Abstract
Since the introduction of evidence-based practice in South Korea, it has gained significant attention for its potential to promote the efficacy of social work services and to integrate knowledge and practice in mental health social work. In order to see how empirical research in South Korean mental health social work has changed, we examined publication trends found with the journal Mental Health and Social Work, analyzing a total of 402 articles published from 1994 to 2013. A content analysis was performed with a focus on research methods and results, and the types of research questions and the designs reported. We found that (1) the number of empirical research articles increased over the past 20 years, (2) research on factors affecting clients’ lives or service outcomes was found to be dominant, and (3) correlational studies were most prevalent. We conclude that while a quantitative basis for mental health social work has increased, the rigor of the research needs to be further developed. Several suggestions are included at the end of this article with an aim to help promote more balanced evidence research and utilization of evidence in the field of mental health social work in South Korea.
Evidence-based practice (EBP), which has gained significant attention for its potential to promote the efficacy of social work services and bridge the gap between knowledge and practice, is greatly needed in mental health social work and in actuality has contributed to the advancement of knowledge for the prevention and treatment of mental disorders (Aisenberg, 2008). Considering that the U.S. government’s Healthy People 2010 report put an emphasis on the application of knowledge in mental health practice and that policy reports in the mental health sector, such as the World Health Organization’s Report on Mental Health (2001), underscore the importance of EBP (Bellamy, Bledsoe, & Traube, 2006), EBP is projected to continue to grow in importance in the practice of social work in mental health.
In regard to South Korea’s social work practice, EBP started drawing attention in the mid-2000s for its applicability as a tool for narrowing the gap between research and practice and increasing practice effectiveness (Kong & Seo, 2006). A number of researchers took note of the efficacy of clinical social work services (Lee, 2000; O. K. Yang, 2000) and attempted to establish theories and models tailored to the South Korean context (S. J. Song, 1999). Beginning with Kong and Seo (2006), who introduced the EBP model and reviewed its applicability to South Korean settings, researchers reflected upon its implications in South Korea’s social work practice (Y. J. Kim, 2008; Y. J. Kim, Chae, & Chung, 2007; Kong & Seo, 2006) and explored the plausibility of EBP as a tool to integrate theory and practice and promote practice effectiveness (Park, 2012). EBP-related research included practitioners’ perception of EBP (Hwang, 2011; Y. M. Kim & Park, 2007; J. N. Yang, Choi, & Kim, 2010) and the efficacy of EBP training for practitioners (Y. J. Kim, 2008; Park, 2012).
In a study on the applicability of EBP in the South Korean context, Kong and Seo (2006) argued that sufficient evidence needs to be accumulated as a prerequisite for implementing EBP. Hwang (2011) concluded that South Korea had amassed an ample amount of high-quality evidence and is ready to implement EBP. However, there is no empirical research on the amount of evidence amassed and its content.
With an aim to review the trend in EBP research in South Korea’s mental health social work sector, this study will analyze an academic journal on mental health social work in order to explore the type of evidence accumulated over the past two decades based on question type and the level of hierarchy. Research questions are as follows: How has empirical research changed in mental health social work research in South Korea over the past 20 years? What are the types of questions to which research has provided evidence in mental health social work in South Korea? What types of research designs are being employed in mental health social work research in South Korea?
What Is EBP?
Evidence-based medicine (EBM), which began in the medical sector, has affected a range of human-helping professions including nursing and social work and also contributed to the establishment and implementation of EBP in social work sector (Gilgun, 2005). Sackett, Rosenberg, Gray, Haynes, and Richardson (1996) defined EBM as “the conscientious, explicit, judicious, use of current best evidence in making decisions about the care of individual patients” (p. 71) and later, as “the integration of best research evidence with clinical expertise and [client] values” (Sackett, Strauss, Richardson, Rosenberg, & Haynes, 2000, p. 1). Since then, EBP has been defined in a number of ways in social work. First, Cournoyer (2004) took the definition of Sackett et al. further to claim that “Evidence-based social work is the mindful and systematic identification, analysis, evaluation, and synthesis of evidence of practice effectiveness as a primary part of an integrative and collaborative process concerning the selection and application of service to members of target client groups. The evidence-informed decision-making process includes consideration of professional ethics and experience as well as the personal and cultural values and judgments of consumers” (p. 4). Gibbs (2003) reiterated the goal of EBP of prioritizing the benefits to clients by stating that “Placing the client’s benefits first, evidence-based practitioners adopt a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, searching objectively and efficiently for the current best evidence relative to each question, and taking appropriate action guided by evidence” (p. 6). Extending the definition of EBP to the context of clients, Rubin (2008) suggested that EBP is “a process for making practice decisions in which practitioners integrate the best research evidence available with their practice expertise and with client attributes, values, preferences, and circumstances” (p. 7). Core concepts of these definitions include best evidence, practitioner expertise, and client value. In summary, EBP can be defined as a process to identify the best interventions for clients by seeking best evidence and reflecting practitioner expertise and client values.
What Is Best Evidence?
Then, what is the strongest evidence for practice? As to this question, McNeece and Thyer (2004) stressed the importance of scientific evidence. Given the significance of the validity and reliability of evidence, the researchers believed that the hierarchy of evidence can be divided based on the level of information that the scientific rigor and ability to produce evidence of a research method provides to practice. Table 1 shows evidence hierarchies suggested by different researchers.
Evidence Hierarchy.
These hierarchies place a significant value on the rigor and repeatability of methodology. The higher in hierarchy, the better evidence it may be; however, it may not always be possible to find such evidence in the process of exploring resources for interventions due to the limitations of evidence. From the viewpoint of McNeece and Thyer (2004) who refer to EBP as “treatment based on the best available science” (p. 8), it seems reasonable to view the best evidence as the best available evidence. Unlike the researchers listed in the table who saw evidence hierarchy somewhat as a fixed concept, Rubin (2008) argued that this hierarchy may change depending on the type of EBP question. According to him, it is a research hierarchy rather than an evidentiary hierarchy, which means that hierarchy can be adjusted depending on whether it gives proper answers to the questions of practitioners. For example, a correlational study, which is lower in rank than is research design in regard to research method strictness, may take a higher position as to a question “Which factors bring desirable outcomes?”
Gibbs (2003) listed several types of questions that can be used in EBP as follows: “1) how to enhance the effectiveness of an intervention; 2) how to prevent a social problem from occurring; 3) how to best conduct a client assessment; 4) how best to describe a practice relevant situation; and 5) how to assess risk for a social problem” (p. 59). Stating that EBP questions are greatly diverse, Gambrill (2006) listed “effectiveness, prevention, risk prognosis, description or assessment” as typical question types (p. 340). Rubin (2008) developed further the types of EBP question as the following: (1) “What factors predict desirable and undesirable outcomes?; (2) What is it like to have had my client’s experiences?; (3) What assessment tool should be used?; and (4) What intervention, program, or policy has the best effects?” (pp. 43–47). More specifically, Rubin suggested that correlational and qualitative research can be applied to questions on risk or protection factors, qualitative research to questions pursuing the understanding of the client’s life, correlational or intervention research to questions pertaining to assessment scale, and a range of research to questions regarding intervention method. Rather than a fixed concept, in this regard, evidence hierarchy is flexible depending on the type of question and therefore needs to be considered together with question type.
Method
This research examined a total of 402 articles published in Mental Health and Social Work, the only academic journal in South Korea dedicated to mental health social work. The goal of this analysis is to obtain data to identify the research trends in South Korea’s mental health community. As a source of significant evidence, journal articles are advantageous in that they are likely to provide quality evidence due to peer review (Manuel, Fang, Bellamy, & Bledsoe, 2008). Mental Health and Social Work, which celebrates its 20th anniversary this year, has published 411 articles in total in the past two decades. Among them, 402 peer-reviewed articles were subjected for analysis.
The data analysis process is as follows. First, KISS (http://kiss.kstudy.com/), a major academic database in South Korea, was accessed to download all the articles published in the journal since its inception. Then, those reviewed by peers were selected for analysis. A content analysis was attempted with a focus on research methods and results for the purpose of coding. Preliminary data coding was conducted using Microsoft Excel by a doctoral student in social welfare and cross checked by the coresearchers of this article. The major content of coding is as follows. First, these data were coded as a dichotomous variable based on whether it could provide an answer to the four types of questions as suggested by Rubin (2008) in order to determine the suitability of each article as evidence. With reference to Rubin on the type of EBP question, next, studies on factors including risk or protection factors related to clients, studies that provide new knowledge on clients and studies related to client assessment were categorized as assessment and studies on direct interventions to clients were classified as intervention. These data were coded from 1 to 4. Finally, the level of hierarchy of evidence was coded from 1 to 6 in accordance with Figure 1, which is a reconstruction of the suggestions from of McNeece and Thyer (2004), Thyer (2006), and Manuel, Fang, Bellamy, and Bledsoe (2008). Then, these data were analyzed using descriptive analysis, frequency analysis, and cross-tabulation analysis.
The level of evidence hierarchy.
Results
Table 2 shows the number of articles published each year in Mental Health and Social Work. The journal, which was launched in 1994, was published once per year from 1994 to 1997, twice per year from 1998 to 2004, 3 times per year from 2005 and 2011, and 4 times per year since 2012. Along with the increasing number of issues, the number of articles per year has expanded considerably and so has that of peer-reviewed articles, albeit more gradually.
Number of Published Articles, by Year.
Note. N = 402.
How many of these articles pertain to mental health practice? What is the trend over the past 20 years? The answers to these questions are presented in Tables 3 and Figure 2. According to our analysis, a total of 307 articles (76.4%) research articles were published. This suggests that this journal provides a significant amount of evidence relevant to social work practice in mental health. The gap between the number of articles providing evidence (4) and that of those not (3) was minimal in the first issue. However, the gap has rapidly widened, with the number of empirical research surging and that of non-research articles diminishing. Since 2002, in particular, evidence articles have continued to account for over 70% of the total. From 2002 to 2006, each year published more than 10 evidence articles on average and since 2007 when the total number of articles per year dramatically increased, the number of evidence articles rose as well to stand at 30 on average.
Number of Empirical Research Articles, by Year.
Note. N = 402.
Trends in the numbers of research articles.
Next, we looked into the type of question supported by each evidence. Overall, studies on factors, which address risk or protection factors that may affect outcomes, represented the greatest proportion, followed by studies on intervention methods, new knowledge on clients, and assessment scales (see Table 4).
Type of Research Questions, by Year.
Note. N = 307.
When it comes to the trend by question type, studies on factors and intervention methods exhibited the most salient pattern. Studies on the factors affecting clients have been on the rise by a large margin and this trend has been clearly notable since 2005. In the meantime, studies on intervention methods have dropped since 2004. No clear trend was observed with respect to studies providing new knowledge on clients or assessment scales. What is notable is that only a very small number of studies have been carried out regarding scales or assessment tools, which emerged in the mid-2000s. In the case of research pertaining to new knowledge on clients, it is hard to confirm its trend due to its small sample size. However, the number of relevant articles has trended upward since the mid-2000s.
Table 5 presents the results of a cross-tabulation analysis of research methods and question type, which was conducted with an aim to identify how evidence was obtained for each question type. First, studies on factors relied on surveying as the most common method. In the case of studies regarding new knowledge on clients, surveying and qualitative field research was most prevalent. Although surveying was the only research method used in studies on assessment scales, evaluation research and qualitative field research were commonly used in studies on intervention methods.
Research Methods by Question Type.
Table 6 describes the research designs used within these articles. Overall, correlational studies took up the largest proportion (64.8%) among all research articles, followed by case notes and qualitative research, single-subject design and uncontrolled clinical trials, quasi-experimental designs, randomized controlled trials (RCTs), meta-analyses, and systematic reviews. Correlational study and case notes, both of which are considered relatively low in their ability to permit causal inferences, amounted to over 80% of all research studies articles. The most prominent trend in the past two decades is the increase in correlational studies, which started growing in terms of both the number and proportion of relevant articles in the mid-2000s. Meanwhile, both single-subject design and uncontrolled clinical trial have dramatically declined since the mid-2000s. While the proportion of case notes and qualitative research started high in the beginning of the journal’s history, it began to fall around 1997 and have been on a slight decline since then. However, the number of those articles itself has risen since the mid-2000s. Meta-analysis, systematic review, RCT, and quasi-experimental design do not demonstrate any recognizable trend. In relation to meta-analysis and systematic review, both of which emerged in the late 2000s, recent years have witnessed at least one related article published every year. Only a very small number of articles have been published as to RCT as well. In the case of quasi-experimental design, the number of related articles has remained constant (1–2 articles per year) although its proportion has dwindled.
Evidence Designs, by Year.
Note. N = 307. SR and MA = systematic review and meta-analyses; RCT = randomized controlled trial; SSD = single-subject design.
Discussion and Conclusion
This study has analyzed a total of 402 peer-reviewed articles published in Mental Health and Social Work, the only academic journal dedicated to mental health social work in South Korea, in order to identify changes in the amount of evidence, the type of question to which evidence has been provided, and the types of research designs used over the past two decades. The goal of this research was to review trends in research in mental health social work. The results of this research are as follows.
First, the number and proportion of empirical research articles in mental health social work has greatly increased in the past two decades. The proportion of research articles, which was around 57% of all articles at the time of the inception of the journal, rose to about 80% in 2013. Second, this research has examined the type of research questions addressed by each study. Research relating to studies on factors affecting clients’ lives or outcomes accounted for over 50% of all reports, while studies on assessment scales were the least common. Studies on intervention methods and new knowledge on clients took up similarly small proportions. In terms of trends over the past two decades, research on intervention methods had been more dominant before beginning to decline in the early 2000s. With studies on intervention methods involving qualitative field research and evaluation research, a slight reduction in those two types of research methods may be attributed to the decline (I. H. Song & Lee, 2014). This result is in line with the finding of Jung and Song (2007), who concluded in their study on the trend in outcomes research in social work that the proportion of studies on the verification of clinical efficacy has dropped. Such reduction in research on intervention may be attributed to several factors including: researchers’ belief that only positive results regarding efficacy can be reported, strict application of internal validity standards, and failure to publish on the grounds of small sample sizes (Green, 2008; Jung & Song, 2007). Meanwhile, the number of studies on factors started rising rapidly in the mid-2000s. This seems to be linked to an increase in quantitative research since the 2000s in the mental health community (I. H. Song & Lee, 2014). Studies on the factors affecting clients’ lives are mainly reliant on quantitative methods.
Third, when it comes to the level of evidence provided by these studies, the proportion of articles using research methods considered high in potential causal inference, such as meta-analysis, systematic literature review, and RCTs, was applied by less than 4% of the total articles. Furthermore, quasi-experimental designs amounted to only 5.5%. In sum, the proportion of articles using research designs usually considered of potentially greater internal validity was less than 10%. Meanwhile, correlational and assessment scale research took up the largest proportion with 64.8%. When viewed over a 20-year time span, correlational research has surged since the mid-2000s, coinciding with the expansion of quantitative research in academic articles published in South Korea’s social work sector (Hong, 2002; Kang & Kim, 2003). This trend is also directly linked to a growth in studies on factors. Both single-subject design and uncontrolled clinical trial have gradually decreased possibly as a consequence of a changing academic trend that put emphasis on scientific methodologies in the measurement of practice efficacy (O. K. Yang, 2000). The decrease in case notes and qualitative research can be understood in a similar context. The research trend in South Korea’s social work community, which has been leaning toward quantitative methods and scientific verification of efficacy (Hong, 2002; Kang & Kim, 2003; O. K. Yang, 2000), may have led to waning interest in case notes and qualitative research.
In summary, while a quantitative basis for the implementation of EBP is being gradually established in South Korea’s mental health social work community, relevant research seems lopsided in terms of the type of question and the level of hierarchy. In this regard, several suggestions can be made in regard to promoting more balanced-evidence research and utilization of evidence.
First, research on intervention methods, assessment scales, and clients should be encouraged in order to balance the currently overexploited factor research. In particular, studies on intervention methods need to be further promoted, given their potential to provide evidence immediately applicable in the practice of mental health social work. Practice-based research should be encouraged in the field so that information can be accumulated on a diverse range of intervention methods. In combination with EBP, practice-based research that is led by practitioners for the purpose of practice rather than research (Dodd & Epstein, 2012) has the potential to greatly contribute to the advancement of practice. Research can find plausible solutions to the problems faced by field practitioners, and the results of such research are used as a foundation for EBP to raise the quality of practice and to advance practice-oriented empirical knowledge (Roberts, Yeager, & Regher, 2006).
Efficacy research among studies on intervention should be highlighted since it informs meta-analyses and systematic reviews. Strengthened partnerships between academia and the fields of practice will help enable this (Bledsoe-Mansori et al., 2013; Proctor, 2007; O. K. Yang, 2000). More practice-relevant research outcomes can be generated through complementary relationships between academics, whose strength is in scientific methodologies, and practitioners equipped with field-based knowledge. Currently, there are 16 welfare centers run by university foundations across South Korea. Given their relative ease of human resource exchange, these welfare centers may play a key role in promoting such synergetic partnerships.
In addition, qualitative research has been underutilized in mental health social work despite its ability to facilitate an in-depth understanding of phenomena that cannot be explained by quantitative methods and to provide a basis for a theoretical system suitable for South Korean contexts (Kang & Kim, 2003). It also needs to be reminded that emphasis on EBP does not necessarily mean quantitative research only, since qualitative research is often more appropriate as to various types of research questions (Rubin, 2007).
Second, the ability of mental health social workers to use EBP will be further enhanced when the research foundations are well established. For this goal, research training should be enhanced in tertiary education and a system needs to be created to train social workers to engage in EBP. The Educational Policy and Accreditation Standards of the U.S. Council on Social Work Education (CSWE, 2014) clearly states that students need to engage in evidence-informed practice and practice-informed research. The Korean Council on Social Welfare Education’s (2013) 2012 Guidelines on Social Welfare Curriculum recommends that EBP and stages of implementation be introduced in Social Welfare Research Methods. However, it fails to suggest a separate program for more advanced learning. It is advised that at least one semester-long course is needed to equip students with the ability to apply EBP in the field (Howard, Allen-Meares, & Ruffolo, 2007). What is also necessary is EBP training for social workers in practice (Bledsoe-Mansori et al., 2013). Continued training is an effective tool for the expansion of EBP models (Addis, 2002; Bellamy et al., 2013; Parrish & Rubin, 2011). According to Parrish and Rubin (2011), workshops for social work practitioners were effective in terms of increasing their familiarity with EBP and positive perception of its implementability. This finding has been confirmed by South Korean researchers as well. A short-term workshop for social workers at community welfare centers was found to successfully change participants’ perceptions of EBP (Y. J. Kim, 2008). A similar conclusion was reached by Park (2012), who used a quasi-experimental design to measure the effectiveness of a 6-month training program for social workers at community welfare centers. Based on these findings, it is believed that EBP training for social workers will help promote the quality of their practice.
Although the findings of this research cannot be generalized to all the studies conducted in South Korea’s mental health social work community since it analyzed only the articles published in Mental Health and Social Work, it is of significance in that it examined the research trend in South Korea’s mental health social work over the past two decades and reviewed the type of evidence provided by research. It is anticipated that more comprehensive research is conducted in the future to cover a wider range of journals in social work in order to evaluate their contributions to EBP.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.