Randomized Controlled Trials in Social Work
- LAST MODIFIED: 07 January 2025
- DOI: 10.1093/obo/9780195389678-0341
- LAST MODIFIED: 07 January 2025
- DOI: 10.1093/obo/9780195389678-0341
Introduction
Randomized controlled trial (RCT) is terminology more commonly employed in the medical arena but has been increasingly used in the behavioral and social sciences. This is because RCTs employ experimental designs to determine the efficacy of interventions, which is extremely important to social work practice. An RCT retains the key features of an experimental design. A primary characteristic is participants’ random or chance allocation to the experimental intervention or the control condition for comparison. This allocation process minimizes participants’ differences between these conditions. In social work, the control condition is often standard treatment or what is considered the acceptable standard of care for achieving the desired outcome, rather than nothing or a placebo, which is common in medical interventions. Furthermore, these true experimental designs require random assignment after a pretest of the outcome assessment normally using a psychometrically sound or objective measure of the outcome and a minimum of two conditions, experimental and control, although the study may have more than one experimental or control condition. RCTs are important to building a base of evidence for social work practice, as the experimental design inherently controls for most biases or threats to the internal validity of the design and, therefore, increases confidence in making causal statements concerning the effectiveness of the experimental intervention. For these reasons, RCTs are considered the “gold standard” of research because they have high internal validity, enabling causal findings. However, they have limited external validity. External validity is best achieved through replication of the RCT. Due to the need for empirically based practice, primarily in the health-care arena, there have been several new innovations in the standard experimental design or RCT, such as pragmatic RCTs aimed at determining the effectiveness of interventions in real-world clinical practice and step-wedge designs, where exposure to the intervention occurs over a period of time.
General Overviews
To know what is entailed in designing a randomized controlled trial (RCT), the books discussed in this section are specialized in designing RCTs. Nezu and Nezu 2008 and Kazdin 2021 are written by psychologists. Although the orientation of Kazdin 2021 focuses on psychotherapy interventions, the issues and considerations are still relevant to psychosocial interventions, which social workers generally study. Likewise, Nezu and Nezu 2008 is oriented to psychosocial interventions within the real world of clinical practice. Torgerson and Torgeson 2008 is consistent with the social work perspective as the book is oriented to RCT studies in the actual field, such as educational settings and health-care sites. Similarly, Boruch 1997 focuses exclusively on RCTs in the field and generally emphasizes policies and programs, hence a more macro-orientation. Solomon, et al. 2009 stands out as the only one specifically written for social workers. All provide a general overview of planning and conducting RCTs, including aspects such as recruitment, assignment, intervention, outcome measurement, and issues related to external and internal validity, as well as considerations for conducting studies in the actual world rather than a well-controlled lab.
Boruch, R. 1997. Randomized experiments for planning and evaluation: A practical guide. Thousand Oaks, CA: SAGE
Takes a macro approach to randomized experiments by putting evaluations in the context of programs and policies and placing programs in environmental operations of organizations. Discusses pipeline studies, assessing how, why, and when potential participants are included in a study and when they enter and exit for assessing study sample size. Covers randomization procedures, ethics and law, measurement, and analyses. This is the only methods book taking a macro perspective.
Kazdin, A. 2021. Research design in clinical psychology. Cambridge, UK: Cambridge Univ. Press.
Spends extensive coverage on internal and external validity and various experimental group designs as well details on potential bias. One chapter focuses on different control and comparison groups, such as waitlist, attention-placebo controls, and routine/standard treatment. Another chapter delves into consideration for evaluating treatment strategies.
Nezu, A. M., and C. M. Nezu, eds. 2008. Evidence-based outcome research. Oxford: Oxford Univ. Press.
DOI: 10.1093/med:psych/9780195304633.001.0001
This edited volume, authored by behavioral psychologists, provides practical guidance for conducting RCTs of psychosocial interventions. It addresses assessment, methodological and design, and data analysis issues.
Solomon, P., M. Cavanaugh, and J. Draine. 2009. Randomized controlled trials. Oxford: Oxford Univ. Press.
DOI: 10.1093/acprof:oso/9780195333190.001.0001
This pocket guide is designed specifically for social workers, recognizing that most of their RCTs involve psychosocial interventions conducted in community-based settings. This covers relevant ethical considerations, planning issues, conceptual foundations, designing, implementing, and generalizing results of these investigations. The book is written in a highly digestible and easy-to-understand style, making it accessible for both students and practitioners developing and conducting RCTs.
Torgerson, D., and C. Torgerson. 2008. Designing randomized trials in health, education and the social sciences: An introduction. New York: Palgrave Macmillan.
This book offers a background of randomized designs and discusses a variety of designs in comparison to RCTs and why they are an improvement over these other designs. Also discussed are specific randomized designs, including cluster randomized design and procedures for allocating participants to conditions. Further, the book covers pilot studies, recruitment issues, sample size decisions, and measuring outcomes.
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