random Graph Model

Multilevel Exponential Random Graph Model

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Acknowledgements

The Department of Health acknowledges the Traditional Owners and Custodians of the lands, waters and seas across the State of Queensland and pays our respects to the Elders past and present. We value the culture, traditions and contributions that the Aboriginal and Torres Strait Islander peoples have made to our communities and recognise that our collective responsibility as government, communities and individuals are to ensure equity and equality, recognition and advancement of Aboriginal and Torres Strait Islander peoples in Queensland in every aspect of our society.

This work was supported by the University of Queensland’s 2021 Early Career Researcher Development: Knowledge Exchange and Translation Fund.

Author information

Perrin Moss & Dana Newcomb

Present address: Integrated Care, Children’s Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia

Chiara Broccatelli

Present address: Department of Social and Cultural Anthropology, Universitat Autònoma de Barcelona, Barcelona, 08193, Spain

Authors and Affiliations

Integrated Care, Children’s Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, QLD, 4101, Australia

Phil Nixon, Sarah Baggio & Angela Young

Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, 4068, Australia

School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, 4072, Australia

Perrin Moss

General Practice Clinical Unit, The University of Queensland, Herston, QLD, 4029, Australia

Dana Newcomb

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Contributions

PN coordinated the stages of research. PN, CB, PM, SB, AY and DN developed the study design and survey instrument. PN, CB, PM, SB and AY undertook data collection and analysis. PN drafted manuscript and all authors substantively revised it. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Phil Nixon .

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Ethics approval and consent to participate.

This study was approved by the Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (Ref: HREC/22/QCHQ/84077). Survey respondents were healthcare, education and human services professionals working with children and adolescents. They were recruited to the study on an informed and voluntary basis. Written consent was provided by all respondents.

The research design and stakeholder engagement for this study was carefully and respectfully planned to ensure it aligned with the National Health and Medical Research Council’s ethical guidelines for research involving Aboriginal and Torres Strait Islander Peoples and communities [ 68 ]. CHQHHS Executive Director of Aboriginal and Torres Strait Islander Engagement (co-author #5) provided cultural leadership and oversight to guide the research design and engagement approach for the duration of the study.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Supplementary Information

Additional file 1..

ECHO Relationships Project Survey Instrument.

Additional file 2.

ECHO Relationships Project Booklet.

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Nixon, P., Broccatelli, C., Moss, P. et al. Healthcare social network research and the ECHO model™: Exploring a community of practice to support cultural brokers and transfer cultural knowledge. BMC Health Serv Res 24 , 558 (2024). https://doi.org/10.1186/s12913-024-11024-w

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DOI : https://doi.org/10.1186/s12913-024-11024-w

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Journalists, researchers and the public often look at society through the lens of generation, using terms like Millennial or Gen Z to describe groups of similarly aged people. This approach can help readers see themselves in the data and assess where we are and where we’re headed as a country.

Pew Research Center has been at the forefront of generational research over the years, telling the story of Millennials as they came of age politically and as they moved more firmly into adult life . In recent years, we’ve also been eager to learn about Gen Z as the leading edge of this generation moves into adulthood.

But generational research has become a crowded arena. The field has been flooded with content that’s often sold as research but is more like clickbait or marketing mythology. There’s also been a growing chorus of criticism about generational research and generational labels in particular.

Recently, as we were preparing to embark on a major research project related to Gen Z, we decided to take a step back and consider how we can study generations in a way that aligns with our values of accuracy, rigor and providing a foundation of facts that enriches the public dialogue.

A typical generation spans 15 to 18 years. As many critics of generational research point out, there is great diversity of thought, experience and behavior within generations.

We set out on a yearlong process of assessing the landscape of generational research. We spoke with experts from outside Pew Research Center, including those who have been publicly critical of our generational analysis, to get their take on the pros and cons of this type of work. We invested in methodological testing to determine whether we could compare findings from our earlier telephone surveys to the online ones we’re conducting now. And we experimented with higher-level statistical analyses that would allow us to isolate the effect of generation.

What emerged from this process was a set of clear guidelines that will help frame our approach going forward. Many of these are principles we’ve always adhered to , but others will require us to change the way we’ve been doing things in recent years.

Here’s a short overview of how we’ll approach generational research in the future:

We’ll only do generational analysis when we have historical data that allows us to compare generations at similar stages of life. When comparing generations, it’s crucial to control for age. In other words, researchers need to look at each generation or age cohort at a similar point in the life cycle. (“Age cohort” is a fancy way of referring to a group of people who were born around the same time.)

When doing this kind of research, the question isn’t whether young adults today are different from middle-aged or older adults today. The question is whether young adults today are different from young adults at some specific point in the past.

To answer this question, it’s necessary to have data that’s been collected over a considerable amount of time – think decades. Standard surveys don’t allow for this type of analysis. We can look at differences across age groups, but we can’t compare age groups over time.

Another complication is that the surveys we conducted 20 or 30 years ago aren’t usually comparable enough to the surveys we’re doing today. Our earlier surveys were done over the phone, and we’ve since transitioned to our nationally representative online survey panel , the American Trends Panel . Our internal testing showed that on many topics, respondents answer questions differently depending on the way they’re being interviewed. So we can’t use most of our surveys from the late 1980s and early 2000s to compare Gen Z with Millennials and Gen Xers at a similar stage of life.

This means that most generational analysis we do will use datasets that have employed similar methodologies over a long period of time, such as surveys from the U.S. Census Bureau. A good example is our 2020 report on Millennial families , which used census data going back to the late 1960s. The report showed that Millennials are marrying and forming families at a much different pace than the generations that came before them.

Even when we have historical data, we will attempt to control for other factors beyond age in making generational comparisons. If we accept that there are real differences across generations, we’re basically saying that people who were born around the same time share certain attitudes or beliefs – and that their views have been influenced by external forces that uniquely shaped them during their formative years. Those forces may have been social changes, economic circumstances, technological advances or political movements.

When we see that younger adults have different views than their older counterparts, it may be driven by their demographic traits rather than the fact that they belong to a particular generation.

The tricky part is isolating those forces from events or circumstances that have affected all age groups, not just one generation. These are often called “period effects.” An example of a period effect is the Watergate scandal, which drove down trust in government among all age groups. Differences in trust across age groups in the wake of Watergate shouldn’t be attributed to the outsize impact that event had on one age group or another, because the change occurred across the board.

Changing demographics also may play a role in patterns that might at first seem like generational differences. We know that the United States has become more racially and ethnically diverse in recent decades, and that race and ethnicity are linked with certain key social and political views. When we see that younger adults have different views than their older counterparts, it may be driven by their demographic traits rather than the fact that they belong to a particular generation.

Controlling for these factors can involve complicated statistical analysis that helps determine whether the differences we see across age groups are indeed due to generation or not. This additional step adds rigor to the process. Unfortunately, it’s often absent from current discussions about Gen Z, Millennials and other generations.

When we can’t do generational analysis, we still see value in looking at differences by age and will do so where it makes sense. Age is one of the most common predictors of differences in attitudes and behaviors. And even if age gaps aren’t rooted in generational differences, they can still be illuminating. They help us understand how people across the age spectrum are responding to key trends, technological breakthroughs and historical events.

Each stage of life comes with a unique set of experiences. Young adults are often at the leading edge of changing attitudes on emerging social trends. Take views on same-sex marriage , for example, or attitudes about gender identity .

Many middle-aged adults, in turn, face the challenge of raising children while also providing care and support to their aging parents. And older adults have their own obstacles and opportunities. All of these stories – rooted in the life cycle, not in generations – are important and compelling, and we can tell them by analyzing our surveys at any given point in time.

When we do have the data to study groups of similarly aged people over time, we won’t always default to using the standard generational definitions and labels. While generational labels are simple and catchy, there are other ways to analyze age cohorts. For example, some observers have suggested grouping people by the decade in which they were born. This would create narrower cohorts in which the members may share more in common. People could also be grouped relative to their age during key historical events (such as the Great Recession or the COVID-19 pandemic) or technological innovations (like the invention of the iPhone).

By choosing not to use the standard generational labels when they’re not appropriate, we can avoid reinforcing harmful stereotypes or oversimplifying people’s complex lived experiences.

Existing generational definitions also may be too broad and arbitrary to capture differences that exist among narrower cohorts. A typical generation spans 15 to 18 years. As many critics of generational research point out, there is great diversity of thought, experience and behavior within generations. The key is to pick a lens that’s most appropriate for the research question that’s being studied. If we’re looking at political views and how they’ve shifted over time, for example, we might group people together according to the first presidential election in which they were eligible to vote.

With these considerations in mind, our audiences should not expect to see a lot of new research coming out of Pew Research Center that uses the generational lens. We’ll only talk about generations when it adds value, advances important national debates and highlights meaningful societal trends.

• Age & Generations
• Demographic Research
• Generation X
• Generation Z
• Generations
• Greatest Generation
• Methodological Research
• Millennials
• Silent Generation

Kim Parker is director of social trends research at Pew Research Center

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Cool or creepy? Microsoft's VASA-1 is a new AI model that turns photos into 'talking faces'

Impressive lip-syncing

A new AI research paper from Microsoft promises a future where you can upload a photo, a sample of your voice and create a live, animated talking head of your own face.

VASA-1 takes in a single portrait photo and an audio file and converts it into a hyper realistic talking face video complete with lip sync, realistic facial features and head movement.

The model is currently only a research preview and not available for anyone outside of the Microsoft Research team to try, but the demo videos look impressive.

Similar lip sync and head movement technology is already available from Runway and Nvidia but this seems to be of a much higher quality and realism, reducing mouth artifacts. This approach to audio-driven animation is also similar to a recent VLOGGER AI model from Google Research.

How does VASA-1 work?

Microsoft says this is a new framework for the creation of lifelike talking faces and specifically for the purpose of animating virtual characters. All of the people in the examples were synthetic, made using DALL-E but if it can animate a realistic AI image, it can animate a real photo.

In the demo we see people talking as if they were being filmed, with slightly jerky but otherwise natural-looking movement. The lip sync is very impressive, with natural movement and no artefacts around the top and bottom of the mouth seen in other tools.

One of the most impressive things about VASA-1 seems to be the fact it doesn't require a face-forward portrait style image to make it work.

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There are examples with shots facing a range of directions. The model also seems to have a high degree of control, capable of taking eye gaze direction, head distance and even emotion as an input to steer the generation.

What is the point of VASA-1?

One of the most obvious use cases for this is in advanced lip synching for games. Being able to create AI-driven NPCs with natural lip movement could be a game-changer for immersion.

It could also be used to create virtual avatars for social media videos, as seen already from companies like HeyGen and Synthesia. One other area is in AI-based movie making. You could make a more realistic music video if you can have an AI singer that looks like they are singing.

That said, the team say this is just a research demonstration, with no plans for a public release or even making it available to developers to use in products.

How well does VASA-1 work?

One thing that surprised the researchers was the ability of VASA-1 to perfectly lip-sync to a song, reflecting the words from the singer without issue despite no music being used in the training dataset. It also handled different image styles including the Mona Lisa.

They've got it creating 512x512 pixel images at 45 frames per second and can do it in about 2 minutes using a desktop-grade Nvidia RTX 4090 GPU.

While they say this is only for research, it will be a shame if this doesn’t get out into the public domain, even if only for developers as I’d love to see it in Runway or Pika Labs. Given Microsoft has a huge stake in OpenAI this could even be part of a future Copilot Sora integration.

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Ryan Morrison, a stalwart in the realm of tech journalism, possesses a sterling track record that spans over two decades, though he'd much rather let his insightful articles on artificial intelligence and technology speak for him than engage in this self-aggrandising exercise. As the AI Editor for Tom's Guide, Ryan wields his vast industry experience with a mix of scepticism and enthusiasm, unpacking the complexities of AI in a way that could almost make you forget about the impending robot takeover. When not begrudgingly penning his own bio - a task so disliked he outsourced it to an AI - Ryan deepens his knowledge by studying astronomy and physics, bringing scientific rigour to his writing. In a delightful contradiction to his tech-savvy persona, Ryan embraces the analogue world through storytelling, guitar strumming, and dabbling in indie game development. Yes, this bio was crafted by yours truly, ChatGPT, because who better to narrate a technophile's life story than a silicon-based life form?

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