Do strengths-based approaches work?

A 2021 literature review (Caiels, J, Milne, A and Beadle-Brown, J. 2021. Strengths-Based Approaches in Social Work and Social Care: Reviewing the Evidence. Journal of Long-Term Care, (2021), pp. 401–422.) (shared on twitter recently by former King’s Fund policy lead and author, Richard Humphries), came to the familiar conclusion that it’s promising, but hard to pin down as a concept and the evidence is still not there.

The authors helpfully note the difficulties in producing traditional kinds of evidence (eg RCTs) for complex cultural and system changes like the shift to strengths-based working. If a system change is hard to define and imperfectly implemented, who would the control group be in a traditional research model? How can you confidently attribute a positive outcome to a strengths-based service intervention, when many factors can be affecting someone’s wellbeing?

They note briefly at the end that the “review may be limited by the lack of evidence in a relatively under-researched area of practice.” This is in fact the key fact here, and is worth setting in context.

Vast sums are spent on evaluating mainstream public service responses and they often produce robust evidence due the large sample sizes available. Tiny sums in comparison are spent on emerging models. They often find promising results, as the recent new economics foundation evaluation of our work did, showing that the PTS Response enabled people to take control of their support and reported huge improvements in their wellbeing including an increase in self-esteem, sense of purpose, and optimism, as well as better mental health including feeling happier, and a reduction in anxiety (report here). But their small scale limits their impact in the context of large scale established services and associated research programme.

This evidence trap is not incidental: it is a fundamental driver against innovation in public services, which set extremely high evidence bars to introducing new approaches (in comparison to the private sector which often tries something, and switches to the new approach rapidly if it appears to work better) while spending tiny amounts researching emerging approaches. This is ironic, because there is vast evidence of the ways that current service models do not work. Mainstream homeless support services for instance typically have little evidence of consistent effectiveness in helping people achieve long-term housing security. But that context is rarely considered or presented by studies such as this one, leading us to think about the evidence for new approaches as if it exists in a vacuum, leading us to ask, Is this new approach proven to be highly effective? Whereas a more realistic question is nearly always, Does this new approach appear to be less problematic than the current one?

Academics invariably unconsciously present themselves as impartial and apolitical, whereas researchers, like the rest of us, are deeply embedded in and influenced by the current public service and its system. An enquiry into strengths-based approaches is inevitably done by someone who has been conditioned to see deficit-based service models as normal and neutral, rather than as, say, institutionally ableist, sexist and racist.

In my book, I argued that public service researchers are unwittingly part of an “academic-public service complex” and to see that and have some chance of escaping it, need to abandon the fantasy of themselves as neutral. Like everyone with power in public services, they – we – are privileged. We either acknowledge that or don’t, but we can’t make that fact disappear. I argued that the impact of this can be lessened by co-designing research funding, programmes and projects with people affected by public services (at present only commissioners, politicians and people leading organisations with large budgets get to do this – again, not a neutral group), by working with peer-researchers and by engaging with the political nature of all public service related activity rather than pretending it doesn’t exist.

So it is indeed unarguable that the evidence for strengths-based approaches is currently patchy and incomplete at best. And also unarguable that deficit-based approaches are harmful and unwittingly or sometimes consciously abusive. Presenting only one of those facts is unconsciously political.

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