Abstract
Although social work scholars have proposed and promoted various models for making effective and ethical clinical decisions, little empirical research has addressed processes of clinical decision-making as they occur naturally in 'real world' mental health practice. This article briefly reviews approaches to the study of decision-making, and presents findings from an ethnographic study of the collaborative decision-making activities of mental health workers in a residential treatment center for children and adolescents. This article describes and analyzes a local theory and practice of interactional clinical decision-making in which workers provide competing interpretations of the 'meaning' of clients' behaviors before committing to a particular course of clinical action. This process, which I term the 'behavior-has-meaning' hermeneutic, serves not only to guide clinical interventions, but as a forum for modeling, developing, and evaluating locally valued forms of clinical expertise. Implications of these findings for the implementation of prescriptive models of clinical decision-making - such as the evidence-based practice process - are discussed.
Original language | English (US) |
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Pages (from-to) | 8-25 |
Number of pages | 18 |
Journal | Qualitative Social Work |
Volume | 13 |
Issue number | 1 |
DOIs | |
State | Published - Jan 1 2014 |
Keywords
- Decision-making
- evidence-based practice
- expertise
- interpretation
- residential care
ASJC Scopus subject areas
- Health(social science)
- Social Sciences (miscellaneous)