This article addresses social workers' use of knowledge by studying the rationale they provided for their actual practice decisions. Extent of knowledge use was compared across four practice decision tasks and between medical and psychiatric social work services. Data were obtained from the records of 297 clients treated by 34 experienced M.S.W. social workers in medical and psychiatric services units of two midwestern hospitals. Workers were previously trained in the approach and procedures of Systematic Planned Practice (SPP). Data were obtainedfrom SPP forms on which workers recorded their treatment decisions and rationale for each decision. Data analyzed by repeated measures (MANOVA and ANOVA's) revealed that giving of rationales, and the types of knowledge it reflected, varied significantly by the decision task and social work service. Intervention decisions were least likely to be supported by rationales, and medical services workers provided fewer rationales than psychiatric services workers. Conceptual rationales were the most frequently used, whereas rationales based on practice experience, values, research, or client wish were very little used. The implications for practice, professional education, quality assurance, and for further research are discussed.
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