SOCIAL WORKERS’ DESK REFERENCE

SOCIAL WORKERS’
DESK REFERENCE
Third Edition

Kevin Corcoran
Editor-in-Chief

Albert R. Roberts
Founding Editor-in-Chief

1
1
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Once again, for Sug and the memory of Harley Bubba Davidson.
 CONTENTS

Foreword  xvii 7 Essentials of Private Practice   51

Raymond D. Fox
Acknowledgments  xix
8 Social Work Practice and the Affordable
Contributors  xxi Care Act  59
Stephen Gorin
Julie S. Darnell
Christina M. Andrews
PART I: OVERVIEW AND
INTRODUCTION TO SOCIAL WORK
9 Social Work Practice in Home-based
Services  67
1 What Changes and What Remains in a
Martha Morrison Dore
Practice Profession   3
Charlene Zuffante
Elizabeth Clark
10 Social Work Practice in
2 Professional Socialization: On Becoming
Disasters  75
and Being a Social Worker   8
Daphne S. Cain
Shari Miller

11 Victim Services   86
PART II: ROLES, FUNCTIONS, AND Karen S. Knox
FIELDS OF SOCIAL WORK PRACTICE
12 Social Work in Domestic Violence
3 Evidence-based Social Work Practice Services  93
with Children and Adolescents   21 Brandy Macaluso
Alison Salloum Diane L. Green Sherman
Lisa Rapp-McCall
13 Traumatic Stress and Emergency
4 Overview of Alcohol and Drug Services  101
Dependence: Identification, Assessment Ted Bober
and Treatment   27
Kenneth R. Yeager 14 Military Social Work   113
Allen Rubin
5 School Social Work   38 James G. Daley
Robert Lucio
15 Military Social Work in the
6 Social Work Practice and Community  118
Leadership  45 Anthony Hassan
Michael J. Holosko Sara Kintzle
viii Contents

16 Social Work with Military PART IV: THEORETICAL FOUNDATIONS

Families  123 AND TREATMENT APPROACHES IN
Diane Scotland-Coogan CLINICAL SOCIAL WORK

17 Social Work Practice and Personal 27 Crisis Intervention with Individual and
Self-care  130 Groups: Frameworks to Guide Social
Jeff Skinner Workers  217
Yvonne Eaton-Stull

PART III: SOCIAL WORK VALUES, 28 Fundamentals of Brief Treatment   223

ETHICS, AND LICENSING STANDARDS Jan Ligon

18 Ethical Issues in Social Work   143 29 Common Factors in

Frederic G. Reamer Psychotherapy  228
James W. Drisko
19 Risk Management in Social
Work  149 30 Task-centered Practice  237
Frederic G. Reamer Anne E. Fortune
Blanca M. Ramos
20 Advocacy in Administrative William J. Reid
Forums: Guidelines for Practice in
Benefit Appeals   156 31 The Life Model of Social Work
John M. Gallagher Practice  244
Alex Gitterman
21 Social Work Regulation and
Licensing  163 32 Client-centered Theory and
Andrew T. Marks Therapy  249
Karen S. Knox William S. Rowe
Samantha A. Hafner
22 The Impaired Social Work Alicia J. Stinson
Professional  170
Frederic G. Reamer 33 Cognitive-behavioral Therapy  257
M. Elizabeth Vonk
23 Technology and Social Work Theresa J. Early
Practice: Micro, Mezzo, and Macro
Applications  176 34 Psychosocial Therapy  263
Jonathan B. Singer Francis J. Turner
Melanie Sage
35 Solution-focused Therapy  268
24 Navigating Complex Boundary Peter De Jong
Challenges  189
Kimberly Strom-Gottfried 36 Theoretical Pluralism and Integrative
Perspectives in Social Work
25 Integrating Values into Social Work Practice  275
Practice  197 William Borden
Juliet Cassuto Rothman
37 Animal-assisted Interventions in Social
26 Adoption Competency in Social Work Work Practice   281
Practice  205 Yvonne Eaton-Stull
Debra Siegel
 Contents ix

38 Narrative Therapy  287 48 Bipolar and Related Disorders   365

Patricia Kelley Elizabeth C. Pomeroy
Mark Smith
49 Guidelines for Selecting and Using
39 The Neurobiology of Toxic Assessment Tools with Children   375
Stress: Implications for Social Work Craig Winston LeCroy
Practice  292 Stephanie Kennedy
Julie M. Rosenzweig Andrea Kampfner
Stephanie A. Sundborg
50 Assessment Protocols and Rapid
40 Fundamental Principles of Behavioral Assessment Tools with Troubled
Social Work    301 Adolescents  381
Denise E. Bronson David W. Springer
Stephen J. Tripodi
41 The Miracle Question and Scaling Stephanie Kennedy
Questions for Solution-building and
Empowerment  308 51 Using Standardized Tests and Instruments
Mo Yee Lee in Family Assessments   388
Jacqueline Corcoran
42 Gestalt Therapy  316
William P. Panning 52 Very Brief Screeners for Practice and
Evaluation  393
43 Contemporary Object Relations Steven L. McMurtry
Treatment  326 Susan J. Rose
William Borden Lisa K. Berger

44 Human Trafficking and Trauma-informed

Care  332 PART VI: WORKING WITH COUPLES
Kristin Heffernan AND FAMILIES
Betty J. Blythe
Andrea Cole 53 Using Genograms to Map Family
Patterns  413
45 Using Self Psychology in Clinical Social Monica McGoldrick
Work  339
Jerrold R. Brandell 54 A Family Resilience Framework   427
Suzanne M. Brown Froma Walsh

55 Treatment Planning with Families: An

Evidence-based Approach   433
PART V: ASSESSMENT IN SOCIAL WORK
Catheleen Jordan
PRACTICE: KNOWLEDGE AND SKILLS
Cynthia Franklin
Shannon K. Johnson
46 Diagnostic Formulation Using the
Diagnostic and Statistical Manual of 56 Effective Couple and Family
Mental Disorders, Fifth Edition   349 Treatment  438
Carlton E. Munson Cynthia Franklin
Catheleen Jordan
47 How Clinical Social Workers Can Easily Laura M. Hopson
Use Rapid Assessment Tools (RATs)
for Mental Health Assessment and 57 Structural Family Therapy  448
Treatment Evaluation   358 Harry J. Aponte
Kevin Corcoran Karni Kissil
x Contents

58 Bowen Family Systems Therapy   456 PART VII: DEVELOPING AND

Daniel V. Papero IMPLEMENTING TREATMENT
PLANS WITH SPECIFIC GROUPS AND
59 Integrative Behavioral Couple DISORDERS
Therapy  462
Katherine J. W. Baucom 68 Guidelines for Establishing Effective
Felicia de la Garza-Mercer Treatment Goals and Plans for Mental
Andrew Christensen Health Disorders: Sample Treatment
Plans for DSM-5 Insomnia and
60 Family Therapy Approaches Using Generalized Anxiety Disorders   537
Psycho-education  469 Vikki L. Vandiver
Joseph Walsh
69 Treating Problem and Disordered
61 Guidelines for Couple Therapy Gambling: Often a Hidden Behavioral
with Survivors of Childhood Addiction  545
Trauma  475 Cathy King Pike
Kathryn Karusaitis Basham Andrea G. Tamburro

62 Working with Children and Families 70 Developing Therapeutic Contracts with

Impacted by Military Service   481 Clients  553
Eugenia L. Weiss Juliet Cassuto Rothman
Jose E. Coll
Tara DeBraber 71 Developing Goals  560
Charles D. Garvin
63 Preventing Antisocial and Aggressive
Behavior in Childhood   493 72 Treatment Planning with
Traci L. Wike Adolescents: Attention Deficit
Jilan Li Hyperactivity Disorder Case
Mark W. Fraser Applications  566
Kimberly Bender
64 Multifamily Groups with Samantha M. Brown
Obsessive-compulsive David W. Springer
Disorder  504
Barbara Van Noppen 73 Eating Disorders and Treatment
Planning  571
65 Collaborating with Families of Nina Rovinelli Heller
Persons with Severe Mental Jack Lu
Illness  511
Tina Bogart Marshall 74 Panic Disorders and Agoraphobia   579
Phyllis Solomon Gordon MacNeil
Jason M. Newell
66 Assessment, Prevention,
and Intervention with Suicidal 75 Treatment Plans for Clients with Social
Youth  516 Anxiety Disorder   586
Jonathan B. Singer Bruce A. Thyer
Kimberly H. McManama O’Brien Monica Pignotti

67 Intensive Family Preservation 76 Integration of Psychodynamic and

Services  528 Cognitive-behavioral Practices   594
Betty J. Blythe Terry B. Northcut
Andrea Cole Nina Rovinelli Heller
 Contents xi

77 The Assessment and Treatment of 87 Motivational Interviewing  684

Posttraumatic Stress Disorder   601 Shannon K. Johnson
M. Elizabeth Vonk Kirk von Sternberg
Mary M. Velasquez
78 Guidelines for Clinical Social Work
with Clients with Dissociative 88 Working with Clients Who Have
Disorders  608 Recovered Memories   691
Lina Hartocollis Susan P. Robbins
Jacqueline Strait
89 Terminating with Clients   697
Anne E. Fortune
PART VIII: GUIDELINES FOR SPECIFIC
TECHNIQUES
PART IX: GUIDELINES FOR SPECIFIC
79 Practice from a Technique INTERVENTIONS
Perspective  621
Francis J. Turner 90 Transtheoretical Model Guidelines
for Families with Child Abuse and
80 Developing Successful Relationships: Neglect  707
The Therapeutic and Group Janice M. Prochaska
Alliances  623 James O. Prochaska
Lawrence Shulman Judith J. Prochaska

81 The Use of Therapeutic Metaphor in 91 Play Therapy with Children in

Social Work   629 Crisis  714
Stephen R. Lankton Nancy Boyd-Webb

82 Cognitive Restructuring 92 Social Skills Training and Child

Techniques  640 Therapy  720
Donald K. Granvold Craig Winston LeCroy
Bruce A. Thyer
93 Guidelines for Chemical Abuse and
83 The Miracle and Scaling Questions Dependency Screening, Diagnosis,
for Solution-building and Treatment, and Recovery   726
Empowering  648 Diana M. DiNitto
Mo Yee Lee C. Aaron McNeece

84 Improving Classroom Management 94 Best Practices in Social Work with

through Positive Behavior Interventions Groups  734
and Supports   656 Mark J. Macgowan
A. M. Thompson Alice Schmidt Hanbidge

85 Best Practices in Parenting 95 Supported Employment  746

Techniques  667 Marina Kukla
Carolyn Hilarski Gary R. Bond

86 Bereavement and Grief Therapy   675 96 Working with and Strengthening Social
Elizabeth C. Pomeroy Networks  753
Kathleen H. Anderson Elizabeth M. Tracy
Renée Bradford Garcia Suzanne M. Brown
xii Contents

97 Eye Movement Desensitization 107 Case Management Practice in

and Reprocessing with Trauma Psychosocial Rehabilitation   830
Clients  758 David P. Moxley
Tonya Edmond
Allen Rubin 108 Case Management and Child
Welfare  840
98 Educational Interventions: Principles Jannah H. Mather
for Practice   767 Grafton H. Hull, Jr.
Kimberly Strom-Gottfried
109 Case Management with
99 Divorce Therapy: The Application of Substance-abusing Clients   846
Cognitive-behavioral and Constructivist W. Patrick Sullivan
Treatment  774
Donald K. Granvold 110 Case Management with Older
Adults  852
100 Primary Prevention Using the Daniel S. Gardner
Go Grrrls Group with Adolescent Dina Zempsky
Females  779
Craig Winston LeCroy 111 HIV/AIDS Case Management   859
Nicole M. Huggett Brian Giddens
Lana Sue I. Ka’opua
101 Cyberbullying and the Social Evelyn P. Tomaszewski
Worker  787
Michelle F. Wright 112 Social Work Case Management in
Diane L. Green Sherman Medical Settings   866
Candyce S. Berger
102 Empirically Supported Treatments
for Borderline Personality
Disorder  798 PART XI: COMMUNITY PRACTICE
Jonathan B. Singer
113 An Integrated Practice Model for
103 The Interface of Psychiatric Community Family Centers   879
Medications and Social Work   806 Anita Lightburn
Kia J. Bentley Chris Warren-Adamson
Joseph Walsh
114 International Perspectives on Social
Work Practice   888
PART X: CASE MANAGEMENT Karen M. Sowers
GUIDELINES
115 Community Organizing Principles and
104 An Overview of the NASW Practice Guidelines   894
Standards for Social Work Case Terry Mizrahi
Management  815
Chris Herman 116 Contemporary Community Practice
Models  907
105 Clinical Case Management   820 Marie Overby Weil
Joseph Walsh Dorothy N. Gamble
Jennifer Manuel
117 Legislative Advocacy to Empower
106 Assertive Community Treatment or Oppressed and Vulnerable
Intensive Case Management   824 Groups  920
Phyllis Solomon Michael Reisch
 Contents xiii

118 Community Partnerships to Support 128 Social Work Practice with

Youth Success in School   928 Latinos  998
Dennis L. Poole Ilze A. Earner
Aidyn L. Iachini Alan Dettlaff

119 Building Community Capacity in 129 Social Work Practice with African
the U.S. Air Force: Promoting a Americans  1004
Community Practice Strategy   935 Sadye M. L. Logan
Gary L. Bowen
James A. Martin 130 The Culturagram   1011
Elaine P. Congress
120 Neoliberalism, Globalization, and
Social Welfare   941 131 Social Work Practice with Persons
Michael J. Holosko Living with HIV/AIDS   1019
Neil Able
121 Community-led Structural Interventions
as Community Practice: A Review of
132 Social Work with Lesbian, Gay, Bisexual,
Initiatives in Haiti and India   950
and Transgendered Clients   1027
Toorjo Ghose
Mary Boes
Katherine van Wormer
PART XII: WORKING WITH VULNERABLE
133 Global Perspectives on Gender
POPULATIONS AND PERSONS AT RISK
Issues  1033
122 Overview of Working with Vulnerable Kristin Heffernan
Populations and Persons at Risk   959 Betty Blythe
Rowena Fong

123 The Legacy of Racism for Social Work PART XIII: SCHOOL SOCIAL WORK
Practice Today and What to Do
About It   962 134 Overview of Evidence-based Practice in
Ann Marie Garran School Social Work   1043
Joshua Miller Paula Allen-Meares
Katherine L. Montgomery
124 Anti-oppressive Practices   969
Katherine Ishizuka 135 Evidence-based Violence Prevention
Altaf Husain Programs and Best Implementation
Practices  1050
125 Effective Practice with Refugees and
Ronald O. Pitner
Immigrants  981
Roxana Marachi
Miriam Potocky
Ron Avi Astor
126 Social Work Practice with Native Rami Benbenishty
Americans  986
Teresa A. Evans-Campbell 136 Solution-focused Brief Therapy
Gordon E. Limb Interventions for Students at Risk to
Drop Out  1069
127 Social Work Practice with Asian and Cynthia Franklin
Pacific Islander Americans   993 Johnny S. Kim
Halaevalu F. Ofahengaue Vakalahi Michael S. Kelly
Rowena Fong Stephen J. Tripodi
xiv Contents

137 Treating Children and Adolescents 147 Assessing and Treating Adolescent Sex
with Attention Deficit Hyperactivity Offenders  1165
Disorder in the Schools   1079 Karen S. Knox
Steven W. Evans
A. Raisa Petca 148 Forensic Social Work with Women
Julie Sarno Owens Who Use Violence in Intimate
Relationships  1172
138 Effectively Working with Michelle Mohr Carney
Latino Immigrant Families in
Schools  1088 149 Best Practices for Assessing and
Eden Hernandez Robles Treating Older Adult Victims and
Alan Dettlaff Offenders  1177
Rowena Fong Tina Maschi
George S. Leibowitz
139 Online Database of Interventions Lauren Mizus
and Resources for School Social
Workers  1100
Natasha K. Bowen PART XV: EVIDENCE-BASED PRACTICE

150 Evidence-based Practice, Science, and

PART XIV: FORENSIC SOCIAL WORK Social Work: An Overview   1193
Bruce A. Thyer
140 The Changing Face of Forensic Social
Work Practice: An Overview   1115 151 Developing Well-structured
José B. Ashford Questions for Evidence-informed
Practice  1198
141 Forensic Social Work and Expert Eileen Gambrill
Witness Testimony in Child Leonard Gibbs
Welfare  1121
Carlton E. Munson 152 Locating Credible Studies for
Evidence-based Practice   1205
142 Mediation and Conflict Allen Rubin
Resolution  1134 Danielle Parrish
John Allen Lemmon
153 Critically Appraising Studies for
143 Child Protection Mediation: An Evidence-based Practice   1215
Interest-based Approach   1139 Denise E. Bronson
Allan Edward Barsky
154 Randomized Controlled Trials and
144 Forensic Social Workers in Offender Evidence-based Practice   1221
Diversion  1145 Paul Montgomery
Michael S. Shafer Evan Mayo-Wilson
José B. Ashford
155 Meta-analysis and Evidence-based
145 Therapeutic Tasks at the Drug Practice  1229
Court  1151 Jacqueline Corcoran
Jill L. Littrell Julia H. Littell

146 Making a Case for Life: Models 156 Systematic Reviews and
of Investigation in Death Penalty Evidence-based Practice   1232
Mitigation  1159 Julia H. Littell
José B. Ashford Jacqueline Corcoran
 Contents xv

157 Qualitative Research and 160 Evaluating Our Effectiveness in

Evidence-based Practiceâ•…â•… 1237 Carrying Out Evidence-based
Michael Saini Practiceâ•…â•…1258
Rory Crath Bruce A. Thyer
Laura L. Myers
158 Integrating Information from
Diverse Sources in Evidence-based Glossaryâ•…â•…1267
Practiceâ•…â•…1244
Author Indexâ•…â•… 1299
Eileen Gambrill
Subject Indexâ•…â•… 1337
159 Evidence-based Practice in Social Work
Educationâ•…â•…1250
Aron Shlonsky
 FOREWORD

For over a century the social work profession has to that effort. It is a useful tool for social work prac-
continued to evolve and develop new responses titioners, educators, and students, as well as other
to the issues and challenges of the times. The first allied professionals who together help to create
and second editions of the Social Workers’ Desk interdisciplinary, interprofessional education, prac-
Reference highlighted and focused attention on tice, and research. Throughout its 160 chapters this
the changes occurring in social work practice, edition responds and brings attention, in a clear,
education, and research. This third edition con- scholarly, and evidence-informed manner, to some
tinues in that tradition by continuing to identify of the most important issues and areas of concern
and put forth responses to the changes occur- confronting current social work practice.
ring in society, especially those that are having It is generally known that professionally
an impact on social work practice, education, and trained social workers practice and provide ser-
research. vices in a variety of settings, including child wel-
On a daily basis people around the world are fare and foster care agencies, community action
confronted by issues such as poverty, a lack of centers, hospitals, government offices, mental
access to quality education, unaffordable and/or health centers, homeless shelters, and schools; we
inadequate housing, and a lack of necessary health also work with persons of diverse ethnic, cultural,
and mental services. Now more than ever, we racial, economic, sexual orientation, and social
need social workers who have access to the most backgrounds. As professionals we help people
relevant, timely, and scholarly materials. Multiple to overcome some of life’s most difficult chal-
social, psychological, and biological factors deter- lenges, including poverty, discrimination, abuse,
mine the level of mental health of a person at any addiction, physical illness, divorce, grief and loss,
point in time. Persistent socioeconomic pressures unemployment, underemployment, educational
are recognized risks to mental health for indi- problems, disability, and mental illness.
viduals and communities. The clearest evidence Central to social work’s primary mission is
is associated with indicators of poverty, including that of enhancing human well-being and working
low levels of education. Poor mental health is also to ensure that people are able to meet their basic
associated with rapid social change, stressful work needs, especially the most vulnerable among us.
conditions, gender discrimination, social exclu- We have done this through our various roles in
sion, unhealthy lifestyles, risks of violence and society and in our varied fields of practice, and
physical ill-health, and human rights violations. now we must work to ensure that those who are
Specific psychological and personality factors the most vulnerable among us are at the front
also make people vulnerable to mental disorders. of all of our efforts as we work to put in place a
Lastly, there are some biological causes of mental more just economic system.
disorders, including genetic factors and chemical Paulo Freire (1960) wrote that:
imbalances in the brain. (http://www.who.int/
mediacentre/factsheets/fs220/en/index.html) The radical, committed to human liberation,
The focus and depth of this third edition of the does not become the prisoner of a “circle
Social Workers’ Desk Reference indeed contributes
xviii Foreword

of certainty” within which reality is also the individual clinical level to community-based
imprisoned. On the contrary, the more radical empowerment and advocacy.
the person is, the more fully he or she enters The world is on the move with billions of
into reality so that, knowing it better, he or people yearning to be truly secure—to be free
she can better transform it. This individual is
from fear and free from want, and able to live in
not afraid to confront, to listen, and to see the
world unveiled. This person is not afraid to meet
peace and in dignity. This is a time when global
the people or to enter into dialogue with them. and national issues intersect, calling for a level
This person does not consider himself or herself of coordination and leadership that is essential
the proprietor of history or of all people, or the for all of us. We must show that these concerns
liberator of the oppressed; but he or she does really can be dealt with collectively and fairly,
commit himself or herself, within history, to with equity and social justice for all. As social
fight at their side. (Friere, 1960) work professionals, we cannot do that if we are
not working together, and do not have at our fin-
Freire also said that “those who authentically gertips the most relevant and timely information
commit themselves to the people must re-examine to ensure that our practice is the best informed
themselves constantly” (Freire, 1 1960, p. 60), that it can be! My friends, we have much work
and that is just what this new edition helps us before us!
to do. This third edition of the Social Workers’ To those who have contributed to this latest
Desk Reference is not only a major contribution edition, thank you all for your hard work.
to the field, but its articles focus on the important
practice issues of this period. It is an important In solidarity,
tool that can and will provide immeasurable ben- Gary Bailey, LHD (h. c.), MSW, ACSW
efits to the social work profession. Its chapters are President, International Federation of Social
written by some of the field’s foremost experts Workers
and bring to the reader the most recent concep- Professor of Practice, Simmons College School of
tual knowledge and empirical evidence to aid in Social Work
their understanding of the rapidly changing field Professor of Practice, Simmons College School of
of social work practice. It offers a guide to social Nursing and Health Studies
work interventions in a variety of settings: from
 ACKNOWLEDGMENTS

Building on the success of the second edition I know I speak for Al when I express my
of The Social Workers’ Desk Reference and Al gratitude to all the staff at Oxford University
Roberts’s efforts, we have assembled an esteemed Press, in particular Joan Bossert, Vice President
Associate Editor Board, many of whom worked at OUP, and Dana Bliss, Senior Editor, and the
so hard on the first two editions. New Associate support staff, Brianna Marron, Mallory Jenson
Editors were included, however, and here I have and Devi Vaidyanathan. They have been ter-
intentionally added young talent for the simple rific and this book would be the lesser without
reason of succession and the anticipated demand them.
for additional volumes in the future. Al is gone, And finally, this edition would not be possible
and by then I will likely be, too, so it is critical to without the involvement, support, and love from
identify who will carry Al’s efforts forward. The Vikki Vandiver. After 32 years, she is finally get-
Associate Editors decided on the scope and con- ting used to me (I hope).
tent of the sections, with only a few added by me.
I am grateful to all the Associate Editors for the Kevin Corcoran
seriousness with which they addressed their tasks VanCor Point of View
and for their dedication to producing excellent Yachats, Oregon
sections and, in total, an improved third edition. March 2014
 CONTRIBUTORS

COEDITORS-IN-CHIEF Criminal Justice, and Director of Faculty and

Curriculum Development in the Faculty of Arts
Kevin Corcoran, PhD, JD is Professor of Social and Sciences at Rutgers, the State University
Work at the University of Alabama, and has of New Jersey in Piscataway. He was a college
been a college professor for over 35 years. He professor for 35 years. Dr. Roberts received an
holds a BA in English literature from Colorado MA degree in Sociology from the Graduate
State University, an MA in counseling from the Faculty of Long Island University in 1967, and
University of Colorado–Colorado Springs, an a doctorate in social work from the School of
MSW and PhD from the University of Pittsburgh, Social Work and Community Planning at the
and a JD from the University of Houston. He has University of Maryland in Baltimore in 1978.
been involved in research and practice of clini- Dr. Roberts was the founding Editor-in-Chief
cal social work since 1973, and was a commercial of the Brief Treatment and Crisis Intervention
and community mediator from 1982 to 2012. He journal and the Victims and Offenders journal.
has published over 130 ephemeral journal arti- He was a member of The Board of Scientific and
cles and book chapters, has authored or edited 15 Professional Advisors and a Board-Certified
books, including Measures for Clinical Practice Expert in Traumatic Stress for The American
and Research, the ever-entertaining cookbook, Academy of Experts in Traumatic Stress,
Food for Thought: A Two-Year Cooking Guide and a Diplomate of the American College of
for Social Work Students, and is co-editor of Best Forensic Examiners. Dr. Roberts authored,
Practices in Mental Health. He is the founder co-authored, or edited approximately 250
of a dotcom called EasyRATs.com (aka Rapid scholarly publications, including numerous
Assessment Tools, RATs) that performs drug, peer-reviewed journal articles and book chap-
alcohol, and mental health assessments in less ters, and 38 books. Among his books were the
than a second; the urls are Do-I-need-therapy. Handbook of Domestic Violence Intervention
com and Is-therapy-effective.com. He is also the Strategies (Oxford University Press, 2002),
designer or inventor of the “The Electric Seating Crisis Intervention Handbook: Assessment,
Chart,” the Internet-based “Sole Mate,” a shoe- Treatment and Research, 3rd edition (Oxford
powered battery for charging smartphones, and University Press, 2005), Juvenile Justice
“The Electric Hamster,” which is designed to Sourcebook (Oxford University Press, 2004),
teach STEM to elementary school girls, and Evidence-Based Practice Manual: Research
“Little Al” the Alabama cheering glove. His hob- and Outcome Measures in Health and Human
bies including gourmet cooking, portrait paint- Services (coedited with Kenneth R. Yeager,
ing, random study of history, bonsai gardening, Oxford University Press, 2004), and Ending
creative writing, and a bad golf swing; he is also Intimate Abuse (coauthored with Beverly
trying to learn to play the piano. Schenkman Roberts, Oxford University Press,
2005). Dr. Roberts was also the editor of three
Albert R. Roberts, PhD, DACFE. The late Albert book series: the Springer Series on Social Work,
R. Roberts was Professor of Social Work and the Springer Series on Family Violence, and
xxii Contributors

the Greenwood/Praeger Series on Social and recidivism and continues as a Senior Consultant
Psychological Issues. Dr. Roberts was the recipi- with Mercer Government Human Services
ent of many awards for his teaching and his Consulting on issues involving forensic and cor-
scholarly publications. rectional mental health. Dr. Ashford has pub-
Prior to his death in the summer of 2008, lished widely on forensic matters, including
Dr. Roberts was in the midst of many projects, a coedited book recognized as one of the most
including his courses on Crisis Intervention, influential books on management of violence
Domestic Violence, Introduction to Criminal risk in the forensic literature. His most recent
Justice, Research Methods, Program Evaluation, book on death penalty mitigation with Oxford
Victimology and Victim Assistance, and University Press addresses an important gap in
Juvenile Justice at Rutgers University; train- forensic literature and is receiving high praise
ing crisis intervention workers, crisis counsel- from sentencing advocates, mitigation special-
ors, and clinical supervisors in crisis assessment ists, and lawyers.
and crisis intervention strategies; and training
police officers and administrators in domes- Rowena Fong, MSW, EdD is the Ruby Lee Piester
tic violence policies and crisis intervention. Centennial Professor in Services to Children and
He was a lifetime member of the Academy of Families at The University of Texas at Austin.
Criminal Justice Sciences (ACJS), a fellow of Her scholarship and research focus on immi-
the American Orthopsychiatric Association, grant and refugee children and families, child
a member of the Council on Social Work welfare, and culturally competent practice. She
Education and the National Association of has over 100 publications, including coauthored
Social Workers (NASW) since 1974, and was books on Culturally Competent Practice with
listed in Who’s Who in America from 1992 Immigrant and Refugee Children and Families
forward. and Culturally Competent Practice: Skills,
Interventions, and Evaluations.

SECTION EDITORS Cynthia Franklin, PhD, is Assistant Dean for

Doctoral Education and Stiernberg/Spencer
Paula Allen-Meares, PhD, is the Chancellor of Family Professor in Mental Health at The
the University of Illinois at Chicago. Previously University of Texas at Austin School of Social
she served as the Dean, Norma Radin Collegiate Work. Dr. Franklin has published widely on top-
Professor of Social Work, and Professor of ics such as dropout prevention, clinical assess-
Education at the University of Michigan. Her ment, the effectiveness of solution-focused
research interests include the tasks and functions therapy in school settings, and adolescent preg-
of social workers employed in educational set- nancy prevention. She is the current Editor-in-
tings; psychopathology in children, adolescents, Chief of the Encyclopedia of Social Work.
and families; adolescent sexuality; premature
parenthood; and various aspects of social work Laura M. Hopson, PhD, MSW is an Associate
practice. Professor at the University of Alabama School
of Social Work. She has published articles
José B. Ashford, MSW, PhD, LCSW is a Professor in the areas of school social work practice,
of Social Work and a member of the Doctoral school climate, substance abuse prevention,
Faculty in Sociology at Arizona State University. and solution-focused brief therapy, and has
He is also the Director of the Office of Forensic coauthored the book, Research Methods for
Social Work Research and Training in the School Evidence-Based Practice.
of Social Work and an Affiliate Professor in the
Schools of Criminology and Criminal Justice Katherine L. Montgomery, PhD, MSSW is the
and Justice and Social Inquiry. He is the chief School Director at Little Sunshine’s Playhouse
research consultant for the City of Phoenix and Preschool in Saint Louis, Missouri. She
Prosecutor on matters involving the implemen- graduated with her BSW from Missouri State
tation of principles of community prosecution, University and MSSW and PhD in Social Work
offender diversion, and problem-solving jus- from The University of Texas at Austin. She has
tice. He is also involved in research with the over 18 years of experience working with children
Social Intelligence Institute on prevention of and families in a variety of settings, but most of
 Contributors xxiii

her recent work focuses on early evidence-based LIST OF CONTRIBUTORS

prevention intervention delivery in school set-
tings. She has authored over 30 publications and Neil Able, PhD
presented at numerous conferences both nation- Professor
ally and internationally. School of Social Work
Florida State University
lisa rapp-McCall, PhD, MSW is a Professor in Tallahassee, Florida
Social Work at St. Leo’s University in St. Leo,
Florida. Her research interests include juvenile Paula Allen-Meares, PhD
crime and violence, at-risk children and adoles- Chancellor
cents, and prevention. University of Illinois at Chicago
Chicago, Illinois
Phyllis Solomon, PhD is a Professor in the
School of Social Policy & Practice and Professor Kathleen H. Anderson, MSW, LCSW
of Social Work in the School of Medicine at the Private Consultant
University of Pennsylvania. She has conducted Austin, Texas
numerous federally funded randomized clini- Christina M. Andrews, PhD
cal trials for adults with severe mental illness Assistant Professor
and their families. She reviews research grants College of Social Work
for U.S. federal agencies, private foundations, University of South Carolina
and Canadian organizations. She also coed-
Columbia, South Carolina
ited another book, The Research Process in the
Human Services: Behind the Scenes. Harry J. Aponte, MSW, PhD
Clinical Associate Professor
Bruce A. Thyer, PhD, LCSW is Professor and for- Programs in Couple and Family Therapy
mer Dean with the College of Social Work at College of Nursing and Health Professions
Florida State University. Dr. Thyer has authored Drexel University
over 250 articles in refereed journals, written Philadelphia, Pennsylvania
over 60 book chapters, and produced over 28
books. He is the Founding and current Editor of José B. Ashford, MSW, PhD, LCSW
the bimonthly peer-reviewed journal Research Professor and Associate Director
on Social Work Practice, produced by Sage School of Social Work
Publications. Director of the Office of Forensic Social Work
Research and Training
Vikki L. Vandiver, MSW, DrPH is Dean and Affiliate Professor in the Schools of
Professor of Social Work at the University Criminology and Criminal Justice and
of Alabama School of Social Work. She is Justice and Social Inquiry
the author of three books on mental health Arizona State University
(Maneuvering the Maze of Managed Care,
Phoenix, Arizona
1996, Free Press; Integrating Health Promotion
and Mental Health, 2009, Oxford University Ron Avi Astor, PhD
Press; Best Practices in Community Mental Professor
Health, 2013, Lyceum Books) and over three Schools of Social Work and Education
dozen chapters and articles on best practices University of Southern California
in mental health. She is also coeditor of the Los Angeles, California
peer-reviewed journal, Best Practices in Mental
Health (Lyceum Books) She has been in the Gary Bailey, PhD (h. c.), MSW, ACSW
field of community mental health for over 35 President, International Federation of
years, has taught Diagnostic and Statistical Social Workers
Manual of Mental Disorders (DSM) content Professor of Practice, Simmons College
for the last 21 years, and has recently completed School of Social Work
a SAMHSA grant to evaluate equine-assisted Professor of Practice, Simmons College
therapy with at-risk tribal and nontribal School of Nursing and Health Studies
youth. Boston, Massachusetts
xxiv Contributors

Allan Edward Barsky, JD, MSW, PhD Ted Bober, MSW, RSW
Professor Program Director
School of Social Work Certificate Program in Crisis Management
Florida Atlantic University for Workplace Trauma and Disasters
Boca Raton, Florida Factor-Inwentash Faculty of
Member of NASW National Ethics Social Work
Committee University of Toronto
Toronto, Ontario, Canada
Kathryn Karusaitis Basham, PhD
Professor Mary Boes, MSW, MPH, PhD
School for Social Work Professor
Smith College Department of Social Work
Northampton, Massachusetts University of Northern Iowa
Cedar Falls, Iowa
Katherine J. W. Baucom, PhD
Department of Psychology Gary R. Bond
University of Utah Chancellor’s Professor
Salt Lake City, Utah Department of Psychology
Rami Benbenishty, PhD Indiana University–Purdue University
Gordon Brown Professor of Indianapolis
Social Work Indianapolis, Indiana
School of Social Work and Social Welfare William Borden, PhD
Hebrew University of Jerusalem Senior Lecturer
Jerusalem, Israel School of Social Administration
Kimberly Bender, PhD University of Chicago
Associate Professor Chicago, Illinois
School of Social Work Gary L. Bowen, PhD
University of Denver Kenan Distinguished Professor
Denver, Colorado School of Social Work
Kia J. Bentley, PhD University of North Carolina
Professor Chapel Hill, North Carolina
School of Social Work Natasha K. Bowen
Virginia Commonwealth University Associate Professor
Richmond, Virginia School of Social Work
Candyce S. Berger, PhD University of North Carolina
Professor and Director of Chapel Hill, North Carolina
Social Work Nancy Boyd-Webb, DSW
University of Texas El Paso Distinguished Professor of
El Paso, Texas Social Work
Lisa K. Berger, PhD James R. Dumpson Chair in
Associate Professor Child Welfare Studies
Helen Bader School of Graduate School of
Social Work Social Service
University of Wisconsin–Milwaukee Fordham University
Milwaukee, Wisconsin Tarrytown, New York
Betty J. Blythe Christine E. Brady, MA
Professor Doctoral Student
Graduate School of Social Work Department of Psychology
Boston College Ohio University
Boston, Massachusetts Athens, Ohio
 Contributors xxv

Jerrold R. Brandell, PhD Elaine P. Congress, BA, MAT, MS, MA, DSW
Professor Professor
School of Social Work Graduate School of Social Service
Wayne State University Fordham University
Detroit, Michigan New York, New York
Denise E. Bronson, PhD Jacqueline Corcoran, PhD
Associate Professor and Professor
Associate Dean of Academic Affairs School of Social Work
College of Social Work Northern Virginia Branch
Ohio State University Virginia Commonwealth University
Columbus, Ohio Alexandria, Virginia
Samantha M. Brown, PhD Kevin Corcoran, PhD, JD
School of Social Work Professor
University of Denver School of Social Work
Denver, Colorado University of Alabama
Suzanne M. Brown, PhD, LICSW Tuscaloosa, Alabama
Associate Professor Rory Crath, PhD
School of Social Work Professor
Wayne State University School of Social Work
Detroit, Michigan St. Thomas University
Daphne S. Cain, PhD Fredericton, New Brunswick,
Director, School of Social Work Canada
University of Mississippi
James G. Daley, PhD, MSW
University, Mississippi
Associate Professor
Michelle Mohr Carney, PhD School of Social Work
Professor and Director Indiana University
School of Social Work Indianapolis, Indiana
Arizona State University
Julie S. Darnell, PhD, MHSA
Phoenix, Arizona
Assistant Professor
Andrew Christensen, PhD School of Public Health
Professor University of Illinois
Department of Psychology Chicago, Illinois
University of California
Los Angeles, California Tara DeBraber, MSW
Clinical Social Worker
Elizabeth Clark, PhD, ACSW, MPH San Diego Veterans Administration
Former Executive Director, NASW San Diego, California
Private Consultant
Rockville, Maryland Peter De Jong, PhD
Professor of Social Work
Andrea Cole, PhD Student
Department of Sociology and
Silver School of Social Work
Social Work
New York University
Calvin College
New York, New York
Grand Rapids, Michigan
Jose E. Coll, PhD
Associate Professor and Alan Dettlaff, PhD
Director of Veteran Services Associate Professor
Social Work College of Social Work
St. Leo University University of Illinois
St. Leo, Florida Chicago, Illinois
xxvi Contributors

Diana M. DiNitto, PhD Rowena Fong, EdD, MSW, BA

Cullen Trust Centennial Professor in Alcohol Ruby Lee Piester Centennial Professor in
Studies and Education Services to Children and Families
Distinguished Teaching Professor School of Social Work
School of Social Work University of Texas at Austin
University of Texas Austin, Texas
Austin, Texas
Anne E. Fortune, PhD
Martha Morrison Dore, PhD Professor
Associate Research Professor in Psychiatry School of Social Welfare
Harvard University Medical School University at Albany
Cambridge, Massachusetts State University of New York
Albany, New York
James W. Drisko, PhD
Professor Raymond D. Fox, PhD
School of Social Work Professor
Smith College Graduate School of Social Service
Northampton, Massachusetts Fordham University
New York, New York
Theresa J. Early, PhD
Associate Professor Cynthia Franklin, PhD
College of Social Work Stiernberg/Spencer Family Professor in
Ohio State University Mental Health
Columbus, Ohio Coordinator of the Clinical Concentration for
Ilze A. Earner, PhD the Masters Program
Associate Professor School of Social Work
School of Social Work University of Texas at Austin
Hunter College Austin, Texas
City University of New York Mark W. Fraser, PhD
New York, New York Professor
Yvonne Eaton-Stull, MSW School of Social Work
Clinical Social Worker University of North Carolina
Director of Crisis Services Chapel Hill, North Carolina
Community Mental Health Services John M. Gallagher, MSW
Erie, Pennsylvania Doctoral Student and Faculty Associate
Tonya Edmond, PhD Office of Forensic Social Work Research and
Associate Professor Training
George Warren Brown School of Social Work School of Social Work
Washington University Arizona State University
St. Louis, Missouri Phoenix, Arizona

Steven W. Evans, PhD Dorothy N. Gamble, MSW

Professor Clinical Associate Professor Emeritus
Ohio University School of Social Work
Athens, Ohio University of North Carolina
Chapel Hill, North Carolina
Teresa A. Evans-Campbell, PhD, MSW
Associate Professor Eileen Gambrill, PhD
Director, Center for Indigenous Health and Professor
Child Welfare Research School of Social Welfare
University of Washington University of California
Seattle, Washington Berkeley, California
 Contributors xxvii

Genoveva Garcia, MSW Brian Giddens, LICSW, ACSW

Psychotherapist and Assistant to Clinical Associate Director of Social Work and
Director Care Coordination
Metropolitan Center for Mental Health University of Washington
New York, New York Medical Center
Clinical Associate Professor
Renée Bradford Garcia
School of Social Work
Private Practice
University of Washington
Pflugerville, Texas
Seattle, Washington
Daniel S. Gardner Alex Gitterman, MSW, EdD
Associate Professor Director of PhD Program
Silberman School of Social Work and Professor
Hunter College School of Social Work
New York, New York University of Connecticut
Charles D. Garvin, PhD West Hartford, Connecticut
Professor Emeritus of Social Work Stephen Gorin
School of Social Work Professor
The University of Michigan Department of Social Work
Ann Arbor, Michigan Plymouth State University
Ann Marie Garran, PhD, MSW Plymouth, New Hampshire
Senior Clinical Supervisor Donald K. Granvold, PhD (deceased)
Hunter College Employee Assistance Program Professor
New York, New York School of Social Work
Adjunct Professor University of Texas at Arlington
School for Social Work Arlington, Texas
Smith College
Northampton, Massachusetts Diane L. Green Sherman, PhD
Associate Professor of
Felicia de la Garza-Mercer, PhD Social Work
Psychologist Florida Atlantic University–Jupiter Campus
Student Health and Counseling Services Jupiter, Florida
University of California San Francisco
San Francisco, California Samantha A. Hafner, PhD, MSW
School of Social Work
Zvi D. Gellis, PhD University of South Florida
Professor and Director Tampa, Florida
Center for Mental Health & Aging
School of Social Policy & Practice Alice Schmidt Hanbidge, PhD, RSW
University of Pennsylvania Assistant Professor
Philadelphia, Pennsylvania Renison University College School of
Social Work
Toorjo Ghose, PhD University of Waterloo
Associate Professor Waterloo, Ontario
School of Social Policy and Practice Canada
University of Pennsylvania
Philadelphia, Pennsylvania Lina Hartocollis, PhD
Associate Dean
Leonard Gibbs, PhD (deceased) Director, Clinical Doctorate in
Professor Social Work Program
School of Social Work School of Social Policy & Practice
University of Wisconsin University of Pennsylvania
Eau Claire, Wisconsin Philadelphia, Pennsylvania
xxviii Contributors

Anthony Hassan, PhD Altaf Husain, PhD

Clinical Associate Professor Assistant Professor
School of Social Work School of Social Work
University of Southern California Howard University
Los Angeles, California Washington, DC
Kristin Heffernan, PhD Aidyn L. Iachini, PhD
Associate Professor Assistant Professor
Department of Social Work College of Social Work
College at Brockport University of South Carolina
State University of New York Columbia, South Carolina
Brockport, New York
Katherine Ishizuka, MSW
Nina Rovinelli Heller, PhD Doctoral Student
Associate Professor School of Social Work
School of Social Work Howard University
University of Connecticut Washington, DC
West Hartford, Connecticut
Catheleen Jordan, PhD
Chris Herman, MSW The Cheryl Milkes Moore Professionship
Senior Practice Associate in Mental Health and
National Association of Professor of Social Work
Social Workers School of Social Work
Washington DC University of Texas at Arlington
Carolyn Hilarski, PhD, LCSW, ACSW Arlington, Texas
Associate Professor Shannon K. Johnson, MSW
Department of Social Work Doctoral Student
Buffalo State College School of Social Work
State University of New York University of Texas Austin
Buffalo, New York Austin, Texas
Michael J. Holosko, PhD Andrea Kampfner, PhD
Pauline M. Berger Professor of Family and Evaluation Associate
Child Welfare LeCroy and Milligan and Associates
University of Georgia School of Tuscan, AS
Social Work
Athens, Georgia Lana Sue I. Ka’opua, PhD, DCSW, LSW
Associate Professor and Head of Health
Laura M. Hopson, PhD
Concentration
Associate Professor School of Social Work and Cancer Research
School of Social Work Center of Hawai’i
University of Alabama University of Hawai’i, Manoa Campus
Tuscaloosa, Alabama Director, Ka Lei Mana’olana
Nicole M. Huggett, MSW Breast Health Project
Evaluation Associate Honolulu, Hawai’i
LeCroy and Milligan Associate Co-Editor-in-Chief, Social Work
Tempe, Arizona Journal of Indigenous Matters
Grafton H. Hull, Jr., EdD Patricia Kelley, PhD
Director, BSW Program Professor Emerita
College of Social Work School of Social Work
University of Utah The University of Iowa
Salt Lake City, Utah Iowa City, Iowa
 Contributors xxix

Michael S. Kelly, PhD, LCSW Mo Yee Lee, PhD

Associate Professor Professor
School of Social Work College of Social Work
Loyola University The Ohio State University
Chicago, Illinois Columbus, Ohio
Coordinator of Research and Outreach,
George S. Leibowitz, PhD, LICSW
Loyola Family and Schools
Associate Professor
Partnership Program
Department of Social Work
Stephanie Kennedy, MSW University of Vermont
Doctoral Student Burlington, Vermont
School of Social Work
John Allen Lemmon, PhD
Florida State University
Professor
Tallahassee, Florida
School of Social Work
Johnny S. Kim, PhD San Francisco State University
Assistant Professor San Francisco, California
School of Social Work Jilan Li, PhD
University of Denver Associate Professor
Denver, Colorado North Carolina A & T
Sara Kintzle, PhD State University
Research Assistant Professor Greensboro, North Carolina
School of Social Work Anita Lightburn, MSS, EdD
University of Southern California Professor of Social Work
Los Angeles, California Graduate School of
Karni Kissil, PhD Social Work
Licensed Marriage and Fordham University
Family Therapist New York, New York
Private Practice Elizabeth Lightfoot, PhD
Jupiter, Florida Professor and PhD Program Director
Karen S. Knox, PhD School of Social Work
Associate Professor University of Minnesota–
School of Social Work Twin Cities
Texas State University St. Paul, Minnesota
San Marcos, Texas Jan Ligon, PhD
Marina Kukla, PhD Associate Professor
Psychologist School of Social Work
Richard L. Roudebush VA Medical Center Georgia State University
Indianapolis, Indiana Atlanta, Georgia
Stephen R. Lankton, MSW, DAHB Gordon E. Limb, PhD
Executive Director Professor
Phoenix Institute of Ericksonian Therapy Brigham Young University
Phoenix, Arizona Salt Lake City, Utah
Craig Winston LeCroy, PhD Julia H. Littell, PhD
Professor Professor
School of Social Work Graduate School of Social Work and
Arizona State University– Social Research
Tucson Component Bryn Mawr College
Tucson, Arizona Bryn Mawr, Pennsylvania
xxx Contributors

Jill L. Littrell, PhD San José, California

Associate Professor
Jennifer Manuel, PhD
School of Social Work
Assistant Professor
Georgia State University
Silver School of Social Work
Atlanta, Georgia
New York University
Sadye M. L. Logan, DSW New York, New York
DeQuincey Newman Professor Andrew T. Marks, LMSW
Director of the Newman Institute for Peace Lecturer
and Justice School of Social Work
College of Social Work Texas State University–San Marcos
University of South Carolina San Marcos, Texas
Columbia, South Carolina
Tina Bogart Marshall, PhD
Jack Lu, MSW
Consultant and Part-time Professor
Doctoral Candidate School of Social Work
School of Social Work University of Maryland–Baltimore County at
University of Connecticut Shady Grove
Stores, Connecticut Rockville, Maryland
Robert Lucio, PhD, LCSW
James A. Martin, PhD, BCD
Department of Child and Family Studies Professor
College of Behavioral and Community Graduate School of Social Work and Social
Sciences Research
University of South Florida Bryn Mawr College
Tampa, Florida Bryn Mawr, Pennsylvania
Brandy Macaluso, BSW Colonel, U.S. Army (Retired)
Crime Victim Practitioner Jannah H. Mather, PhD
Coalition for Independent Living Options, Inc. Dean and Professor
West Palm Beach, Florida College of Social Work
Mark J. Macgowan, PhD University of Utah
Professor Salt Lake City, Utah
Robert Stempel College of Public Health and Tina Maschi, PhD, LCSW
Social Work School of Social Work
Florida International University Fordham University
Miami, Florida New York, New York
Gordon MacNeil, PhD
Evan Mayo-Wilson, MGA, MSc
Associate Professor Department Lecturer
School of Social Work Centre for Evidence-Based Intervention
The University of Alabama University of Oxford
Tuscaloosa, Alabama Oxford, England, United Kingdom
Kimberly H. McManama O’Brien, PhD
Monica McGoldrick, MSW, PhD (h. c.)
Assistant Professor Director, Family Institute of
Simmons College New Jersey
Boston, Massachusetts Highland Park, New Jersey
Roxana Marachi, PhD Adjunct Associate Professor of Clinical
Associate Professor Psychiatry
Department of Elementary Education Robert Wood Johnson Medical School
Lurie College of Education University of Medicine and Dentistry
San José State University Piscataway, New Jersey
 Contributors xxxi

Steven L. McMurtry, PhD Carlton E. Munson, PhD

Professor Professor
Helen Bader School of Social Welfare School of Social Work
University of Wisconsin University of Maryland
Milwaukee, Wisconsin Baltimore, Maryland
C. Aaron McNeece, PhD Laura L. Myers, MSW, PhD
Former Dean and Walter W. Hudson Associate Professor
Professor of Social Work Department of Social Work
College of Social Work Florida A & M University
Florida State University Tallahassee, Florida
Tallahassee, Florida
Jason M. Newell, PhD
Joshua Miller, PhD, MSW Associate Professor and Director of
Professor and Chair of Policy Sequence Social Work
School for Social Work University of Montevallo
Smith College Montevallo, Alabama
Northampton, Massachusetts
Barbara Van Noppen, MSW
Shari Miller, PhD Clinical Social Worker
Associate Professor Angel Wellness Center
School of Social Work Providence, Rhode Island
University of Georgia
Terry B. Northcut, PhD, LCSW
Athens, Georgia
Associate Professor
Terry Mizrahi, PhD Director of the Doctoral Program
Professor and Chair, Community School of Social Work
Organization & Planning Loyola University of Chicago
School of Social Work Chicago, Illinois
Hunter College
Julie Sarno Owens, PhD
City University of New York
Associate Professor
New York, New York
Department of Psychology
Lauren Mizus, MA, PhD Ohio University
Master of Social Work Program Athens, Ohio
University of Vermont
William P. Panning, MSW
Burlington, Vermont
Private Practice and
Katherine L. Montgomery, PhD Guest Lecturer
School Director College of Social Work
Little Sunshine Playhouse and PreSchool The Ohio State University
St. Louis, Missouri Columbus, Ohio
Paul Montgomery, DPhil Daniel V. Papero, PhD
Reader in Psycho-Social Intervention Private Practice
Centre for Evidence-Based Intervention Director of Clinical Services
University of Oxford Georgetown Family Center
Oxford, England, United Kingdom Washington, DC
David P. Moxley, PhD Danielle E. Parrish, PhD
Oklahoma Health Care Authority Professor Associate Professor
Professor of Social Work Graduate College of
School of Social Work Social Work
University of Oklahoma University of Houston
Norman, Oklahoma Houston, Texas
xxxii Contributors

A. Raisa Petca, MA Blanca M. Ramos, PhD

Ohio Education Research Associate Professor
Ohio University School of Social Work
Athens Ohio State University of New
York Albany
Monica Pignotti, MSW, PhD
Albany, New York
Assistant Professor
College of Social Work Lisa Rapp-McCall, PhD, MSW
Florida State University Professor
Tallahassee, Florida Department of Social Work
St. Leo University
Cathy King Pike, PhD
St. Leo, Florida
Professor
School of Social Work Frederic G. Reamer, PhD
Indiana University Professor
Indianapolis, Indiana School of Social Work
Rhode Island College
Ronald O. Pitner, PhD
Providence, Rhode Island
Independent Research Consultant
North Brunswick, New Jersey William J. Reid, DSW (deceased)
Distinguished Professor and Chair, PhD
Elizabeth C. Pomeroy, PhD
Program
Professor
School of Social Work
School of Social Work
State University of
University of Texas
New York
Austin, Texas
Albany, New York
Dennis L. Poole, PhD
Professor Michael Reisch, PhD, LMSW
College of Social Work Daniel Thursz Distinguished Professor of
University of South Carolina Social Justice
Columbia, South Carolina School of Social Work
University of Maryland
Miriam Potocky, PhD Baltimore, Maryland
Professor
School of Social Work Albert R. Roberts, PhD (deceased)
Florida International University Professor of Criminal Justice and
Miami, Florida Social Work
School of Arts and Sciences
James O. Prochaska, PhD Rutgers University
Professor and Director Livingston Campus
Cancer Research Center and Piscataway, New Jersey
Department of Psychology
University of Rhode Island Eden Hernandez Robles, MSW, Doctoral
Kingston, Rhode Island Candidate
Assistant Instructor
Janice M. Prochaska, PhD School of Social Work
CEO and Social Work Consultant University of Texas–Austin
Pro-Change Behavior Systems Austin, Texas
Kingston, Rhode Island
Susan P. Robbins, PhD
Judith J. Prochaska, PhD, MPH Professor
Associate Professor of Medicine Graduate School of
Stanford University Prevention Research Center Social Work
Stanford University University of Houston
San Francisco, California Houston, Texas
 Contributors xxxiii

Susan J. Rose, PhD Michael S. Shafer, PhD

Professor Professor
Helen Bader School of School of Social Work
Social Welfare Arizona State University
University of Wisconsin Phoenix, Arizona
Milwaukee, Wisconsin
Aron Shlonsky, PhD
Julie M. Rosenzweig, PhD Associate Professor
Professor Faculty of Social Work
School of Social Work University of Toronto
Portland State University Toronto, Ontario, Canada
Portland, Oregon Lawrence Shulman, EdD, MSW
Juliet Cassuto Rothman, PhD, LCSW Professor
Lecturer in Social Welfare and School of Social Work
Public Health State University of New York at Buffalo
University of California–Berkeley Buffalo, New York
Berkeley, California Debra Siegel, PhD
William S. Rowe, DSW Professor
Professor and Director School of Social Work
School of Social Work Rhode Island College
University of South Florida Providence, Rhode Island
Tampa, Florida Jonathan B. Singer, LCSW
Allen Rubin, PhD Instructor
Kantambu Latting College Professorship for Social Administration
Leadership and Change Temple University
Graduate School of Philadelphia, Pennsylvania
Social Work Host and Founder of The Social Work Podcast
University of Houston Jeff Skinner, MSW
Houston, Texas School of Social Work
Melanie Sage, PhD University of Georgia
Assistant Professor Athens, Georgia
University of North Dakota Mark Smith, PhD
Grand Forks, North Dakota Associate Professor
Michael Saini, PhD School of Social Work
Associate Professor Barry University
Faculty of Social Work Miami, Florida
University of Toronto
Phyllis Solomon, PhD
Toronto, Ontario, Canada
Professor
Alison Salloum, PhD School of Social Policy & Practice
Associate Professor University of Pennsylvania
School of Social Work Philadelphia, Pennsylvania
University of South Florida
Karen M. Sowers, PhD
Tampa, Florida
Dean and Professor
Diane Scotland-Coogan, MSW College of Social Work
Instructor The University of Tennessee
Social Work Knoxville, Tennessee
St. Leo’s University Coeditor, Best Practices in Mental Health: An
St. Leo, Florida International Journal
xxxiv Contributors

David W. Springer, PhD Evelyn P. Tomaszewski, MSW

University Distinguished Teaching Professor Project Director and Senior Policy Advisor
School of Social Work Practice, Human Rights, and
The University of Texas International Affairs
Austin, Texas National Association of Social Workers
Washington, DC
Alicia J. Stinson, MSW
School of Social Work Elizabeth M. Tracy, PhD
University of South Florida Grace Longwell Coyle Professor of
Tampa, Florida Social Work
Mandel School of Applied Social
Jacqueline Strait, MSW, PhD
Sciences
Instructor
Case Western Reserve University
School of Policy and Practice
Cleveland, Ohio
University of Pennsylvania
Philadelphia, Pennsylvania Stephen J. Tripodi, PhD
Associate Professor
Kimberly Strom-Gottfried, MSW, PhD
College of Social Work
Smith P. Theimann Jr. Distinguished Professor
Florida State University
of Ethics and Professional Practice
Tallahassee, Florida
School of Social Work
University of North Carolina Francis J. Turner, DSW
Chapel Hill, North Carolina Professor and Dean Emeritus
Wilfred Laurier University
W. Patrick Sullivan, PhD
Waterloo, Ontario, Canada
Professor
School of Social Work Halaevalu F. Ofahengaue Vakalahi, MSW, MEd,
Indiana University BS, PhD
Indianapolis, Indiana Associate Dean and Associate Professor
School of Social Work
Stephanie A. Sundborg, MA, PhD Candidate
Morgan State University
Director of Research Baltimore, Maryland
Deschutes County Health Authority
Bend, Oregon Vikki L. Vandiver, MSW, DrPH
Dean and Professor
Andrea G. Tamburro, EdD, MSW
School of Social Work
Assistant Professor University of Alabama
Director of Social Work Tuscaloosa, Alabama
Indiana University Northwest
Gary, Indiana Katherine van Wormer, MSW, PhD
Professor
A. M. Thompson
School of Social Work
Doctoral Student University of Northern Iowa
School of Social Work Cedar Falls, Iowa
University of North Carolina
Chapel Hill, North Carolina Mary M. Velasquez, PhD
Professor in Leadership for Community,
Bruce A. Thyer, PhD
Professional, and Corporate Excellence
Professor Director of Health Behavior Research and
College of Social Work Training Institute
Florida State University School of Social Work
Tallahassee, Florida University of Texas at Austin
Editor, Research on Social Work Practice Austin, Texas
 Contributors xxxv

M. Elizabeth Vonk, MSW, PhD Eugenia L. Weiss, PhD

Professor Clinical Associate Professor
School of Social Work School of Social Work
University of Georgia University of Southern California
Athens, Georgia Los Angeles, California
Kirk von Sternberg, PhD Traci L. Wike
Associate Professor Assistant Professor
School of Social Work School of Social Work
University of Texas at Austin Virginia Commonwealth University
Austin, Texas Richmond, Virginia
Froma Walsh, PhD Michelle F. Wright, PhD
Mose and Sylvia Firestone Professor Emerita Faculty of Social Studies
School of Social Service Administration Department of Psychology
University of Chicago DePaul University
Chicago, Illinois Brno, Czech Republic
Joseph Walsh, PhD Kenneth R. Yeager, PhD
Professor Associate Professor of Psychiatry
School of Social Work Director of Quality Assurance
Virginia Commonwealth University Department of Psychiatry
Richmond, Virginia Ohio State University
Medical School
Chris Warren-Adamson, MPhil Columbus, Ohio
Senior Lecturer
School of Social Sciences Dina Zempsky, MSW, LCSW
University of Southampton Program Director
Southampton, England, StoryCorps
United Kingdom New York, New York

Marie Overby Weil, DSW Charlene Zuffante, LICSW

Berg-Beach Distinguished Professor of Director of Wraparound Services
Community Practice The Guidance Center, Inc.
School of Social Work Somerville, Massachusetts
University of North Carolina
Chapel Hill, North Carolina
PART I
Overview and Introduction to
Social Work
 What Changes and What Remains
1 in a Practice Profession

Elizabeth Clark

It has been six years since the second edition of in the search for solutions to the interrelated
the Desk Reference was released. Since that time, social challenges around the globe.
our world has changed in many large and small Social work principles of human rights and
ways. Our political landscape has become more social justice underlie the efforts of our social
partisan and more entrenched. The numbers of work colleagues in both developed and develop-
baby boomers, veterans, prisoners, and the home- ing countries. The over 200 member countries of
less have increased. Global warming and natural the International Federation of Social Workers
disasters are on the rise. Health care reform has (IFSW), in partnership with the International
moved forward; immigration reform has stalled. Association of Schools of Social Work (IASSW)
The list goes on and on. Against this backdrop of and the International Council on Social Welfare
rapid acceleration and social complexity, editors (ICSW), have developed a Global Agenda for
Kevin Corcoran and Albert Roberts and their edi- Social Work and Social Development (http://
torial board had to decide what content to leave cdn.ifsw.org/assets/globalagenda2012.pdf). The
in, what to add, and what to revise. This was a Agenda is committed to “supporting, influenc-
formidable task, and they collectively rose to the ing and enabling structures and systems that
challenge. allow people to have power over their own lives”
It has been suggested that a profession will (IFSW, 2012). These efforts currently are focused
not seek new ways or contexts until it feels the in four areas:
“challenge of crisis” (Kuhn, 1970, p. 144). Today,
numerous factors are driving social work practice • Promoting social and economic equalities
changes. These include globalization, an unend- • Promoting dignity and worth of people
ing war, an uncertain economy, a fraying of the • Working toward environmental
social safety net, and the speed and impact of sustainability
technology. • Strengthening recognition of the importance
Social work has become a global profession. of human relationships.
In the United States, social workers serve in the
United Nations, the U.S. Department of State, Internationally, social workers are being
USAID, the World Bank, Congress, the Peace sought for their ability to resolve human and
Corps, the U.S. Department of Agriculture, and social problems and for the contributions they
many nongovernmental organizations (NGOs) can make to the emerging global social, political,
that work abroad. Many schools of social work and economic landscape. More specifically, social
have established, or are in the process of estab- workers can help translate policy into workable
lishing, schools and programs in countries projects, help design and evaluate direct ser-
such as China, India, Cambodia, and Viet Nam. vices and projects, and work toward community
I would contend that the profession now has a capacity building.
moral mandate that crosses geographic boundar- In the United States, social workers work in
ies. We must become a visible and active partner refugee settlements and in communities with an

3
4 PART I • Introduction and Overview

influx of immigrants. In clinical practices, they veterans, and their families have the support that
work with victims of torture or those who were they have earned.
imprisoned for their political beliefs and social The United States Department of Veterans
activism. Social workers volunteer their services Affairs (VA) is now the largest employer of mas-
and mobilize resources when natural or man- ter’s level social workers in the country, with over
made disasters occur around the globe. At the 11,000 professional social workers employed
macro level, social workers are champions of fair in their many settings and programs (U.S.
immigration laws, the eradication of hunger and Department of Veterans Affairs, 2011). Because
infectious diseases such as HIV/AIDS, and the this practice area continues to grow, standards for
reduction of world violence. best practices and advanced credentials need to be
Jane Addams was awarded the Nobel Peace available.
Prize in 1931. Eighty years later, social worker In 2012, the National Association of Social
Leymah Gbowee was a 2011 recipient for her Workers (NASW) worked in partnership with
peace efforts in Liberia (Gbowee, 2011). Efforts the White House Joining Forces initiative, which
on behalf of peace have always been a part of was led by First Lady Michelle Obama and Dr. Jill
the fabric of social work practice. On September Biden (NASW News, 2012). As part of NASW’s
14, 2001, Congresswoman and social worker commitment to Joining Forces, expert practitio-
Barbara Lee was the only negative vote for ners developed the Standards for Social Work
House Joint Resolution 64, the Authorization of Practice with Service Members, Veterans, and
Use of Military Force against terrorists involved Their Families (NASW, 2012). These standards
in the attacks on September 11. Lee said, “We are a resource for clinical social workers provid-
must step back for a minute . . . and think ing mental and behavioral health services, direct
through the implications of our actions today practitioners in social service agencies, and social
so that this does not spiral out of control” (The work advocates. In addition, NASW created three
Guardian, 2013). professional credentials to demonstrate in-depth
Twelve years later, the United States seems knowledge, proven work experience, leader-
unable to extricate itself from what has been ship capacity, competence, and dedication in this
described as an endless war. The effects of the field of practice at the baccalaureate, advanced,
war are significant. We now have a generation or clinical levels (http://www.socialworkers.org/
of young people who have grown up against the military.asp).
backdrop of war. The number of American troops Despite the record numbers of social work-
who have died fighting in the wars in Iraq and ers within the VA system and the Department of
Afghanistan is nearing 7,000 (U.S. Department Defense, veterans today constitute a vulnerable
of Defense, 2013). Depending on sources used, population. They also highlight the inadequacy
the number physically wounded in battle has of the nation’s social safety net that genera-
surpassed 50,000 (U.S. Department of Defense, tions of social workers have worked to build and
2013), and there have been more than 250,000 maintain.
brain injuries, the signature wound of this war
(American Forces Press Service, 2013).
As a country, we have been slow to recog- RECAPTURING THE PAST
nize the sacrifices and the incredible need for
assistance and services for our nation’s service In late 2006, I had the honor of attending a “Social
members and veterans. In addition to the mil- Work Pioneer Listening Conference” where six
lions of veterans from past conflicts who still Pioneers talked about the investments in the
deserve the care and resources that have been social work profession from the post-World War
promised to them, there have been 2.5 million II era through the present day. They discussed
service members involved in the wars in Iraq the social context, major events, and problems
and Afghanistan. Many of these young men and social work practitioners faced during that time
women have struggled with mental and behav- (Stuart, 2009). They also discussed the successes
ioral health challenges, unemployment, home- they achieved.
lessness, or general difficulties re-acclimating to For example, Delwin Anderson discussed his
civilian life. Social workers have been a critical role at the VA. He joined the VA as a field social
component of the interdisciplinary workforce worker in Minnesota in 1947. He became the
tasked with ensuring that service members, national Director of the Social Work Service in
 1 • A Practice Professor 5

1964, and served in that position until he retired namely, the passage of the Patient Protection and
in 1974. He was responsible for 2,600 social Affordable Care Act of 2010 (ACA) (P.L. 111–148).
workers employed in 171 hospitals. Together, The ACA contains many welcome and posi-
they revolutionized care for our veterans. They tive changes including expanding health care
looked at treatment and rehabilitation of the coverage to millions of uninsured individuals,
whole patient, and developed ways for patients to eliminating preexisting condition exclusions and
receive community care. lifetime caps, and offering mental health par-
Although the clinical accomplishments of ity (Patient Protection and Affordable Care Act,
Anderson and his co-presenters at the Listening 2010). With an emphasis on prevention, social
Conference were remarkable, what was most determinants of illness, and early intervention,
impressive was their community organizing the ACA also offers opportunities for health care
skills and expertise. They saw the need for social and public health social workers.
work in various agencies and settings and worked One downside of the ACA for social workers
from both inside and outside to bring it about. is role blurring. Over the past few decades, the
There are many, many examples of the leader- diversity of practice areas in social work has wid-
ship of social workers in our history. In fact, most ened significantly. A consequence of this rapid
of the social safety net we have come to rely upon growth has been an expanding overlap of profes-
today was fashioned by social work advocates. sional practice fields. At the same time, we have
Frances Perkins was the first woman and seen a narrowing of what we traditionally have
social worker appointed to a cabinet position. She called social work.
served as Secretary of Labor from 1933 to 1945, New titles and credentials, such as peer coun-
that is, through all of President Franklin Delano selors (championed by Substance Abuse Mental
Roosevelt’s terms. She began her career as a cru- Health Services Administration), community
sader for factory safety. Her agenda as Secretary health workers (Centers for Disease Control and
of Labor included a major unemployment relief Prevention [CDC] and the Centers for Medicare
program, workers’ rights protections, minimum and Medicaid Services [CMS] offer training
wage, and child labor laws. She also served as grants), and patient navigators (funded by the
Chairwoman of the commission that ultimately Patient Protection and Affordable Care Act) have
crafted the Social Security Act (P.L. 74–271) emerged. In many ways, these terms address
(Downey, 2009). functions that need to be fulfilled rather than
Harry Hopkins began his social work career individual professions (SWPI, 2012), but they
in a New York City settlement house. He was still present challenges. Add to these the need for
chosen by President Roosevelt to head the first service integration to ensure cost-effectiveness,
state emergency relief agency during the Great as well as the use of trans-disciplinary teams, and
Depression, and later ran the $500 million fed- the role blurring and professional competition
eral program (Cohen, 2009). increase.
Another challenge is the legal regulation of
the profession. Social work efforts around licen-
CRAFTING THE FUTURE sure began in the 1940s. Now all 50 states have
some level of licensure for social workers to seek
Advocacy had its roots in social work, and advo- legal recognition, protection, and reimbursement
cacy for social supports and increased social for services. Because licensing is determined
services deserves our full attention. In the past within the states, different definitions of social
decade we have experienced the worst reces- work and aspects of social work practice vary
sion since the Great Depression. Salaries have from state to state. This contributes to confusion
remained static and the minimum wage does not about our profession among the public, lawmak-
cover minimal family needs. Our schools are in ers, other providers, and insurers. This lack of
disrepair and their service programs are woefully clarity, as well as a lack of reciprocity state-to-
inadequate. state, makes it harder to define and defend what
Despite the advocacy efforts of the 12 social we do and are entitled to do as a profession.
workers in Congress working with tens of thou- In 2010, the major social work organizations
sands of social work activists, recent political suc- came together to hold a national Social Work
cesses have been few and far between. The one Congress to reaffirm, revisit, and reimagine
major exception has been health care reform, the profession. It focused on issues internal
6 PART I • Introduction and Overview

to the profession. The result was consensus and licensing concerns, and despite increasing
around ten “Social Work Imperatives” that privacy and ethical issues, computer-based or
needed action in the next decade. They included e-therapy is accelerating (Reamer, 2013). We no
(NASW, 2010): sooner develop standards and guidelines than a
new type of technology enters the horizon and
1. Business of Social Work: Infuse models our efforts are outdated. Young social workers
of sustainable business and management are early adapters of such technology. They grew
practice into social work education and up living online, and they are not only comfort-
practice. able with it, but find it essential to their lives as
2. Common Objectives: Strengthen well. Schools and educators have struggled to
collaboration across social work keep up by using technology in the classroom
organizations, their leadership, and their and by offering classes and entire programs
membership for shared advocacy goals. online. Supervision is being done electronically,
3. Education: Clarify and articulate the unique and health care reform requires electronic health
skills, scope of practice, and “value added” records and billing for services.
aspects of social work to prospective social Technology has contributed positively to
work students. social work practice. We can find information
4. Influence: Build a data-driven business case quickly and easily. We can keep up with the lit-
that demonstrates the distinctive expertise erature in our fields. This can enhance practice
and the impact and value of social work to by ensuring that our interventions are evidence
industry, policy makers, and the general based and current. We can find models and best
public. practices, as well as locate colleagues and experts
5. Influence: Strengthen the ability of national and check resources needed by our clients, our
social work organizations to identify and agencies, and our communities. Technology also
clearly articulate, with a unified voice, issues is an asset for our social advocacy efforts. It is
of importance to the profession. now easy to send an e-mail to a legislator, com-
6. Leadership Development: Integrate pose and submit a letter or blog to a news line, or
leadership training in social work curricula get a requisite number of signatures to make a
at all levels. political point or request an action.
7. Recruitment: Empirically demonstrate to What is needed is an increased sensitivity to
prospective recruits the value of the social the potential negatives of living online, while
work profession in both social and economic at the same time incorporating technology
terms. into our practices and our lives. Additionally,
8. Retention: Increase the number of we need the new generation of social workers,
grants, scholarships, and debt forgiveness those who are expert in these areas, to take the
mechanisms for social work students and lead in establishing acceptable parameters and
graduates. guidelines for use.
9. Retention: Ensure the sustainability of the
profession through a strong mentoring
program, career ladder, and succession CONCLUSION
program.
10. Technology: Integrate technologies that The questions that remain are (1) Is social work
serve social work practice and education in still relevant? (2) Do we have the necessary out-
an ethical, practical, and responsible manner. comes data to show our value? (3) Can we ensure
a profession appropriate to our times and for the
In one way or another, progress toward all of future?
these imperatives is included in this comprehen- Based on the writings and shared wisdom of
sive reference volume. The last imperative, tech- the scholars and expert practitioners who have
nology, is covered extensively by several authors. authored the Social Workers’ Desk Reference,
This highlights both the importance and the we can answer these questions in the affirmative.
immediacy of the topic. They clearly show that the profession of social
We are just beginning to understand the poten- work continues to grow and expand through
tial impact of technology on social work practice. practice. They also illustrate how practice informs
Despite uncertainties around policy, liability, both research and policy and vice versa.
 1 • A Practice Professor 7

Forty years ago, Khan, in his preface to the International Council on Social Welfare,
book Shaping the New Social Work, asserted that www.icsw.org
social work practice answers the call of its time International Federation of Social Workers,
(1973, p. vii). We agree that it does. The world www.ifsw.org
is changing rapidly and some things must be National Association of Social Workers,
surrendered to progress. Yet, there are historical www.socialworkers.org
tenets of social work that we deem essential, if Society for Social Work and Research,
not sacred. www.sswr.org
The purpose of the profession remains solid
and steadfast—to enhance human well-being References
and meet the human needs of all people; to seek
social justice and positive social change; to pro- American Forces Press Service (2013, August 15).
mote peace; and to practice ethically. Advocacy National plan supports veterans’ mental health,
brain injury care. Retrieved October 25 from
is our professional cornerstone. Our core values,
http://www.defense.gov/news/newsarticle.
first adopted as a Code of Ethics in 1960, and aspx?id=120631
only amended slightly since that time, remain Cohen, A. (2009). Nothing to fear: FDR’s Inner cir-
our guiding principles: service, social justice, cle and the hundred days that created modern
dignity and worth of the person, importance of America. London: Penguin Press.
human relationships, integrity, and competence Downey, K. (2009). The woman behind the new
(NASW, 2008). deal: The life of Frances Perkins, FDR’s Secretary
We have a professional obligation to live up of Labor and his moral conscience. New York,
to our founding documents and to honor, sup- NY: Nan A. Talese.
port, and advance the teachings upon which the Gbowee, L. (2011). Mighty be our powers: A memoir.
New York, NY: Perseus Books Group.
profession of social work has been built. We also
International Federation of Social Workers. (2012).
need to claim our expertise, and to assume lead-
The global agenda for social work and social
ership roles in addressing the social problems and development: Commitment to action. Bern,
issues of today. Switzerland: Author.
Whitney M. Young, Jr., the social worker who Kuhn, T. (1970). The structure of scientific revolution
transformed the National Urban League during II (End ed., Vol. 2). Chicago, IL: University of
the Civil Rights movement and who was an advi- Chicago Press. p. 144.
sor to three presidents, challenged social workers NASW News. (2012, March). NASW supports join-
to be more visible. He said: ing forces [Press release]. Retrieved October 24,
2013 from https://www.socialworkers.org/pubs/
There is a lot to tell the public. The important thing news/2012/03/joining-forces.asp?back=yes
is that we can begin saying something as persistently National Association of Social Workers. (2008). Code
as we can. The media and the government, regardless of ethics of the National Association of Social
of their reasons, cannot continue to disregard the Workers. Washington, DC: Author.
findings of current research and the knowledge of National Association of Social Workers. (2010). Social
thousands of social workers who know as much or Work Congress—Final Report. Washington,
more than the so-called experts on the social problems DC: Author.
draining the spirit and resources of our nation National Association of Social Workers. (2012).
(Young, 1971). Standards for social work practice with service
members, veterans, and their families. Washington,
DC: Author.
The authors in the Social Workers’ Desk
Reamer, F. (2013). Social work values and ethics (4th
Reference have answered that call to action. ed.). New York, NY: Columbia University Press.
The content of this third edition will be an Social Security Act of 1935, P.L. 74-271, 49 Stat. 620
indispensable resource for practitioners, educa- (1935).
tors, researchers, policy makers, and students Social Work Policy Institute. (2012). Critical conversa-
everywhere. tion brief: Social work in health and behavioral
health care: Visioning the future. Washington,
DC: NASW Foundation, p. 1.
WEBSITES Stuart, P. (2009). Investment in social work after World
War II: Reflections on the pioneers’ listening con-
International Association of Schools of Social ferences. Washington, DC: National Association
Work, www.cdn.ifsw.org of Social Workers.
8 PART I • Introduction and Overview

The Guardian. (2013, May 7). Barbara Lee and Dick U.S. Department of Veterans Affairs (Ed.). (2013,
Durbin’s “nobody-could have known” defense. March 8). National professional social worker
Retrieved October 24, 2013 from http:// month. Retrieved October 24, 2013 from http://
www.theguardian.com/commentisfree/2013/ www.martinsburg.va.gov/features/National_
may/07/aumf-durbin-barbara-lee-defense Professional_Social_Worker_Month.asp
The Patient Protection and Affordable Care Act of U.S. Department of Veterans Affair. (2011, Nov
2010, P.L. 111-148, 124 Stat. 119 (2010). 23)What VA Social Workers do. www.
U.S. Department of Defense. (2013, October 23). socialwortk.v.gov/SOCIALWORK/docs/whatso-
Casualty Report [Fact sheet]. Retrieved October cialworkersdo.docx
24, 2013, from http://www.defense.gov/news/ Young, W. (1971, March). From the President. NASW
casualty.pdf News, p. 7.

Professional Socialization
2 On Becoming and Being a
Social Worker

Shari Miller

Although social work in practice is a “job” (or more Research in this area allows us to develop an
accurately a vast range of jobs), and while it is also understanding of key variables, how certain
a career, it can further be understood as a profes- processes unfold over time in particular con-
sional culture unto itself, replete with defined val- texts, and how they all contribute to profes-
ues, attitudes, norms, and a sense of identity. Would sional development. A solid understanding of
you be willing to engage in a brief thought experi- these variables and processes affords the pro-
ment? If you like to make things visual, feel free to fession of social work a much more informed
grab a sheet of paper and draw a picture; if you pre- understanding of its workforce and its capacity,
fer to think in terms of language use words as your of its educational structures, and of its realms
symbols. Now, close your eyes and think “social of service provision. And with an understand-
worker”: Who do you see? How do you see her/ ing of professional socialization, social work
him? Now close your eyes again and think doctor, students and practitioners are empowered to
or attorney, or nurse, etc. (select one): Now who engage in their own professional development
do you see? How do you see her/him? Were they from an informed standpoint, and with agency.
different? How so? The drawings or narratives you This chapter, with its focus on the professional
might craft for these respective professionals, and socialization of social workers, invites you to
the notable qualitative differences between them spend time reflecting on the culture of the pro-
can be explained by the idea that professions are fession—this context sheds light on the “hows”
cultures. And the differences between the cultures and “whys” of social work so that practitioners
help to shape those narratives. can be best prepared to go out and do the “whats”
The questions that began this chapter invite of practice. This chapter is designed to help you
us to look inside the culture of social work. understand what professional socialization is,
 2 • Professional Socialization 9

how it fits within the historical evolution of as a child, to new and specific reference groups
social work as a profession, and how it might that are related to the profession (e.g., classroom
look in an applied sense. instructors, field instructors, peers). These new ref-
erence groups serve as her/his “principal anchor-
ing point for values and behavior with respect to
PROFESSIONAL SOCIALIZATION
the professional role” (Shuval, p. 6). S/he locates
DEFINED
these reference groups and makes choices about
how s/he fits as s/he enters into the profession’s
Socialization in general can be understood as the culture. In order to be professionally socialized
process through which people gain knowledge, there needs to be a professional culture within
skills, and orientations that organize their mem- which to be socialized; what do we know about
bership in a society (Brim & Wheeler, 1966). This social work’s professional culture?
process happens over time and contains primary
facets that occur during childhood, which tend
to be sturdy and hard to change; a worldview THE CULTURE OF SOCIAL WORK
becomes situated and serves as a way of making an
objective-seeming reality a subjective vehicle for A professional culture is typically character-
understanding and guiding action (Jarvis, 1983). ized by an explicit and/or implicit set of values,
The secondary facets happen in adulthood as preferred attitudes, and norms of behavior; its
people begin to locate themselves in other spheres members have clear professional role identities.
in their interaction with the world around them In order to understand the culture of a profes-
(Jarvis); their functioning in society shifts and so sion and the members who are socialized into it,
does the emphasis of this secondary socialization. it is essential to consider context. In this instance,
The focus of this phase of socialization is no lon- it is particularly important to consider elements
ger so much on values and establishing a world- of social work’s history, and to clarify its mission
view, but instead is on honing and sculpting the and values.
ways in which people behave and/or act in those
different spheres. Here, in this secondary phase of
socialization, professional socialization can occur. Social Work’s History: Critically
Individuals entering a profession adapt “externally, Reflective Identity Struggles
in the requirements of the specific career role, and The social work profession has a long and storied
internally, in the subjective self-conceptualization history of grappling with its self-definition. This
associated with that role” (McGowen & Hart, history and its related dialogue can be understood
1990, p. 118). They bring their primarily socialized as part of social work’s path toward professionaliza-
selves into a new cultural space and make shifts tion—the process via which an occupation attains
in what they think and how they act to adapt and professional status (Abbott, 1988), which has
accommodate to the new professional cultural direct implications for professional socialization.
expectations and requirements. Abraham Flexner’s (1915 see Flexner, 2001) “Is
Though adult socialization does not rest on the Social Work a Profession?” speech is often consid-
acquisition of basic values, in professional social- ered a pivotal moment in social work’s history, and
ization there is a focus on professional values the distinct point in time that marked the begin-
and norms, which makes it a specialized form of ning of the profession’s ongoing and colorful dis-
adult socialization that does involve some active course about its own professionalization. Here we
grappling with those sturdy worldviews (Shuval, will discuss the history from the point of Flexner’s
1980). The process of professional socialization 1915 speech forward, while all the while acknowl-
happens before, during, and after formal edu- edging that the very fact he was invited to speak on
cation (Barretti, 2004; Miller, 2010) and can be this topic suggests social work began questioning
understood as linked to both “the intended and its professionalization earlier than 1915.
unintended consequences of an educational pro- As the Assistant Secretary of the General
gram” (Shuval, 1980, p. 6). Over the course of Education Board, Flexner was considered emi-
time, the person entering the culture’s space shifts nently influential in the area of professional edu-
her/his focus from those reference groups (e.g., cation, though more specifically, medical education
parents, extended family, school, community) that in the United States (Austin, 1983, p. 361). Because
informed her/his worldview as s/he was socialized of these credentials, he was invited to speak by the
10 PART I • Introduction and Overview

National Conference of Charities and Corrections controversy and conflict, dove into the hard work
and to answer the question “Is social work a pro- of “self”-reflection and into its intentional, cre-
fession?” Flexner approached the speech with his ative self- organization and development.
background expertise, but also with what he said With this critically self-reflective response to
was a lack of familiarity with “social work, with Flexner’s speech, a lively dialogue emerged for
the literature of social work, and with social work- social work scholars that was then, and in some
ers” (Flexner, 2001, p. 152), and warned at the ways is still now, characterized by a polarized set
opening of his speech that he doubted his “com- of views: those who strive to achieve profession-
petency to undertake the discussion” (p. 152). alism as originally defined by Flexner and those
That he was this uninformed about social work, who believe that very striving to be antithetical to
and was invited to speak anyway because he was social work’s mission (Hugman, 1998). Some have
well informed about medicine, provides us with suggested that, in fact, “the quest for status and
a window into the social work professionaliza- identity has occupied center stage within social
tion discourse at that time. With his caveat in work since its inception” (Gibelman, 1999, p. 298).
place, Flexner moved forward and applied his set In 2001, a special issue of the journal Research on
of six criteria that define a profession. There are Social Work Practice was published with Flexner’s
some who have criticized his criteria as arbitrary analysis at its core. The purpose of the special issue
because they were based on a subjective set of was to “examine the perceptions of social workers
ideas rather than on detailed comparative study about the position of social work as a profession
(Austin, 1983). He grounded his six criteria in the at the end of the 20th century against the back-
example of medicine as the consummate profes- ground of the Flexner statement [made] some
sion and indicated that professions 85 years ago” (Austin, 2001, p. 147). The perspec-
tives of the contributing authors unified around
(1) Involve essentially intellectual operations the idea that there are significant changes taking
with large individual responsibility place with regard to the organization of human
(2) Derive their raw material from science and services in our society that will likely continue
learning to be of critical importance to social work. Some
(3) This material they work up to a practical suggested that in the face of these changes the
and definitive end profession has stood up well and others suggested
(4) Possess an educationally communicable that there remain critical issues to be evaluated
technique and challenges to be met with that were as yet not
(5) Tend to self-organization being addressed (Austin, 2001).
(6) Are becoming increasingly altruistic in Over time, as the profession and its scholars
motivation (Flexner, 2001, p. 156). and members worked diligently in these ways
to self-identify, while also working to serve the
After applying these criteria to his analysis of needs of those who seek its services, the agil-
social work, Flexner determined that social work ity of social work has been unwavering. What
was not a profession. To this day, you can almost appears to be a never-ending quest for profes-
hear the audience gasp at the conclusion, but sional identity (Gilbert, 1977) may, in fact, be
in that gasp rested confirmation of doubts and one of the defining features of social work and
impetus for future directions. its very professional identity—it shifts with the
Flexner explicated in some detail his reasons changing societal tides (Gibelman, 1999) and so
for determining social work’s nonprofessional by its very nature cannot be structured around
status, but a full discussion of these conclusions one static professionalized identity. Social work
is beyond the scope of this chapter (see Flexner, can be defined as a social movement (Reynolds,
2001 for complete transcript of speech). It was, 1965) that is a profession (Greenwood, 1957), and
however, his assessment that launched social as such may have adaptively shifting faces over
work on its quest to prove its status and define its time. This agility, flexibility, and this orientation
identity as a profession. Rather than regarding to action are very much a part of what defines
the pivotal Flexner moment as a blow to social social work’s culture.
work’s sense of professional identity, it is crucial As social work positions itself in the present
to instead regard it as a moment that concret- day to meet the ever-growing demands for social
ized one of social work’s essential defining fea- services in the face of shifts in demographics, pro-
tures. The profession itself, though not without found economic changes, global demands, etc.,
 2 • Professional Socialization 11

it is increasingly clear that it does not have the and our social community is becoming increas-
workforce capacity to meet the predicted level ingly globalized, and that with its characteris-
of need (Whitaker, Weismiller, & Clark, 2006). tic agility social work’s professional culture is
How social workers make their way to the pro- becoming increasingly transnational, it is essen-
fession and why they choose to remain, or not, tial to look beyond the borders of the United
as members of the profession is key. In order to States to understand whether the profession’s
build and maintain a professional workforce that mission is consistent worldwide. According to
is well prepared to meet the profound and grow- the International Federation of Social Workers
ing needs of local and global society, social work (IFSW), social work’s mission is
must lend resources to understanding its own
culture, its educational structure, and its applica- to enable all people to develop their full potential,
tions in practice. At present, research in the area enrich their lives, and prevent dysfunction.
of professional socialization is limited but grow- Professional social work is focused on problem solving
ing, and there is a lot of room and opportunity to and change. As such, social workers are change
agents in society and in the lives of the individuals,
learn more.
families and communities they serve. Social work is
A professional culture is replete with values, an interrelated system of values, theory and practice
attitudes, and norms—all of which rest solidly (http://ifsw.org/policies/definition-of-social-work/)
upon or emanate directly from the profession’s
unifying mission. These are primarily commu- IFSW notes that, with social work’s origins in
nicated through the central organizing institu- humanistic and democratic ideology, the profes-
tion, the collection of accredited schools of social sion’s values “are based on respect for the equal-
work. With a history characterized by seemingly ity, worth, and dignity of all people . . . human
binary and simultaneous strains of influence, and rights and social justice serve as the motivation
questions around professionalization, social work and justification for social work action” (http://
has often grappled with whether or not there is ifsw.org/policies/definition-of-social-work/).
one clear mission, and whether or not those edu- IFSW specifies that “in solidarity with those
cated and practicing as social workers are indeed who are dis-advantaged, the profession strives
true to the profession’s traditional mission to alleviate poverty and to liberate vulnerable
(Specht & Courtney, 1994). Furthering under- and oppressed people in order to promote social
standing of how practitioners professionally inclusion” (http://ifsw.org/policies/definition-of-
socialize to social work, who plays what roles, social-work/). When taken together, it appears
how this socialization looks, and what it informs that both the NASW and IFSW statements
in practice, will enable social work to remain both reflect consistency—social work’s mission and
agile and sturdy in the face of change, and enable values, according to these statements, emphasize
its practitioners to be best equipped to meet the working with those at greatest risk, driven by a
critical needs of populations at risk. So, what is commitment to human rights, social justice, and
the mission of social work? change. When considering professional socializa-
tion to social work, it is the essence of this mission
The Mission and Values of and associated values that define the standards.
Social Work

In the United States, the National Association THE PROFESSIONAL SOCIALIZATION

of Social Workers (NASW) indicates that the LITERATURE
primary mission of social work is “to enhance
human wellbeing and help meet the basic human When exploring the scholarly literature related
needs of all people, with particular attention to to the professional socialization of social work-
the needs and empowerment of people who ers, there is both an expansive variety of places
are vulnerable, oppressed, and living in pov- to look and also, within that variety, an absence of
erty” (http://www.naswdc.org/pubs/code/code. a clear and systematic body of knowledge in this
asp). NASW denotes social work’s core values area. There are rich bodies of literature related to
as “service, social justice, dignity and worth of social work values, attitudes, professional identity,
the person, importance of human relationships, the mission of the profession, and to why people
integrity, and competence” (http://www.naswdc. become social workers, to name a few. All of this
org/pubs/code/code.asp). Given that the world work is of profound value to the profession and
12 PART I • Introduction and Overview

this author would encourage the reader to explore to how they view the world, how they engage in
it, but extensive discussion of it here is beyond relationships, how they see themselves, and to
the scope of this chapter. Aspects of all of this lit- choices they make as they develop into adults. As
erature are relevant to how we understand pro- young adults, they may choose or find an educa-
fessional socialization as a comprehensive process, tional path that is meant to relate in some way
but because the literature focuses on one of these or another to their entry point into the adult
variables at a time, or is broken up into smaller work world. Those people who choose to enter
fragments, taken as a whole what we understand the social work profession do so for a whole host
in a systematic way about professional social- of possible reasons and at various points in their
ization is characterized by more questions than developmental trajectories. As they make the
answers (Barretti, 2004; Miller, 2010; Weiss, Gal, choice to become social workers they carry their
& Cnaan, 2004). (For an extensive review of the primary socialization with them (e.g., demo-
literature, see Barretti, 2004, and for further graphics, childhood experiences), and in some
review of the literature, see Miller, 2010.) cases other experiences of secondary socialization
In the interest of defining at least one com- (e.g., a prior career); with and through this, they
mon language that would enable the profession begin to make some anticipatory changes/choices
to consider questions of professional socializa- as they approach their formal social work edu-
tion, this author offered a conceptual framework cation. These changes/choices are informed by
for the professional socialization of social workers what they think are the cultural expectations of
and some research findings designed to provide a social work—how do they imagine social work-
systematic foundation for further research in this ers act, talk, believe, think, maybe even dress,
area (Miller, 2010, 2013). The next section offers etc.? They then begin to try on for size some of
an applied synthesis of the conceptual framework these conceptions, and carry those, along with
(for full discussion of the framework, see Miller, aspects of primary socialization, with them into
2010), and highlights elements grounded in the their social work education.
research findings that might be helpful launching When they get to their formal social work
points for unraveling the complexity of profes- education they enter into a higher education
sional socialization. Aspects of theory suggest that institution, take classes, have instructors, meet
each professional who socializes to social work is their peers, and often become part of a cohort;
going to have a unique set of influences and expe- they function as interns in typically two differ-
riences, although there will also be things common ent field settings, and meet their field instructors,
among them, including aspects of the educational other professionals, clients, constituents, stake-
structure via which they are formally socialized. holders, etc. As they engage in this process they
Following the applied synthesis of the concep- acquire knowledge and skills, a relationship with
tual framework, a case study is provided to illus- social work values (e.g., commitment to social
trate one hypothetical social worker’s (Allison’s) justice, service), norms (e.g., social workers are
experience of professional socialization. The case change agents; social workers are overworked;
includes elements of Allison’s experience across all social workers do a lot of self-reflection), and atti-
three stages of the framework: pre-socialization, tudes (e.g., social workers need to hold onto their
formal socialization, and practice after formal idealism in the face of great challenges; social
socialization. It points to factors that had a poten- workers are compassionate and kind; social work-
tial influence, and also what her professional ers do not judge), while all the while interacting
socialization outcomes look like over time. in idiosyncratic settings, with people and within
structures that differ. They have agency and they
make choices, they are also potentially influenced
WHAT DO YOU NEED TO KNOW via structural mechanisms, power and hierarchy,
ABOUT THE PROFESSIONAL and role models. When they finish their formal
SOCIALIZATION OF SOCIAL social work education and head out into practice
WORKERS RIGHT NOW? CONCEPTUAL they take all of this with them into that par-
FRAMEWORK SYNTHESIZED ticular context of practice. They call themselves
something (e.g., social worker). Based on their
People are born into an experience and carry with practice context and what they bring with them,
them certain demographic characteristics. Over they adapt situationally, and their role identity
the years, events in their childhood contribute and overall professional socialization continue to
 2 • Professional Socialization 13

evolve. They may keep calling themselves social She also took part in yearbook and theater activi-
workers. Or they may identify as something else, ties; she loved to be involved, and she loved to
such as a clinical social worker, community orga- be around people. She did well in her classes, but
nizer; or therapist. As this process unfolds for was not sure what she would major in when she
each individual, these individually diverse expe- got to college, or what she wanted to do for work.
riences collectively and reciprocally feed back She thought about becoming a teacher or maybe
into the culture of the profession—this informs a doctor; she wanted to help people in some way,
change and expectations moving forward. and she wanted a job that was about “doing
something,” not “just sitting in an office.” When
she got to college she decided to major in English
Case Study: Allison’s Professional
because she was still not sure “what in the world”
Socialization to Social Work
she wanted to do for work, and because she liked
Phase I: Pre-socialization. When Allison was to read and loved stories about people. When she
a child she spent almost every Saturday morn- was in college she continued her civic engage-
ing with her mother and her older brother at ment, serving as a volunteer for a local nonprofit
the local community food bank packing up bags agency focused on providing services to homeless
of food for families in need. Allison remembers families. This was her first notable exposure to
seeing the families come into the food bank and the idea of social work; she realized there was a
observing that there were “kids just like me job you could do that “paid you to help people, to
except they don’t have enough food at home, develop relationships with people, to be kind and
and sometimes they don’t even have homes.” compassionate, and to take action.” After finish-
This always seemed unfair to Allison, and she ing her undergraduate degree, Allison was hired
wanted to do more to make things “more fair.” by the agency to do office management work.
Allison grew up in a three-bedroom apartment During her first year employed there, she decided
in an urban environment with her older brother to return to school and get her Master of Social
and her single-mother. Allison’s mother worked Work (MSW) degree.
very hard to take care of Allison and her older Anticipatory socialization. Allison began
brother and had a “good paying job” as an spending a lot more time talking to her friends
account manager for a large corporation. Allison about what needed to change in the world, and
and her brother went to after-school program- she also began paying more attention to the way
ming and she remembered how tired her mom she listened and how she communicated. She
always was when they got home. Allison and her asked the social workers at her agency questions
brother helped with food preparation and other about their jobs, about their social work educa-
chores at home. No matter how tired her mother tion, about their lives. She was a little worried
was, however, Allison remembers that she always because it seemed like they were often really
made time to go to the food bank on Saturdays; tired, and from what she could tell, it did not look
she was deeply committed to service. She always like they got paid that much. They also talked
talked about how she would have loved to have a lot about how the agency just did not have
a different job, a job where she could help peo- enough resources. But, they also seemed to be so
ple and make the world a better place, instead of committed to their work, and it was “amazing” to
one where she managed accounts for businesses see what they could do to “help these families get
that “have more than their fair share.” But, she back on their feet.”
said, she needed to make sure she earned enough Allison applied to four MSW programs in her
money to provide for Allison and her brother city, two at public institutions and two at private
and was always grateful to be able to provide in institutions; she was accepted to all four. She was
the way that she could. Allison’s father was not so excited and could feel her future unfolding,
often present in her life and rarely, if ever, pro- but she did not want to take out student loans.
vided any child support. She and her brother got Growing up with her mother she had learned a
birthday and holiday cards from him, but that whole lot about managing money and what it
was about it. was like to live paycheck to paycheck. She was
When Allison was in high school, she joined hoping that she might be able to get a scholar-
a student service organization; when she was a ship or an assistantship. Allison was offered
junior, she became the chairperson of that group a scholarship for her first year by one of the
and remained in that position until she graduated. smaller private programs and was guaranteed
14 PART I • Introduction and Overview

an assistantship in her second year. She decided placed there (from another university), as well
to accept this offer, but she did feel a bit uncom- as with one of the staff social workers, and also
fortable. Because tuition to attend this program formed some strong relationships with clients.
was high, she was concerned that her classmates She enjoyed her classes but sometimes found it
would all come from privileged backgrounds, and hard to figure out how to connect what she was
that she would be out of place. In preparation doing in her classes with what she was doing
for school and for her soon-to-start field intern- in the field. Her practice teacher was pretty
ship, and with concerns about money, Allison great, but unlike her supervisor, he sometimes
started thinking about how professional social seemed cynical to her. He talked a lot about how
workers act and even dress. She looked through under-resourced agencies were and how hard it
her closet to see if she had anything that would was to function as a social worker in a healthy
work. She talked to her Mom and her colleagues way. He had been in the field for 10 years before
at the agency and decided to go to Goodwill and beginning to teach, and he talked a lot about
buy some professional clothes for her placement. burnout. Allison respected his perspective, but
She e-mailed her professors to ask whether they she wondered if he was blowing things out of
could let her know what she would be reading proportion.
so she could buy books online, or used books in Allison ended up developing a great relation-
advance, to save money. She did some reading ship with the professor of her Human Behavior
ahead and was excited to get started—she could in the Social Environment (HBSE) course. She
understand what she read, but she was ready to initially found this course to be particularly frus-
be told how to make it all pragmatic, that is, how trating; she just wanted to know how to do things
to actually do it. already. The readings and class content were
Phase II: Formal socialization (academic always so abstract; she told her HBSE professor
settings, role models, peers). Allison went that she wished they could get past all of this idea
to orientation a bit nervous, but also ready and stuff and just learn what they were supposed to
eager to begin this program and her career. She do. This professor talked to Allison and the rest
had so many ideas about what she wanted to do of the class about how their energy and motiva-
when she was done, maybe even start her own tion were wonderful, and about how ready they
community organization! At her orientation she were to go out there and change the world. She
met a whole bunch of other students and real- encouraged them not to let go of that, but to take
ized that she was wrong, they were not all from a step to the side. She also encouraged them to
privileged backgrounds, and even if they were, it recognize that what they were doing in class was
did not really matter so much. There were a lot of pragmatic. Critical thinking and reflection-in-
approachable, friendly, open, “awesome” people. action were essential skills for social workers, she
They liked to talk a lot—she thought “it was not said. If they were going to go out and apply what
like when you walk into a room with a group they learned, they first had to learn it and learn
of people for the first time and everyone’s quiet how to think about it. This professor really chal-
and awkward; there were a few people in this lenged Allison to think, challenged her to locate
group who were just so outgoing and they did her clients in the theories she learned in class or
this amazing job getting everyone comfortable.” vice versa. This professor was available to meet
Allison felt as though she had found her home. with students and always had a supportive ear.
She did her first-year field placement at an Allison felt as though this professor was some-
agency that served a formerly homeless older one she could call a mentor. She also talked a lot
adult population living in a single-room occu- about self-care in class and helped the students
pancy residential facility. Her supervisor was figure out what it actually was and how to begin
a woman who had been in the field for over to think about it. Allison’s field instructor was
20 years—she started as a community orga- also interested in self-care; she helped Allison to
nizer and then became a licensed clinical social think through her own self-care plan, but also
worker, and she functioned in both these roles in allowed Allison to do an assessment of the agency
her agency. With her broad perspective, she chal- itself and the practices that either supported or
lenged Allison to do work across and around the inhibited worker well-being. Allison discovered
practice spectrum; Allison formed a meaningful during her placement that she really enjoyed the
relationship with her supervisor. She also had one-on-one work with clients, as well as some
some good relationships with the other students of the program development work. She was not
 2 • Professional Socialization 15

sure where to concentrate her efforts during her that if they could. They laughed a lot together
second year of the MSW program. and felt like they were a wonderful resource for
After talking with her supervisor, her HBSE each other. Allison’s mom let her know repeat-
professor, a social worker at her agency, and edly how proud she was of her, the work she was
some of her MSW student friends, Allison chose doing, and that she had found her way to this
a clinical track. Wanting what she thought of meaningful type of employment. Her Mom did
as a balanced experience, she advocated for a express concerns about Allison’s postgraduation
research assistantship with a faculty member income potential, but she also said she trusted
whose work focused on community organizing Allison and knew she would “be okay.” Allison’s
and community-based participatory research. In father had been a bit more present in her life over
this second year of her MSW program, Allison the past year, and each time she talked with him
was placed in a community mental health clinic about school or her internship he said something
that provided clinical services to a diverse popu- like, “I don’t know how you spend all your time
lation of individuals, families, and groups; cli- around people who are so miserable. Don’t you
ents spanned the age spectrum and were diverse get depressed? Are you going to make any money
across the board. Allison was excited to begin this doing this social work thing? Are you sure you
placement; she entered this second year “feeling don’t want to go to medical school or something
like a social worker.” She was not concerned as instead?” Allison tolerated her father’s perspec-
much about her clothing or her relationships; tive, but tried her best to educate him about what
she knew what she needed to do in that sense. social work really is, and she also tried her best
She was concerned about whether or not clients to explain all the ways in which she knew he was
would take her seriously; she wanted so badly to wrong.
help make their lives better, to fix what was bro- Allison had a deeply meaningful experience
ken for them, but was scared that she would fail. in her second-year field placement and in her
Her placement last year had been an “awesome” research assistantship, and she very much appre-
learning experience, but this just felt different. ciated some of the focused and applied content
She remembered how her HBSE professor talked of her advanced coursework. She particularly
about the thinking process and how powerful and enjoyed hearing about the practice experiences
important it is. She felt as though she had learned of her course instructors, and she engaged in
some useful skills in her classes last year and reflective clinical supervision at her placement,
definitely from her supervisor. She felt pretty learning a lot about herself and her work in the
confident that she knew how to “know what she process. She realized she did not do a very good
doesn’t know,” as her HBSE professor had said. job making space for herself, given that each night
She felt she knew how to reflect back, how to she went home and thought about her clients.
engage empathically, how to locate strengths, but She stopped making healthy lunches, stopped
she did not know whether she felt confident in exercising, and was feeling pretty stressed out
her ability to deliver the best possible services. and tired. She loved her job and wanted to stay
How evidence-based was her agency’s practice? at the agency after graduation, but she knew
What did that even mean??? she would need to make some changes if this
Allison took a deep breath, and called upon the work was going to be sustainable. She loved the
very close friends she had made in her MSW pro- research assistantship she had and learned a great
gram last year. The group of five friends met up deal about advocacy and about the community.
for dinner before the semester began and talked Though her internship was clinical, she was able
with one another about their fears, apprehen- to begin to locate some of the research work she
sions, and excitement. They discussed how they was doing in her agency and in the community.
were planning to manage time, what their agen- She knew she needed to do some more self-care
cies were like, and what they would be doing this and she knew she needed to keep self-reflecting,
coming year. They talked about feeling as though but when she graduated she felt ready to call her-
they knew they had learned “stuff” last year, self a social worker.
and they knew they were ready for this concen- Phase III: Practice after formal socializa-
tration placement, but what if . . .? They agreed tion. After Allison graduated, she was hired on
to remain a support system for one another by to work for the community mental health clinic.
getting together at least once a month for this She was very excited to get under way as a prac-
kind of dinner, but for sure more often than titioner. Once she got assigned her caseload of
16 PART I • Introduction and Overview

28 regular clients and 10 intakes per week, she WEBSITES

remembered back to what her practice instructor
in her first year said about being under-resourced International Association of Schools of Social
and over-worked. “Maybe he was not so cynical Work, www.cdn.ifsw.org
after all,” she thought. At her agency, Allison International Council on Social Welfare,
worked primarily with other clinicians—some www.icsw.org
of them called themselves clinical social work- International Federation of Social Workers,
ers and others called themselves therapists. Her www.ifsw.org
supervisor called herself a therapist so Allison National Association of Social Workers,
tried that out for a while, but it did not really www.socialworkers.org
feel like her. Then she remembered the instruc- Society for Social Work and Research,
tor of her policy analysis class, whom she www.sswr.org
admired so much. Allison had found her inspir-
ing and always loved to listen to what she said. References
She remembered that professor (a grant-funded
Abbott, A. A. (1988). Professional choices: Values at
researcher who had written books and was the
work. DC: NASW Press.
Director of the MSW program) coming to class Austin, D. M. (1983). The Flexner myth and the his-
on the first day and saying, “Hi, I’m Dr. Jasper tory of social work. Social Service Review, 57(3),
and I’m a Social Worker.” When Allison thought 357–377.
about this, she decided that no matter where she Austin, D. (2001). Guest editor’s foreword. Research
worked, or what kind of practice she did, she on Social Work Practice, 11(2), 147–151.
would always identify herself as a social worker. Barretti, M. (2004). What do we know about the pro-
Over the next five years, Allison continued to fessional socialization of our students? Journal of
practice at this agency and she also continued to Social Work Education, 40, 255–283.
do collaborative research with her former profes- Brim, O. G., Jr., & Wheeler, S. (1966). Socialization
after childhood: Two essays. New York: John
sor—she loved how it kept her out in the com-
Wiley & Sons.
munity. Not only was she a social worker inside Flexner, A. (2001). Is social work a profession? Research
this office doing work with her clients, but she on Social Work Practice, 11(2), 152–165.
was a social worker out there knocking on doors, Gibelman, M. (1999). The search for identity: Defining
doing community needs assessment, organizing, social work—past, present, future. Social Work,
and working toward social justice. 44(4), 298–310.
Gilbert, N. (1977). The search for professional identity.
Social Work, 22, 401–406.
CONCLUSION Greenwood, E. (1957). Attributes of a profession. Social
Work, 2(3), 45–55.
Hugman, R. (1998). Social work and de-professionaliza-
Having just read about Allison, reflect back to
tion. In P. Abbott & L. Meerabeau (Eds.). The
the thought experiment that you engaged in at sociology of the caring professions (pp. 178–199).
the beginning of this chapter. Look back at your London: UCL.
drawing or narrative. What do you see now that Jarvis, P. (1983). Professional education. London: Croom
you can identify as an aspect of social work’s pro- Helm.
fessional culture? Who is that social worker? All McGowen, K. R., & Hart, L. E. (1990). Still differ-
of this is the stuff of professional socialization; it ent after all these years: Gender differences in
is powerful and complex, and informs the how, professional identity formation. Professional
what, and why of practice. Regardless of where Psychology: Research and Practice, 21(2),
you are in your own professional development, 118–123.
Miller, S. E. (2010). A conceptual framework for
theories of professional socialization would sug-
the professional socialization of social work-
gest that you are not done. Not only is social
ers. Journal of Human Behavior in the Social
work about lifelong learning, it is also about Environment, 20, 924–938.
career-long professional socialization. Some Miller, S. E. (2013). Professional socializa-
things will remain consistent, but others may tion: A bridge between the explicit and implicit
shift to stay current with and, in turn, affect the curricula. Journal of Social Work Education, 49,
shifting culture of social work. 368–386.
 2 • Professional Socialization 17

Reynolds, B. C. (1965). Learning and teaching in the Weiss, I., Gal, J., & Cnaan, R. A. (2004). Social work
practice of social work. New York: Russell & education as professional socialization: A study
Russell. of the impact of social work education upon stu-
Shuval, J. T. (1980). Entering medicine: The dents’ professional preferences, Journal of Social
dynamics of transition. A seven year study Service Research, 31, 13–31.
of medical education in Israel. Oxford, Whitaker, T., Weismiller, T., & Clark, E. (2006).
England: Pergamon. Assuring the sufficiency of a frontline work-
Specht, H., & Courtney, M. E. (1994). Unfaithful force: A national study of licensed social workers.
angels: How social work has abandoned its mis- Executive summary. Washington, DC: National
sion. New York: The Free Press. Association of Social Workers.
PART II
Roles, Functions, and Fields of
Social Work Practice
 Evidence-based Social Work Practice
3 with Children and Adolescents

Alison Salloum & Lisa Rapp-McCall

ASSESSMENT OF CHILDREN AND of Mental Disorders (American Psychiatric

ADOLESCENTS Association (APA), 2014) includes parent and
child and adolescent measures that assess for
Evidence-based Assessment 12 psychiatric domains and functions. These
Building on the growing field of evidence-based APA measures can also be used to track clini-
practices (EBP), the use of evidence to guide cal progress (the assessment tools for children
the assessment process is currently evolving. and adolescents may also be found online at
Evidence-based assessment incorporates the http://www.psychiatry.org/practice/dsm/dsm5/
use of evidence and theory to select the aspects, online-assessment-measures#Level1
conditions, or domains to be assessed; uses
evidence-based assessment tools; and uses the Child-focused Developmental,
best methods for the assessment processes. An
Ecological, and Cultural Assessment
evidence-based assessment can help guide the
practitioner and client to choose the best avail- An evidence-based assessment with children,
able evidence-based intervention for the assessed adolescents, and their families must include a
condition and to monitor progress throughout multidimensional assessment that considers
the intervention (Hunsley & Mash, 2007). development, ecological context, and cultural
Accessible and practical evidence-based assess- influences. These three areas of assessment may
ment tools and methods are becoming available be considered the foundation for child-focused
for practitioners and clients. These brief and assessments. With children, evidence-based
easy-to-use tools, commonly referred to as rapid assessment often includes assessing caregivers,
assessment instruments, are available to assess a including multiple informants (such as day care
child’s or family’s general functioning and com- providers or teachers) and sources of data (i.e.,
petence relative to specific conditions. Assessment observation, school records); understanding the
tools and processes are being developed to variations and effects of development and culture
address situations in various settings and con- on the situation; and including a broad-based
texts. For example, Counts and associates (2010) assessment of competencies and challenges
have developed and tested an easy to adminis- (Achenbach, 2007).
ter self-report measure of multiple family-level Generally, the younger the child, the more
protective factors against abuse and neglect. involved the parent or caregiver and significant
Similarly, Edelson et al. (2007) are developing other adults in the child’s daily life will be in the
a 46-item tool to assess children’s exposure to assessment process. With older children, espe-
domestic violence. These types of evidence-based cially adolescents, it is important to engage the
assessment tools and methods are readily avail- youth directly in the assessment process. This
able through various websites and books on clini- may be accomplished by using evidence-based
cal measures (e.g., Corcoran & Fischer, 2013). In self-report assessment instruments with the
addition, the Diagnostic and Statistical Manual child and adolescent. When practitioners conduct

21
22 Part II • Roles, Functions, and Fields

the assessment process in a collaborative fashion in choosing the most appropriate multimodal and
with the child, the assessment tool can be used multicontextual interventions.
to provide education and normalization and elicit In addition to developmental and ecological
specific goals for treatment, as well as to highlight assessment processes, evidence-based assessment
the child’s strengths and treatment progress. must be culturally sensitive. Specific assess-
Developmental assessments may be used to ment tools are being tested with various cul-
select the best available treatments for children tural groups to establish within group norms.
that take into account the child’s developmen- In addition to the use of specific culturally rel-
tal status (including emotional, cognitive, bio- evant assessment tools, an understanding of the
logical, social, and behavioral milestones, assets, cultural context of the child may lead the practi-
and delays). As research on EBP continues, we tioner and client to decide on a more culturally
will learn more about which treatments work congruent evidence-based treatment. A cultural
best with which populations. More specifically, assessment may help the practitioner understand
we will learn how development, neurobiology, the child and family better and identify cultural
gender, culture, and context affect treatment out- resources to include in treatment. Discussing
comes. Developmentally specific assessment can culturally competent practice is beyond the scope
then be used to suggest developmentally specific of this chapter, and practitioners are encour-
treatments to the child and parent or caretaker. aged to read the National Association of Social
For example, recent advances have been made in Workers’ NASW Standards for Indicators for
assessment processes for the mental health needs Cultural Competence in Social Work Practice
of infants, toddlers, and young children. With that was developed in 2007 (available on the
this knowledge, specific prevention and treat- NASW website). Assessments may include areas
ment strategies grounded in empirical research such as communication patterns, family struc-
for this young population are increasing (for ture, accepted roles of children, intergenerational
more information about early childhood assess- conflicts, assimilation of family members, adher-
ment see the Zero to Three website listed at the ence to traditions, spiritual beliefs, values and
end of this chapter). Similar advances are being norms, acceptance of expression of emotions and
made for middle childhood, early adolescence, behaviors, developmental expectations, language
adolescence, and late adolescence. preference and proficiency, historical experi-
The child-in-environment perspective must be ences, views of mental health, and help-seeking
considered during the assessment processes. The behaviors.
influence of the relational processes within the
child’s ecological context may have a significant
Client-centered Process
impact on the child’s functioning and growth.
Ecological relational processes may include the Evidence-based practitioners value the child and
child’s family; school environment and peers; family as a collaborative partner in the assess-
neighborhood and community; recreational ment process and treatment. Indeed, parents’
opportunities; religious or spiritual membership and children’s beliefs, values, and preferences are
or rituals; national and international situations; key factors in successfully implementing EBP.
and systems such as foster care, child welfare, and Program developers and practitioners can ensure
juvenile justice. Though a beginning point for that the child, youth, and family members play
the practitioner is to assess the strengths within an active role in the process of assessment, goal
the child and child’s family (see Simmons & planning, treatment choices, and evaluation.
Lehmann, 2013 for strengths-based assessment During the assessment process, practitioners
measures) a more multidimensional assessment should assess the client’s (child and participat-
is optimal. This encompasses the child’s and fam- ing family members) beliefs about credibility
ily’s protective or resilience factors within the (i.e., believable and logical) and effectiveness of
cultural context of the child and family (e.g., the agreed-upon intervention or treatment prior
Cardoso & Thompson, 2010; Jones, Hopson, & to implementation. Beliefs about credibility of
Gomes, 2012), and examines the salience of spe- treatment and expectations of improvements
cific and cumulative risk factors, including social may be associated with motivation for and
conditions such as poverty, discrimination, and adherence to treatment, which are important
limited opportunity. A multidimensional assess- factors for effective outcomes (Nock, Ferriter, &
ment can assist the practitioner, child, and family Holmberg, 2007).
 3 • Children and Adolescents 23

A collaborative practitioner–client assess- • Assess the child and family’s beliefs,

ment process begins with the initial meeting and values, preferences, and expectations about
continues throughout the intervention to moni- evidence-based treatment.
tor progress and assess outcome and satisfaction.
Eliciting feedback from children and families Promotion and Prevention
regarding treatment satisfaction and the ser-
vice delivery process can be empowering for cli- Current models to guide practices serving chil-
ents. Valuing systematic approaches to hearing dren and youth suggest providing promotion
from clients about their experiences can lead to programs followed by prevention, treatment,
improved treatments and delivery of care (Baker, and maintenance services (Frey & Alvarez, 2011;
2007). A collaborative evidence-based assess- National Center for Mental Health Promotion
ment may lead to more objective accountability and Youth Violence Prevention, 2011). Promotion
of satisfaction, effectiveness, and improved ser- programs focus on improving the overall emo-
vices for children and families. tional and social well-being of the child such that
self-esteem, coping, social integration, and healthy
development are promoted. Some overlap exists
Considerations for Child-focused between promotion and prevention because both
Evidence-based Assessment types of efforts try to intervene before the onset
of problems. Previously, youth began treatment
• Use evidence-based assessment tools and when they had significantly serious disorders or
processes to guide client and practitioner in symptoms that significantly impacted their func-
choosing EBP. tioning at home, at school, or in the community.
• Conduct a multidimensional assessment However, research studies have supported what
that includes sources of data, including practitioners have observed all along—starting
multiple informants (i.e., parents, caretakers, treatment earlier, at the first sign or symptom
teachers, and other important child–adult of difficulty, drastically improves the outcome.
relationships), multiple settings (i.e., home, This approach is also far more cost-effective than
school, peers), and multiple methods (i.e., typical interventions, which wait too long and
rapid assessment instruments, interviews, then require more intensive intervention. Thus,
observations). promotion and prevention programs have been
• Consider using a broad assessment tool used to promote well-being, and when needed,
followed by a selected specific condition intervening early can prevent the disorder com-
assessment tool. pletely or lessen its progression. There are many
• Assess the child’s developmental status, empirically based prevention interventions that
including emotional, cognitive, biological, are used when youth present no risk factors (uni-
social, and behavioral milestones, assets, versal), exhibit some risk factors (selective), and/
and delays and take into account the or when they evince some symptoms of the prob-
developmental stage of the child to match lem (indicated). These prevention interventions
appropriate intervention. are now more readily available and used more fre-
• Consider the entire ecological context of child quently (e.g., Fagan & Catalano, 2013); however,
and family. there is still much work to be done in reframing
• Use standardized assessment tools and our thinking to integrate preventive interven-
processes to assess protective factors, tions and programs into our current systems. For
competencies, and strengths. example, programs need to be sufficiently funded
• Use standardized assessment tools or for delivering promotion programs and preventive
processes to assess risks and emotional, interventions, not just brief interventions after the
behavioral, and social difficulties. problems have grown too serious to change.
• Understand the cultural influences on the
child, family, and situation and conduct a
Treatment and Maintenance
culturally competent assessment.
• Assess throughout practice to evaluate Treatment and maintenance that involves long-
progress, outcomes, and client satisfaction. term care to minimize relapse and reoccurrence
• Practice from a child–family-centered must be available to children and youth needing
collaborative perspective. this level of care. Many advances have occurred
24 Part II • Roles, Functions, and Fields

in the development of EBP for children and ado- systematically assessing and tracking progress
lescents. Currently, many social problems and (Barth et al., 2012).
disorders of childhood and adolescence have
treatments that are evidence supported (Kendall
Multimodal and Multicontextual
& Beidas, 2007). Emerging evidence suggests that
Interventions
children and youth who receive EBP are more
likely to improve than when non-evidence based Research suggests that treatments for youth
practices are provided (e.g., Kolko, Herschell, be multimodal and multicontextual, meaning
Costello, & Kolko, 2009). The contemporary that interventions should be delivered in a vari-
controversy lies not in whether to utilize these ety of formats for learning and change to occur,
practices but how to consistently facilitate the and that interventions should occur in multiple
implementation of these practices with fidelity in environments or milieu of the youth. In other
real-world community settings. words, individual treatment for children alone,
There are many barriers to implementing without family, school, or community inter-
EBP in agencies, including limited practitioner vention is rarely effective, especially for youth
time, training and ongoing supervision, practi- who are having difficulty functioning in vari-
tioner attitudes toward EBP, and lack of adequate ous contexts. Likewise, one type of intervention
resources. Current implementation science, alone, for instance, life skills, may only have a
however, has focused on contributing factors to small-to-medium effect as opposed to a multi-
implementing and sustaining EBP in real world modal approach that may result in a large effect.
settings. Some factors contributing to the suc- Take the following example: a practitioner work-
cessful implementation of EBP include adequate ing with a child experiencing severe difficulty
funding and support for implementation, train- with controlling anger may talk about angry
ing and ongoing supervision and consultation, outbursts and their consequences with the child,
treatment fidelity monitoring, and “buy-in” teach the child anger-control skills, role-play/
from agency leaders and practitioners (Swain, practice the skills, and read a story about a char-
Whitley, McHugo, & Drake, 2010). Additionally, acter who learns to control her anger. In addi-
while earlier concerns included treatment manu- tion, the practitioner may use functional family
als that were too rigid and difficult to apply in therapy with the child’s family to intervene with
real world settings, current manual and treat- family difficulties, assist the teacher in develop-
ment protocols are more flexible and are trans- ing a behavior modification system for the child
portable to community-based settings. Another at school, and work with the child’s soccer coach
barrier to implementing EBP has been that many to help apply the newly learned anger-control
of these treatments do not address comorbid or skills to replace angry outbursts during soc-
complex client problems that are often presented cer practice. The comprehensive nature of these
by children, youth, and families in community interventions is more likely to produce change
settings. Newer approaches to treatment are than one modality in one context.
combining core components of various EBP to
address multiple issues and conditions.
Considerations for Child-focused
Scholars are not only calling for social work-
Evidence-based Treatment
ers to provide up-to-date EBP that match the
child’s and family’s needs, but also to become • Intervene early with empirically supported
competent in empirically supported common ele- and evidence-based prevention interventions.
ments and common factors. Common elements • Stay abreast of EBP and use with appropriate
involve using a modular approach in which spe- clients.
cific methods common to many EBP, such as • When no known EBP exists for disorders or
psychoeducation, exposure, and rewards, are pro- problems, use common elements and factors
vided based on the results of an evidence-based that have been associated with treating similar
assessment. Common factors consist of those conditions and monitor progress carefully.
ingredients critical to positive outcomes, such as • Intervene in multiple contexts (micro, mezzo,
a strong therapeutic alliance, client engagement, and macro).
motivation, and hope. The implementation of • Intervene with multiple approaches, when
common factors and common elements requires indicated.
 3 • Children and Adolescents 25

FUTURE DIRECTION FOR and challenges that children and youth face
ASSESSMENT AND INTERVENTION today, we must advance our knowledge of the
programs or methods that work best for par-
Understanding the complexities and unique- ticular children. We must also determine the
ness of the child or adolescent by empathetic most effective the settings, intensity of delivery,
face-to-face interaction has always been the and timing of delivery. Barriers to implementa-
starting point for the practitioner. Although tion of child-focused evidence-based assessment
this will not change, advances in assessment and practices can be overcome by such tools
tools and methods will help the practitio- as web-based clearinghouses, webinars, video-
ner obtain a broader contextual understand- conferencing to engage in collaborative learn-
ing as well as more rapidly ascertain targeted ing and consultation, and podcasts and apps on
goals. Advances in evidence-based assessment implementation of EBP. Although technology
will lead to more research on the influence of and new approaches may assist with dissemi-
development, context, and culture on treat- nation and implementation of evidence-based
ment outcomes and a broader understanding assessment and EBP, collaboration with all stake-
of resilience in childhood. These assessment holders—children, adolescents, parents, com-
tools and methods will become standard prac- munity leaders, practitioners, researchers, and
tices and will be integrated within systems of policy makers—is needed to advance practices to
care for children. improve the well-being of children, adolescents,
Collaboration with the client will remain and their families.
central to evidence-based assessment and
evidence-based treatment. Once the client and WEBSITES
practitioner have collaboratively decided on
which evidence-based treatment seems most
American Psychiatric Association, Online
appropriate, preparation for treatment may be
Assessment Measures. http://www
warranted. Treatment readiness or pretreatment
.psychiatry.org/practice/dsm/dsm5/
sessions help prepare clients for the treatment
online-assessment-measures
when it is delivered. The sessions are offered
Blueprints for Violence Prevention. http://
prior to the formal treatment and work to
www.colorado.edu/cspv/blueprints.
engage and motivate the client. The idea began
Campbell Collaboration. http://www.campbell-
with mandated adults and has found its way into
collaboration.org
the child and adolescent arena. Treatment readi-
National Center for Childhood Traumatic Stress
ness sessions seem to be more common with
Network. http://www.nccts.org. See measures
difficult or mandated young clients (adolescent
review database for assessment tools. http://
offenders and substance abusers) but may be
www.nctsn.org/resources/online-research/
promising for use with other client populations.
measures-review
They may also show promise for reducing resis-
National Institutes of Health. http://www
tance with other interventions and with brief
.nih.gov
treatments where change is expected to occur
North Carolina Evidence-Based Practice Center
quickly. In addition, practitioners may consider
(NCEBPC). http://www.ncebpcenter.org.
using pretreatment sessions prior to family or
Substance Abuse and Mental Health Services
group treatments.
Administration; see National Registry of
Developing and implementing empirically
Evidence-based Programs and Practices.
supported and evidence-based social work prac-
http://www.nrepp.samhsa.gov/
tices for children requires integration and col-
The California Evidence-Based Clearinghouse
laboration: the integration of evidence-based
for Child Welfare. http://www.cebc4cw.org/
assessment and promotion, prevention, and
Zero to Three. http://www.zerotothree.org/
treatment; the integration of social work
research and practice; and collaboration with all
concerned parties, including children and fami- References
lies, community residents and leaders, practitio- American Psychiatric Association. (2014). Diagnostic
ners, researchers, child advocates, child systems and statistical manual of mental disor-
(i.e., education, child welfare, juvenile justice), ders: DSM-V. Washington, DC: American
and policy makers. Due to the complex problems Psychiatric Press.
26 Part II • Roles, Functions, and Fields

Achenbach, T. M. (2007). In P.S. Jensen, P. Knapp, & Frey, A. J., & Alvarez, M. E. (2011). Social work prac-
D.A. Mrazek, Toward a new diagnostic system titioners and researchers realize the promise.
for child psychopathology: Moving beyond the Children and Schools, 33, 131–134.
DSM. Journal of Child and Family Studies, 16, Hunsley, J., & Mash, E. J. (2007). Evidence-based assess-
589–591. ment. Annual Review of Clinical Psychology, 3,
Baker, A. J. L. (2007). Client feedback in child wel- 29–51.
fare programs: Current trends and future direc- Jones, L. V., Hopson, L. M., & Gomes, A. M. (2012).
tions. Children and Youth Services Review, 29, Intervening with African-Americans: Culturally
1189–1200. specific practice considerations. Journal of Ethnic
Barth, R. P., Lee, B. R., Lindsey, M. A., Collins, K. S., & Cultural Diversity in Social Work, 21, 37–54.
Strieder, F., Chorpita, B. F., Kimberly D., . . . doi: 10.1080/15313204.2012.647389
Sparks, J. A. (2012). Evidence-based practice at Kolko, D. J., Herschell, A. D., Costello, A. H., & Kolko,
a crossroads: The timely emergence of com- R. P. (2009). Child welfare recommendations to
mon elements and common factors. Research improve mental health services for children who
on Social Work Practice, 22(1), 108–119. have experienced abuse and neglect: A national
doi: 10.1177/1049731511408440 perspective. Administration, Policy, and Mental
Cardoso, J. B., & Thompson, S. J. (2010). Revising risk Health, 36, 50–62. doi: 10.1007/s10488-008-0202-y
and resilience: Common themes of resilience Kendall, P. C., & Beidas, R. S. (2007). Smoothing
among Latino immigrant families: A systematic the trail for dissemination of evidence-based
review of the literature. Families in Society: The practices for youth: Flexibility within fidelity.
Journal of Contemporary Social Services, 91, Professional Psychology: Research and Practice,
257–265. doi: 10.1606/1044-3894.4003 38(1), 13–20.
Corcoran, K., & Fischer, J. (2013). Measures for clinical Nock, M. K., Ferriter, C., & Holmberg, E. (2007).
practice and research. Volume 1: Couples, fami- Parent’s beliefs about treatment credibility and
lies, and children. 5th ed. New York, NY: Oxford effectiveness: Assessment and relation to subse-
University Press. quent treatment participation. Journal of Child
Counts, J. M., Buffington, E. S., Chang-Rios, K., and Family Studies, 16, 27–38.
Rasmussen, H. N., & Preacher, K. J. (2010). The National Center for Mental Health Promotion and
development and validation of the protective fac- Youth Violence Prevention. (2011). Realizing the
tors survey: A self-report measure of protective promise of the whole-school approach to chil-
factors against child maltreatment. Child Abuse dren’s mental health: A practical guide for school.
& Neglect, 34, 762–772. Boston, MA: Education Development Center, Inc.
Edelson, J. L., Ellerton, A. L., Seagren, E. A., Kichberg, Simmons, C. A., & Lehmann, P. (2013). Tools for
S. L., Schmidt, S. O., & Ambrose, A. T. (2007). strengths-based assessment and evaluation.
Assessing child exposure to adult domestic violence. New York, NY: Springer Publishing Co.
Children & Youth Services Review, 29(7), 961–971. Swain, K., Whitley, R., McHugo, G. J., & Drake, R. E.
Fagan, A. A., & Catalano, R. F. (2013). What works in (2010). The sustainability of evidence- based
youth violence prevention: A review of the lit- practices in routine mental health agencies.
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141–156. doi: 10.1177/1049731512465899 doi: 10.1007/s10597-009-9202-y
 Overview of Alcohol and Drug
Dependence
4 Identification, Assessment, and
Treatment

Kenneth R. Yeager

Alcohol and drug abuse is ubiquitous; it is associated Administration (SAMHSA), 2011; Harwood,
with 2.5 million deaths annually, representative of 2000; Harwood & Bouchery, 2001):
4% of all deaths worldwide annually. The National
Council on Alcoholism and Drug Dependence • Alcohol accounts for $191.6 billion (37.5%)
(NCADD) reports “The harmful use of alcohol of the $510.8 billion.
(defined as excessive use to the point that it causes • Tobacco is responsible for $191.6 billion
damage to health) has many implications on public (32.9%) and drug abuse for $151.4 billion
health as demonstrated in the following key findings: (29.6%).

The majority of the costs associated with sub-

• Harmful use of alcohol results in the death stance abuse in the United States can be related to
of 2.5 million people annually, causes illness treatment and prevention of substance abuse, medical
and injury to millions more, and increasingly care, police, fire department, legal and court-related
affects younger generations and drinkers in expenses, property damages, theft, crime, motor
developing countries. vehicle crashes, and fires involving alcohol and drug
• Nearly 4% of all deaths are related to abuse (Harwood & Bouchery, 2001).
alcohol. Most deaths caused by alcohol result Additionally, productivity costs are closely
from injuries, cancer, cardiovascular disease, linked to the cost to society. For example: Smoking
and cirrhosis of the liver. contributed to 440,000 deaths in 1999. Alcohol
• Among males, 6.2% of deaths are related abuse accounted for 42,000 (Harwood, 2000) to
to alcohol, compared with 1.1% of deaths 76,000 deaths (Midanik et al., 2004), while drug
among females. abuse accounted for an additional 23,000 deaths
• Among young people aged 15–29 years, 320,000 (Harwood & Bouchery, 2001). This loss in produc-
die annually from alcohol-related causes, tivity is calculated as estimates of individual lost
resulting in 9% of all deaths in that age group. work time, including impairment, sickness, unem-
• Almost 50% of men and two thirds of women ployment, incarceration, disability, and the like.
do not consume alcohol (NCADD, 2013). It is important to note that a significant num-
ber of persons with substance use disorders have
The burden of drug and alcohol dependence concurrent mental health disorders. In 2011, there
in the United States is estimated to be $510 bil- were an estimated 45.6 million adults age 18 years
lion, up from $184.6 billion per year in 2005. The or older in the United States with any mental
break-out of the impact on children, adults, and illness in the past year. This represents 19.6%
communities in the United States is as follows of all adults in this country. Of this population,
(Substance Abuse and Mental Health Services SAMSHA (2012) estimates 8 million adults met
27
28 Part II • Roles, Functions, and Fields

the criteria for a substance use disorder (i.e., illicit diagnoses, the effectiveness of a single approach for
drug or alcohol dependence or abuse.) Additionally, mental health or substance abuse is limited in lev-
among the 11.5 million adults with severe mental els or degree of effectiveness.
illness in the past year, 22.6% experienced concur-
rent substance dependence or abuse. This is sig-
nificantly higher than the population without a ADDICTION TREATMENT WITHIN THE
mental illness, which demonstrated only a 5.8% HEALTH CARE ENVIRONMENT
prevalence of substance dependence or abuse, rep-
resenting 10.9 million adults (SAMHSA, 2012). Alcohol can be a significant contributing factor to
When considering risk factors among persons medical conditions such as hepatitis, hypertension,
with concurrent mental health and substance tuberculosis, pneumonia, pancreatitis, and cardio-
abuse, it is important to note the increased risk myopathy (Project CHOICES, 2003). One half of
of self-harm among this population. SAMSHA all cases of cirrhosis in the United States are due
(2012) reports: Adults aged 18 years or older with to alcohol abuse. Excess alcohol consumption also
a past-year substance use disorder were more contributes to cancers of the mouth, esophagus,
likely than those without substance use disorders pharynx, larynx, and breast (Emmen, Schippers,
to have had serious thoughts of suicide within Wollersheim, & Bleijenberg, 2005). Alcohol abuse
the past year (11.2% vs. 3.0%). Those with a inflicts central nervous system disease (including
substance use disorder were at greater risk for dementia and stroke) and peripheral nervous sys-
suicidal ideation, and more likely to make plans tem disease (neuropathy and myopathy).
for suicide, compared with adults without depen- Excessive alcohol consumption is the third lead-
dence or abuse (3.6% vs. 0.8%). They also were ing preventable cause of death in the United States
more likely to attempt suicide when compared and was estimated to be responsible for approxi-
with the adult population without dependence or mately 80,000 deaths annually between 2001 and
abuse (1.9% vs. 0.4%) (SAMSHA, 2012). 2005 (Ballesteros, Duffy et al., 2004). This appears
Considerable gaps in the continuum of care to be related in large part to an increased risk of
exist when considering the need for integrated accidental deaths. However, nearly 17,000 traffic
mental health and substance dependence treat- fatalities in the United States in 2000 were related
ment for persons with concurrent mental illness to alcohol use, that is, 40% of all traffic deaths. It
and substance use disorders. In the population is also noteworthy that a 3.5 times greater risk for
of the 2.6 million adults aged 18 years or older drowning exists within age adjusted populations
in 2011 with both severe mental illness and sub- (Bertholet, Daeppen Wietlisbach et al., 2005).
stance dependence or abuse in the past year, 65.6% Growing evidence in the form of systematic
received substance use treatment at a specialty reviews and meta-analyses confirms the efficacy
facility or mental health care in that time period. of brief intervention for unhealthy alcohol use in
Included in the 65.6% are 12.4% who received primary care patients identified by screening. As
both mental health care and specialty substance an example, a meta-analysis of eight trials of 2,784
use treatment, 49.5% who received mental health patients found that brief intervention decreased the
care only, and 3.6% who received specialty sub- proportion of patients drinking risky amounts one
stance use treatment only. Among adults who had year later when compared to patients who did not
a past year substance use disorder, those who also receive brief intervention (57% vs. 69%; absolute
had past year Serious Mentally Ill (SMI) were risk reduction of 12%) (Beich, Thorsen, & Rollnick,
more likely to have received mental health care 2003). A meta-analysis of nine trials reported con-
or specialty substance use treatment (65.6%), fol- sumption outcomes for intention-to-treat partici-
lowed by those who had moderate mental illness pants at 6 or 12 months (Bertholet, Daeppen, &
(41.0%), then by those with low (mild) mental ill- Wietlisbach, 2005). Receiving brief intervention
ness (29.7%), then by those who had no mental decreased patients’ drinking by an additional three
illness in the past year (15.1%). It is important to standard drinks per week compared with patients
recognize that only 12.4% of those with concur- not receiving brief intervention.
rent mental illness and substance use disorders Studies have found brief intervention in at-risk
received treatment concurrently for both disor- substance abusing populations functions to reduce
ders. This is a fact that continues to contribute to health care utilization, and results in cost savings
the “revolving door” aspect of persons seeking care (Solberg, Maciosek, & Edwards, 2008). In one trial,
for their disorders. Without attention paid to both 774 patients with unhealthy alcohol use identified
 4 • Drug and Alcohol Dependence 29

by screening for risky drinking amounts were ran- use, leading to clinically significant impairment or
domized to brief intervention or usual care in 17 distress, as manifested by three or more of the fol-
primary care practices with a total of 64 physicians lowing seven criteria, occurring at any time in the
(Fleming, Mundt, French et al., 2002). The interven- same 12-month period, characterized by:
tion, consisting of two 10- to 15-minute physician
discussions and a follow-up phone call, decreased 1. Tolerance, as defined:
consumption more than usual care, an effect that 2. Withdrawal, as defined:
persisted at 36 months. Hospital use was lower 3. The substance is taken in larger amounts or
over the three-year period in patients assigned to over a longer period than was intended.
the intervention compared with patients receiving 4. There is a persistent desire or there are
usual care (420 vs. 663 days). The intervention was unsuccessful efforts to cut down or
estimated to have saved $546 per patient in medical control use.
costs and $7,780 per patient in total costs (primarily 5. A great deal of time is spent in activities
due to a reduction in motor vehicle crashes). necessary to obtain, use, or recover from
What is becoming clear is the need to dem- effects of the substance abused.
onstrate multiple levels of competence in brief 6. Important social, occupational, or recreational
intervention across populations within a variety activities are given up or reduced because of
of settings to determine potential risk of active substance use.
substance abuse and dependence, in order to iden- 7. Substance use is continued despite knowledge
tify, assess, and treat substance use disorders more of having a persistent or recurrent physical
effectively (Yeager et al., 2013). There exist grow- or psychological problem that is likely to
ing bodies of evidence to suggest that multidis- have been caused or exacerbated by said
ciplinary approaches across a variety of settings substance use.
(e.g., substance abuse, mental health, and health
care settings), focusing on identification, brief In the DSM-5, the DSM-IV criteria for sub-
intervention, and referral to the most appropri- stance abuse and substance dependence have
ate level of care are both effective and efficient. been combined into single substance use disor-
The goals of a brief intervention for those demon- ders specific to each substance of abuse within a
strating nondependent behaviors should focus on new “addictions and related disorders” category.
reduction of use, harm reduction, or abstinence, Each substance use disorder has been divided into
as well as changes in risk behaviors (e.g., avoiding mild, moderate, and severe subtypes. Whereas
bars and events centered around drinking or drug DSM-IV substance abuse diagnostic criteria
use). In the population where use has been deter- required only one symptom, the DSM-5 now
mined to be detrimental and unhealthy, absti- requires at least two. The DSM-5 revisions are
nence is generally the best option. Those defined intended to (1) strengthen the reliability of sub-
as being appropriate for abstinence-based inter- stance use diagnoses by increasing the number of
vention include any of the following: required symptoms and (2) clarify the definition
of “dependence,” which is often misinterpreted as
• A diagnosis of dependence implying addiction and has at its core compulsive
• Failed prior attempts to moderate/control use drug-seeking behaviors. For example, features of
• A physical or mental health condition physical dependence, such as tolerance and with-
secondary to substance use drawal, can be normal and expected responses
• Taking medications that contraindicates any to prescribed medications that affect the central
alcohol use nervous system and that need to be differentiated
• Pregnant or planning to conceive from addiction. There is a converse example, that
• Prior consequences or a family history that is, although marijuana abuse can be functionally
suggest remaining abstinent may be indicated. very impairing, physical dependence is not part
of the clinical picture, even in severe cases. In this
sense, the new DSM-5 criteria are specifically
DIAGNOSIS OF ALCOHOL AND designed to recognize and account for mental
DRUG DEPENDENCE and behavioral aspects of substance use disorders
(APA, 2013).
Substance dependence is defined by the DSM-IV-TR Although the new criteria require an
as a maladaptive pattern of alcohol and/or drug increased number of symptoms to qualify for a
30 Part II • Roles, Functions, and Fields

substance-related diagnosis, critics of the revision OVERVIEW OF TREATMENT

argue that chances of meeting the new criteria APPROACHES
are now much greater. They further worry that
many individuals who qualify for a substance use Treatment of alcohol and drug dependence
disorder diagnosis by the new criteria may have includes identification of alcohol and drug abuse
only minor symptoms, making it more difficult and dependence, initiating treatment plans, edu-
for those with more severe symptoms and dis- cating the individual and family about the abuse
tress to access already scarce treatment. and dependence, conducting clinically based
interventions within group settings, and indi-
vidual approaches. The interventions include
What Is Substance Dependence?
referral to Alcoholics Anonymous, Narcotics
Dependence is a chronic progressive and poten- Anonymous, or Cocaine Anonymous, employee
tially fatal disease, with genetic, psychosocial, assistance programs, and couple and family coun-
and environmental factors influencing its devel- seling. Early intervention is important because it
opment and manifestations. It is characterized serves to minimize consequences experienced by
by continuous or periodic impaired control over the individual abusing illicit substances. Social
drinking, preoccupation with the drug or alco- consequences include legal, marital, employment,
hol and use of drugs or alcohol despite adverse and financial problems. Additionally, early inter-
consequences, and distortions in thinking, most vention minimizes the potential for long-term
notably denial. health and mental health consequences. Later
intervention includes referral to detoxification
services, health and mental health services, legal
What Does “Progressive and
intervention, and other services necessary to
Fatal” Mean?
stabilize the individual (Holder & Blose, 1992;
“Progressive and fatal” means that the disease Yeager & Gregoire, 2005).
persists over time and physical, emotional, and
social changes are often cumulative and may
progress as drinking continues. Substance depen- ASSESSING ALCOHOL AND
dence causes premature death through overdose; DRUG DEPENDENCE
organic complications involving the brain, liver,
heart, and many other organs; and contributing There are a variety of current best practices for
to suicide, homicide, motor vehicle crashes, and the diagnosis and management of alcohol and
other traumatic events. drug addiction. The following case study exam-
ines the various ways that alcohol and drug
addiction can impact an individual. This case rep-
What Does “Primary” Mean?
resents various symptoms of dependence as well
“Primary” refers to the nature of substance as various treatment needs.
dependence as a disease entity in addition to and Working with alcohol- and drug-dependent
separate from other pathophysiologic states that individuals is challenging and rewarding work
may be associated with it. The term suggests that that requires both skill and tact. Although resis-
substance dependence is not a symptom of an tance and active defense structures are hallmarks
underlying disease state. of alcohol dependence, resistance is less than one
might expect. Williams et al. (2006) reported that
within a sample of 6,400 patients, a full 75%
What Does “Disease” Mean?
demonstrated at least minimal levels of willing-
A disease is an involuntary disability. It rep- ness to change. When placed within a stages-of-
resents the sum of the abnormal phenomena change model, approximately 24% presented
displayed by a group of individuals. These phe- in the contemplative stage of change and 51%
nomena are associated with a specified common demonstrated characteristics of taking action to
set of characteristics by which these individuals change drinking patterns.
differ from the norm and which places them at a Social workers serve a unique role in assist-
disadvantage. ing persons with alcohol abuse and dependence
 4 • Drug and Alcohol Dependence 31

issues. Frequently, the task of conducting a com- Establish a Timeline of Alcohol and
plete and thorough assessment of the dependent Drug Use and Amounts Consumed
individual falls to the social worker. Components
As the family history unfolds, it provides a natu-
of a thorough alcohol assessment include, but are
ral segue into the individual’s experience with
not limited to, the following.
alcohol and drug use. Again using a nonjudgmen-
tal, inquisitive approach, begin gathering history
Establish the Individual’s Perception surrounding childhood perceptions of drinking
of the Problem and drug use, onset of use, type of substances
consumed, and under what circumstances. Make
Begin with the individual’s perception of his or
a genuine effort to understand the individual’s
her drinking history and the exact nature of the
frame of reference surrounding alcohol and
problem. Understanding the individual’s percep-
drug consumption (especially over-the-counter
tion informs the social worker of where he or she
drugs). When possible, reinforce the person’s
will begin in the treatment process. A willingness
self-motivational statements and problem recog-
to listen openly to the individual’s perception of
nition while assessing the level of desire to make
need will also provide an opportunity to begin
positive changes in his or her life.
to gently probe into sensitive areas in a manner
As accurately as possible, begin to piece
that is less intrusive, thus opening channels of
together daily, weekly, and monthly drinking or
communication.
drug use patterns. How do weekdays differ from
weekends? What happens on payday, holidays,
Application of a Disease Frame of and vacations? Begin to weave together behav-
Reference ioral and consumption patterns. Discuss the
Persons seeking assistance with their drink- meaning of alcohol and drug withdrawal: what
ing frequently feel trapped, guilty, helpless, or it is, what it looks like, and the risks associated
hostile. Conducting the initial interview from with it. Based on the individual’s pattern of use
a disease or illness frame of reference, based in and potential for withdrawal, a determination
nonjudgmental language, minimizes defensive- can be made regarding the most appropriate level
ness while establishing a working relationship. of care. In general, the presence of withdrawal
In many cases, individuals are well aware of the symptoms warrants an inpatient detoxification
need to become active participants in their health program. This, of course, will depend on the drug
care. Just as persons with diabetes or hyperten- of use—some drugs require inpatient detoxifica-
sion are responsible for altering their lifestyle tion and others do not. Those with lesser with-
to treat their illness, alcohol-dependent persons drawal risk are more appropriately treated in an
should be encouraged to assume a greater level of outpatient program.
self-responsibility for their treatment. Always be on the lookout for red-flag
responses, such as arrests, domestic disturbances,
accidents, and emergency room visits. Also look
Construct a Comprehensive for comorbidities commonly associated with
Family History alcohol and or drug dependence, such as hyper-
Alcohol and drug dependence has long been deter- tension, diabetes, liver problems, gastrointestinal
mined to have a strong genetic link, therefore, problems, injuries sustained through accidents,
building a family history will begin to normal- and sleep difficulties.
ize the individual’s perception of how he or she
came to acquire this illness. A good family his-
Examine Social and Emotional Factors
tory should include examination of maternal and
paternal drinking patterns and potential alcohol Once the lines of communication are open, the
dependence. Examination of lifestyle, community professional can begin the process of examin-
involvement, reputation, marital, legal, employ- ing sensitive areas of the individual’s life. While
ment, spiritual, and educational history will pro- valuing the previously shared family history
vide important insight into family responses to and perceptions associated with alcohol and
and perceptions of alcohol and drug dependence. drug use, begin to examine the individual’s
32 Part II • Roles, Functions, and Fields

day-to-day activities to build understand- periods. Emphasize that resumption of drinking

ing of social, emotional, and environmental is not a sign of failure but part of a process.
factors associated with alcohol or drug con- When possible, family members should be
sumption. Seek to understand how the use of involved in the treatment process. Assessment of
mood-altering substances is integrated into the potential family involvement should begin with
individual’s rituals. When and where does he or the initial assessment and continue throughout
she drink or use? With whom do they drink or the entire treatment process. Establishing fam-
use? Has this changed over time? If the pattern ily support is a strong positive reinforcement
has changed, question the reason for changes. for adopting and maintaining new approaches
What are the most common social activities? to establishing and maintaining abstinence.
If there are children, to what extent is the par- Finally, provide information on risks. Family
ent involved? How are things in the home? Are members and patients should understand that
family members frequently together, or are alcohol dependence is a chronic, progressive, and
there estrangements? potentially fatal disease. It is important to know
Examine the person’s educational, vocational, what they are up against, what role each per-
military, employment, financial, legal, spiri- son has to play, and how support, openness, and
tual, and recreational history, as well as current self-responsibility can lead to positive changes.
day-to-day activity patterns. It is important to Figure 4.1 describes potential approaches to care
note that many alcohol or drug abusers replace and integration of social factors to be addressed
previously enjoyable activities with drinking or by social workers when providing comprehensive
drug use. Question whether substance use has addition treatment.
any impact on the social aspects of the indi-
vidual’s life and examine what that impact has
THERAPEUTIC APPROACHES
been. The assessment process is one of explora-
tion and education, so take time to teach and set Motivational Interviewing and
boundaries. Avoid the tendency to overexamine Motivational Enhancement Therapy
areas that present with emotionally charged
responses. More often than not, this will lead Motivational interviewing (MI) is a counseling
the assessment away from productive interac- technique frequently applied in the treatment
tion into a dead-end of rationalization, blame, of alcohol-dependent or -abusing persons. This
and frustration. Remain positive and avoid approach elicits changes in behavior by help-
demoralizing statements and negative attitudes ing the individual explore and address ambiva-
about alcohol or drug problems and treatment lence about change. Motivational enhancement
programs. therapy (MET) is a nonconfrontational approach
that focuses on establishing new and different
approaches toward problematic drinking behav-
Summarize and Teach
iors. Goals of this approach are:
Use the assessment process to reinforce and
direct the individual with summary statements. • Seek to understand the individual’s frame of
Summary statements are designed to present the reference.
individual with nuggets of information you have • Elicit and reinforce the individual’s personal
summarized. The intent is twofold. First, you are motivational statements of problem
checking to be certain you have heard and under- recognition, desire, intent to change, and
stood the person’s perception. Second, summa- confidence in ability to change.
rizing statements can be used to tie pieces of • Monitor the individual’s readiness to
information together in a way that leads the indi- change and maintain a steady and consistent
vidual to insights and conclusions previously not approach to problem resolution.
examined. Patients need to understand the impact • Provide support and affirmation of individual
of substance abuse and dependence. Examination choice and potential for self-regulation.
of what has worked for them in the past and what
has not worked is an important part of the assess- Motivational interviewing is a directive,
ment summary. Frequently, individuals will have client-centered counseling style for eliciting
stopped drinking for periods of time. Examine behavior change in which patients explore and
what did and did not work during those time resolve ambivalence (Miller & Rollnick, 2002).
 4 • Drug and Alcohol Dependence 33

Medical
Financial Mental Health

Group/Individual
Housing & Core Counseling Urine
Monitoring Vocational
Transportation Treatment Abstinence
Intake Based Case
Assessment Management
Treatment Pharmaco-therapy Continuing
Child
Plans Care Educational
Care
Self-Help (AA/NA)

Family Legal
AIDS/HIV Risks

Figure 4.1 Core components of comprehensive services.

Motivational interviewing is less structured than might not have previously been clearly under-
the brief intervention described here, but effec- stood. In motivational interviewing this concept
tive brief interventions have been developed that is considered “change talk” (Miller & Rollnick,
are adaptations of motivational interviewing or 2002).
involve similar skills. In motivational interview- Change talk—Miller and Rollnick suggest
ing, patients are helped to recognize a discrepancy sessions should seek to elicit “change talk” or
between their values and goals and their current statements from the patient that are in the direc-
actions, which can lead them to consider change. tion of change. Examples of change talk include
Motivational interviewing involves collaboration the individual’s perceptions of his or her readi-
with the patient, eliciting the patient’s thoughts ness and how their current behavior relates to his
and listening to them, and making it clear that or her personal goals. Elements of change talk can
the patient has choices and the autonomy and be abbreviated with the acronym DARN-C, that
ability to make them (Miller & Rollnick, 2002). is, when the patient expresses:
The individual’s perceptions of his/her readi-
ness to change can be used to elicit change talk. • Desire to change
For example, if the importance of change is rated • Ability to change
as a 3 on a scale of 1 to 10, the clinician can rec- • Reasons for change
ognize that the score was not zero and ask why. • Need to change
This may lead the individual in question to iden- • Ultimately, Commitment to change (Miller
tify his or her concerns about their substance use. & Rollnick, 2002).
The clinician can then inquire as to what it might
take for the score (or identified importance) to Carroll et al. (2006) conducted a random-
increase. The patient’s response when examined ized trial of MET motivational interviewing in
by the individual and clinician can then be used a community-based substance abuse program
as a starting point for discussion of how to go setting. Findings from this study indicate that
about initiating the process of change (Miller & exposure to motivational interviewing dem-
Rollnick, 2002). onstrated greater levels of program retention
As this discussion continues and the individ- when compared to control groups. However,
ual expresses an increasing interest in change, substance abuse outcomes at 84 days did not
the clinician should use reflective listening. differ significantly from controls. Despite this
Doing so permits the patient to hear, in their disparity, MI continues to emerge as a best
own words from the clinician, clarifying state- practice in treatment of alcohol abuse and
ments that help them to understand and become dependence. Current literature indicates that
comfortable with motivations for change that there are more than 160 randomized trials,
34 Part II • Roles, Functions, and Fields

numerous multisite trials, and recently pub- • The individual as the expert in developing
lished meta-analyses of the effectiveness of MI. effective change and solutions rather than
In these studies, the effectiveness of MI demon- the social worker
strates wide variability within defined problem • The role of the social worker is to assist in
areas. In general, positive effects of MI appear the development of potential solutions.
early but tend to diminish over time. It is criti- • Emphasizing the “here and now” rather than
cal to remember that MI effectively captures the “then and why.”
the individual early in the treatment process,
leading to increased participation and poten- Steve de Shazer and Insoo Kim Berg of the Brief
tially increased retention in programming, Family Therapy Center in Milwaukee are the
both of which are key components of successful originators of this form of therapy.
treatment outcomes.
HOSPITALIZATION AND
Cognitive-Behavioral Therapy REFERRAL OPTIONS

Cognitive-behavioral therapy (CBT) is a struc- There are times when brief intervention is not
tured, goal-directed approach designed to help useful for patients experiencing severe alcohol
patients learn how thought processes affect their abuse or alcohol dependence. If the initial assess-
behavior. The social worker helps the individual ment suggests severe alcohol dependence, and
develop new ways of thinking and behaving the individual indicates a willingness to stop
through improved cognitive awareness. This drinking, level-of-care options should be consid-
leads to an increased ability to adapt to and ered. These options consist of the following:
alter situations within the social environment
that present as potential triggers for alcohol • Inpatient detoxification
consumption. • Inpatient treatment
The evidence for CBT is favorable and indi- • Residential treatment
cates it is an effective treatment approach for • Day treatment or outpatient therapy.
alcohol dependence and abuse. Current evidence,
however, suggests that CBT is most effective Patients presenting with mild-to-moderate
when applied as part of a comprehensive treat- symptoms of alcohol withdrawal have the poten-
ment plan (Cutler & Fishbain, 2005). tial to be managed within an outpatient treat-
ment setting. Outpatient detoxification has
Solution-focused Approach become increasingly popular since the emer-
gence of cost-reduction approaches to substance
Solution-focused therapy approaches addic- dependence treatment emerged in the late 1980s
tion issues from a prospective approach. Rather and early 1990s.
than examining problems and past behaviors, Patients with more severe withdrawal symp-
solution-focused therapy examines current real- toms and susceptibility to environmental cues
ity, building on the unique strengths and abilities are better cared for in inpatient treatment envi-
each individual brings to the therapy process. In ronments that are free of relapse triggers. Many
the treatment of alcohol abuse and dependence, providers place their patients in an inpatient
solution-focused therapy focuses on: treatment setting to initiate detoxification and
medical stabilization. This is followed by transi-
• Envisioning the future without alcohol and tion into residential or day-treatment programs.
the problems that led to treatment The third level of step-down approaches to
• Discovering effective approaches/solutions to alcohol dependence involves transition into
present issues intensive outpatient treatment, which is com-
• Encouraging the individual to build on prised of education, group, and individual ses-
previous successes, as well as adding sions usually three hours in duration occurring
new approaches to methods that have three times per week. Following completion of
demonstrated success previously this level of care the individual transitions into
• Directing and facilitating self discovery a traditional outpatient treatment. Figure 4.2
through self-examination presents options for individualized treatment
 4 • Drug and Alcohol Dependence 35

Select Level of Care Select Treatment Select Therapeutic Select Adjunctive

Intake (consider step-down Modality Approach Support
Assessment approach) (any combination) (any combination) (any combination)

Inpatient Pharmacotherapy
Motivational Supportive
Detoxification Abstinence
Interviewing Pharmacotherapy
based

Outpatient Group Cognitive Case

Detoxification Therapy Behavioral Management

Residential Individual Solution Urine

Treatment Therapy Focused Monitoring

Day 12-Step Strengths Health

Treatment Support Perspective Management

Intensive Couple and Psycho- Continuing

Outpatient Family educational Care

Traditional Manage Eclectic Professional

Outpatient Comorbid Illness Approach Support Group

Figure 4.2 Options for individualized treatment approaches with alcohol- and drug-dependent
individuals.

On three occasions, his physician increased the

approaches when working with alcohol- and
strength of his medication. John began to order
drug-dependent individuals.
prescriptions online. He doubled the prescribed
dose. He began to miss business appointments
CASE EXAMPLE and experienced increased marital stress related
to his prescription medication use. Finally, John
John G. is a 50-year-old self-employed civil crashed his company car into a school bus when
engineer who has been extremely successful he apparently fell asleep at the wheel in the
in developing his own business. John has four middle of the afternoon. At the point of enter-
regional offices and travels extensively manag- ing treatment, John was facing legal problems
ing each of them, bidding jobs and interacting related to this accident, financial problems
with various construction companies on busi- related to lack of attention to his business, mar-
ness. Seven months ago, while working, John ital difficulties as a result of the prescription
fell while jumping onto a bulldozer to speak drug abuse, and an emerging single-episode
with a friend. He injured two vertebrae (L-4 depressive disorder.
and L-5) in his lower back in this fall. This John will benefit from a combined approach
injury created severe nerve pain that radiates of MI and CBT. It is best to begin with motiva-
down his leg and causes limited mobility. John tional interviewing to ensure initial connection
is prescribed an opiate-based pain medication. with treatment processes. Given John’s level of
He has always been a drinker, and he enjoys cognitive functioning, CBT will be appropriate as
drinking with business associates. His drink treatment progresses. This approach can be help-
of choice is beer, yet there is no stated history ful in assisting him in developing concrete plans
of drug or alcohol abuse in his medical record. to address issues of chronic pain, as well as estab-
Initially, John used the pain meds sparingly, but lishing a plan for returning to work. An initial
as time progressed, his use increased. Soon he focus will elicit information and take advantage
was taking more than the prescribed amount. of change talk revealed in statements such as “I
36 Part II • Roles, Functions, and Fields

am ready to quit” or “I have to quit to get my life a.m. March 9, in the fifth-floor conference
back in order.” room.
Change talk is talk that recognizes a desire Goal 3: John will write a letter to each of his
to change, the ability to change, provides reason physicians by noon, March 12, (1) informing
for the change, and describes a need to change. them of his entering treatment for substance
Simply remember DARN. However, change does dependence, (2) specifically describing his
not occur without action or positive steps in the program of abstinence, and (3) asking for
direction of recovery. Action talk requires iden- their assistance in managing his pain without
tification and support of commitment; a willing- the use of mood-altering substances.
ness, intention, determination, or readiness for Goal 4: John will continue to build his sober
treatment activation; and the willingness and support network by attending three 12-step
preparedness to take action and actually take pos- meetings of his choice on a weekly basis.
itive steps toward recovery, which in John’s case He will obtain the telephone number of at
requires entering treatment. For action steps, least one group member per meeting and
simply remember CAT. will make phone contact with at least one
Cognitive-behavioral approaches can be used person whose number he has collected to
to frame very specific treatment plans to address discuss the progress he has made in treat-
underlying issues associated with treatment need ment to date.
and to facilitate continued movement toward
established goals. An example of John’s treat- It is important that treatment goals be spe-
ment goals might look like the following: cific in nature, measurable, time-limited, and,
most important, accomplishable. In this case,
Goal 1: John will attend physical therapy at 10 John is combining CBT with MI and health
a.m. He will work with Joan to complete 30 care, as well as legal and social support. In doing
minutes of stretching and strengthening so, he is addressing many of the components
exercise during each session. that brought him to treatment, while estab-
Goal 2: John will work with Rick (social worker) lishing a firm foundation for ongoing recovery
to address pending legal charges with Mr. processes. Figure 4.3 outlines multiple options
Anderson, his attorney. John will complete available to care providers when considering
necessary paperwork to document actions treatment and community based support for
taken to date. This meeting will take place 9 treatment.

Legal Mental Health Financial Educational

Health care Access
Transportation

Inpatient Pharmacotherapy Motivational Supportive

Detoxification Abstinence based Interviewing Pharmacotherapy

Outpatient Group Cognitive Case

Detoxification Therapy Behavioral Management

Residential Individual Solution Urine

Treatment Therapy Focused Monitoring

Day 12-Step Strengths Health

Treatment Support Perspective Management
Child Care

Traps/Triggers

Intensive Couple and Family Psycho- Continuing

Outpatient Therapy educational Care

Traditional Manage Comorbid Eclectic Professional

Outpatient Illness Approach Support Group

Primary Treatment Focus

Vocational Social Support Peer Pressure Housing

Figure 4.3 Competing social/environmental factors requiring social work intervention.

 4 • Drug and Alcohol Dependence 37

Case autopsy: John initially was treated on WEBSITES

the inpatient unit for detoxification and stabili-
zation. He then transitioned into intensive out- Center for Substance Abuse Treatment.
patient treatment, where he remained under the http://csat.samhsa.gov.
care of a social worker for a total of 16 sessions. National Association of Addiction Treatment
John attended psycho-educational, group, indi- Providers. http://www.naatp.org.
vidual, and family sessions while in treatment. National Institute on Drug Abuse.
He successfully resolved his pending legal issues. http://www.nida.nih.gov.
The DUI charge was resolved with consequences Substance Abuse and Mental Health Services
of probation, 90-day license suspension, and Administration. http://www.samhsa.gov.
requirement to document ongoing treatment for
a one-year period of time. John returned to his
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related-deaths-worldwide-annually. Accessed Au- (2013). Introduction. In: Yeager, K. R., Cutler,
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Medicine, 34, 2, 143–152. New York: Oxford University Press.

5 School Social Work

Robert Lucio

While the history of school social work over in specialized environments, there is a clear need
the first 100 years has shown adaptability to for social workers to develop and use effective
the changing social climate, it also reveals a pro- strategies in practice and research. School social
cess of specialization (McCullah, 2004). Bartlett workers are becoming increasingly aware of the
(1959) drew a distinction between generic social need to be accountable for outcomes related to
work theory and specialized social work theory. the services provided and are also beginning to
A generic social work theory was proposed for understand the need to show decision makers the
all social workers with the understanding that value of school social work in impacting the lives
each field of social work also needed its own of students.
specialization-specific theory. As social workers Risk and protective factor determinants can
develop specialized skills and continue working be viewed as core components of an ecologically
 5 • School Social Work 39

driven approach to children’s issues (Miles, (Bye, Shepard, Partridge, & Alvarez, 2009; Kelly,
Espiritu, Horen, Sebian, & Waetzig, 2010). It Berzin, Frey, Alvarez, Shaffer, & O’Brien, 2010;
is the process of deciding the if, what, where, Whittlesey-Jerome, 2013). These researchers
why, and how of intervening. Having a com- looked at the activities that consume their time,
mon understanding that includes assets, com- what services they are providing, and the broad
petence, and protective processes along with classification of their services. It was found that
the traditional measures of risk factors, symp- almost all school social workers engage in indi-
toms, problems, and risk-producing processes vidual counseling, group counseling, and class-
is critical for student success. As school social room groups. In addition, a majority of school
workers find themselves in the fight for limited social workers perform psychosocial evaluations
resources within an educational host setting, and case management services. In fact, school
it is vital that services and outcomes be geared social workers reported that over 60% of their
toward academic achievement and success. The time is spent on secondary and tertiary preven-
social work profession has the ability to influ- tion, while only 30% is spent on primary pre-
ence many areas that will improve students’ vention. The activities are focused on school
achievement, behaviors, and other school out- attendance, discipline problems, school climate,
comes, but presently has few empirical ways of achievement, school violence, drop-out, and teen
showing this to those who are making crucial pregnancy (Bye et al., 2009).
financial decisions. School districts and school When asked about things they wish they
personnel need to be shown that school social could change about their jobs, school social
workers can help impact student academic and workers most frequently reported wanting more
behavioral outcomes. administrative decision-making ability and a
Beyond understanding the current roles that troubling lack of understanding on the part of
school social workers play, the future of school others regarding their roles and responsibili-
social work is being influenced by (1) Response ties (Peckover, Vasquez, Van Housen, Saunders,
to Intervention (RtI); (2) data informed decisions; & Allen, 2013). When roles are not clear, there
(3) evidence-based practices; and (4) the devel- can be confusion about what school social work-
opment of a comprehensive school social work ers actually do. This can lead to duties being
model. In addition to these four emerging areas assigned to them that do not fit with their skills
of school social work, the role of social workers in and training.
the future will also be discussed. These are criti- Although school social workers have the abil-
cal areas that need to be brought to the attention ity to focus and direct resources where they are
of school social workers preparing for the next likely to have the greatest impact, and to where
100 years of practice. there is a high chance of sustainability, the
current state of social work practice in schools
points to a focus on clinical services for those
SCHOOL SOCIAL WORKERS’ ROLE students already identified as at risk. Currently,
school social workers have taken limited roles
School social workers are already asked to do as leaders in prevention, improvement of school
many things and wear many hats throughout culture, and policy change at the local, state, and
the day, including clinician, case manager, advo- national levels (Kelly et al., 2010). Despite the
cate, and even policy maker. As the demands on current roles, which often focus on direct ser-
social workers increase, so will the roles they vices, with the introduction of new approaches
are asked to fill. These range from supporting to social work practice, namely a Response to
the mission of the school to serving children Intervention framework, the potential exists for
on multiple systemic levels in order to promote social workers to move beyond providing ser-
effective learning through interventions in the vices to one student at a time. Although there is
school and home environment. Social workers no doubt this is valuable work, a shift in focus to
may also be called upon to select appropriate a prevention model in schools creates an oppor-
interventions for students, work in small groups tunity for school social workers to be at the
or with individuals, or even provide referrals for forefront of this movement and affect both the
other services. broader systemic influences (such as the family,
Several recent studies of school social work- teachers, school, and district) and also student
ers have looked at how they spend their time level outcomes.
40 Part II • Roles, Functions, and Fields

In an effort to expand prevention activities bullying or identified as potential bullies could be

and impact all levels of the schools, it has been offered a service if the problem persists despite
suggested that school social workers start by the system-wide intervention program. Finally,
engaging teachers in a collaborative process by Tier 3 tertiary interventions and services are pro-
offering training and in-service opportunities to vided at an individualized level for those students
empower teachers, providing support for school who were provided Tier 1 and Tier 2 services, but
personnel in dealing with academic and behavior did not respond positively to the interventions.
problems, and being advocates for helping chil- Students who continue to have concerns with
dren, families, schools, and communities (Bye bullying would be seen by school personnel on a
et al., 2009). one-to-one basis at the Tier 3 level.
RtI involves the use of data-informed decision-
making to modify instruction and implement
RESPONSE TO INTERVENTION scientifically based interventions effectively,
and is delivered in the following compo-
The No Child Left Behind Act (NCLB) of nents: multiple tiers of evidence-based instruc-
2001 (P.L. 107–110) and the Individuals with tional service delivery; and problem-solving
Disabilities Act (IDEA) in 2004 (P.L. 108–446) methods designed to inform decisions at each
have radically changed the way in which ser- tier of service delivery. Most importantly, RtI is
vices within education are delivered to students. applicable to all general education students and
These laws have introduced evidence-based exceptional student education (ESE). In fact, the
practices into the realm of schools as one ingre- nationwide Response to Intervention adoption
dient within the Response to Intervention survey found that 71% of school districts were
(RtI) approach to services. RtI is a three-tiered in the process of implementing, piloting, or
framework for providing high-quality instruc- already fully using RtI district wide (Spectrum
tion and intervention matched to the student’s K12, 2009).
needs. It provides intervention and educational Some school social work researchers have
support to all students with increasing levels discussed RtI specifically around the impact
of intensity based on individual student needs. on school social work (Kelly et al., 2010). They
The interventions can be based on academic note four primary principles of RtI where school
and/or behavioral systems. The key character- social workers can have a direct impact. First is
istics of this approach are to identify students the notion that services provided by school social
at risk, closely monitor behavioral or learning workers should help build the capacity of fami-
outcomes, provide evidence-based interven- lies, teachers, schools, and districts. In addition
tions, and adjust the intensity of the services to direct services, collaborative endeavors that
provided depending on the student’s response impact the ability of each of the systems to adopt,
to the intervention. implement, and maintain interventions and ser-
The RtI framework is much like a public vices should be one focus of school social workers.
health approach to applied education in identi- Although this principle is one of the core build-
fying students who are at risk for academic or ing blocks of RtI and school social work, it was
behavioral problems and providing instruction found that these critical activities were the least
and interventions based on the student’s needs. likely to be performed in the current school social
The first tier (Tier 1) is focused on primary pre- worker’s job activities. In order to reverse this
vention and intervention efforts for all students trend, it is critical that school social workers look
at a system-wide level in order to minimize any for opportunities to expand their role by engag-
concerns before they become a problem. For ing in strategies and interventions that assist
instance, a school-wide anti-bullying program each part of the system; assume leadership roles
could be implemented in order to reduce the risk that influence the broader macro-system; support
of bullying in a specific school. For those students families, teachers, and administrators in making
who do not respond to the Tier 1 interventions, and sustaining changes; and apply the ecologi-
small groups of students are engaged in Tier 2 cal model to all three tiers. This might take the
secondary prevention services. These small group form of community engagement efforts, teacher
interventions can be specialized groups or even trainings, working with families, and working to
systems interventions for those students iden- change the culture of the school to support posi-
tified as at risk. Students who are reacting to tive academic and behavioral outcomes.
 5 • School Social Work 41

The second principle relates to the provi- is the use of practices, interventions, and treat-
sion of evidence-based practices by school social ments which have been proven, through data
workers. Schools should use evidence-based based research, to be effective in improving out-
practices based on interventions that have comes for individuals when the practice is imple-
proven through empirical research and data to mented with fidelity” (p. 1). The implementation
be effective in dealing with the specific academic of the RtI approach is centered on evidence-based
or behavioral concern. The third principle is practice, and using this approach mandates that
the application of the public health prevention interventions “must be evidence-based” (Bureau
framework to education, using a multi-tiered of Exceptional Education and Student Services,
intervention approach. The fourth principle of 2006, p. 2). With the importance being placed on
RtI calls for data to inform decisions about the outcomes in schools, evidence-based practice is
effect of interventions on student outcomes. certainly moving to the forefront of school social
School social workers may need to support work and has become a strong directive in school
schools in selecting and implementing interven- social work.
tions, or even collecting, analyzing, and inter- Raines (2004) provides steps in the process of
preting data in order to ensure students are implementing evidence-based practice. The list
receiving appropriate services. of the steps is presented as: formulating ques-
The adoption of this framework within tions, investigating the evidence, appraising the
the context of schools has broad implications evidence, applying the evidence, and evaluat-
for school social workers. This type of frame- ing progress. Under each process, an example
work requires that school social workers be is given so that school social workers can see
versed in more than direct clinical services or how this applies to their practices. The author
case management activities. They must also be also notes that in order to make evidence-based
capable of supporting each of the three tiers in practice most practical, there must be the cre-
order to improve student outcomes. This might ation of relevant knowledge and the dissemina-
involve learning new skills and taking on new tion of that knowledge. Of the seven guidelines
roles, such as directing the implementation of listed for deciding which interventions to use,
evidence-based practices and assisting in helping two refer to the interaction with theory, namely,
schools collect, monitor, and interpret data that whether there is empirical support for a the-
helps schools understand whether students are ory or technique and whether the framework
improving. recognizes a person-in-the-environment per-
spective. The tie to theory is a vital key to inte-
grating evidence-based practice into this new
EVIDENCE-BASED PRACTICES framework. Simply reading about best practices
does not mean a practitioner has the ability to
Another step impacting the future of school implement that intervention effectively.
social work is to look at which evidence-based School social workers must understand the
interventions can be applied specifically to the context of the schools in which they are pro-
identified academic or behavior concerns. This viding services in order to successfully imple-
gives social workers a tangible way to impact ment evidence-based practices. The effective
students, by referring them to or providing the integration of these interventions and services
appropriate services. The current research on into everyday practice requires knowledge of
evidence-based practice can be used as a guide key organizational and political systems within
in deciding which interventions to implement, schools, and knowledge of which interventions
thus allowing the use of best practices with stu- promote change, given the characteristics of
dents. Evidence-based practice (EBP) has had the current students, teachers, school climate,
a significant impact on school social work and and school administration (Phillippo & Stone,
education. 2011). This also requires school social workers
The No Child Left Behind Act (NCLB) of 2001 to have a thorough knowledge base of appropri-
requires the use of scientifically based research ate interventions, an understanding of how to
in schools (Pub. L. No. 107–110). The Colorado get information on additional evidence-based
Department of Education (2005) addresses the practices, the ability to collect and analyze data
use of evidence-based practices within this around effectiveness of services, and an approach
framework by stating “evidence-based practice that encourages supporting other elements of
42 Part II • Roles, Functions, and Fields

the school system through a consultation and SCHOOL SOCIAL WORK FRAMEWORK
collaboration.
The major prevailing framework in school social
DATA INFORMED DECISIONS work is the ecological approach, which serves
as a guiding framework for school social work
The adoption of RtI as a framework for edu- services. This approach enables school social
cational services has created a push toward workers to view students, families, schools,
making data-informed decisions. However, communities, and districts within the multiple
even within this new directive there are few systems that interact to impact a student’s aca-
clear guidelines as to who and how services are demic and behavioral outcomes. Moving to a
delivered, which adds to the confusion among more ecological approach recognizes all of the
student services professions regarding which influences on student outcomes. One of the
roles to adopt (Weist, Ambrose, & Lewis, 2006; benefits of using this systems view is the abil-
Weist, Lowie, Flaherty, & Pruitt, 2001). Not ity to be both student and system focused. The
only do school social workers have to struggle ecological model takes into account numerous
to define their roles within the schools, but factors that have an effect on an individual per-
they must do so while attempting to incorpo- son, including individual, family, peer, school,
rate evidence-based interventions borne from and community influences. Connecting the per-
sound social work theory. Using data to inform son to the environment takes into account mul-
decisions involves screening at the system and tiple levels of interaction and the impact of this
individual levels to help determine needs and network of social and interpersonal influences.
the effectiveness of interventions and services The ecological perspective and school social
in promoting or inhibiting academic and/or work practice go hand in hand. School social work
behavioral concerns. This might also involve practice has four major focus areas: (1) early
identifying which children are responding to intervention to reduce or eliminate stress within
the intervention and which might require more or between individuals or groups; (2) problem
intensive services. solving services to students, parents, school per-
In order for school social workers to engage sonnel, or community agencies; (3) early iden-
fully in this process, they should have access to tification of students at risk; and (4) work with
valid and reliable measures, the ability to ana- various groups to develop coping, social, and
lyze and interpret the data, and make an effort to decision-making skills. However, because school
engage key stakeholders in conversations around social workers function within a larger host set-
the meaning of the findings (Allen-Meares, ting, there is a “need to develop strategies that
Montgomery, & Kim, 2012). Having access to optimize, enhance, and augment the goals of edu-
appropriate scales, measures, school data, and cation” (Atkins, Hoagwood, Kutash, & Seidman,
any other information will help provide an accu- 2010, p. 40). As school social workers operate in a
rate and useful evaluation of student outcomes system moving toward outcomes, evidence-based
(Whittlesey-Jerome, 2013). School social work- practices, and accountability, it is vital to focus
ers should also develop a process to collect and attention on how services ultimately impact
organize data, especially if the data are not part students.
of a regular school data system. Once the data are Although it is clear the ecological model
collected, analysis and interpretation of the data takes into account numerous factors that have
is another essential task that school social work- an effect on an individual person, a lack of uni-
ers must have the ability to perform. It is not form practice among school social workers exists
enough to provide reports if the data presented due to its multiple roles and complexity. School
do not lead to improvements in student out- social workers must understand all levels of the
comes. Taking findings and understanding how to system to enact change, requiring social work-
communicate this information to key stakehold- ers to have complete vision of the micro, meso,
ers (e.g., community, faculty, or even schools) macro, and chrono systems. However, not hav-
increases the likelihood that data will be used to ing a consistent model can lead to unclear roles
inform student services and also increases the and misunderstanding of the capabilities of
visibility of school social workers in the success school social work by faculty and administrators
of students. (Dupper, 2003).
 5 • School Social Work 43

A new model for school social work has been social workers are beginning to look at how they
called for in order to apply school social work impact achievement, the questions about how or
practices consistently in a way that is useful to why this occurs still need to be examined. These
all parts of the “system.” School social workers processes and mechanisms for success and failure
should be able to engage in the process of clos- provide the key to developing and selecting use-
ing the “research to practice gap” and translating ful interventions. Understanding where to put
research into practice (Ringeisen, Henderson, & the effort is important, but it is only the first step
Hoagwood, 2003). Kelly and Stone (2009) looked in deciphering the complex notion of academic
at the contextual characteristics of school social and behavioral success.
workers and how their environment impacted The ability to identify students who are at
which interventions were used. Looking at the greatest risk allows for the most efficient use
characteristics of the practitioner, characteristics of time and resources by school social work-
of the practice setting, and socio-cultural factors, ers. Targeting interventions to students whose
they found little impact on the interventions need is greatest enables school social workers to
used. This suggested the need to develop a new direct services where they are most vital, opti-
school social work model that includes more than mizing resources and allowing for school social
individual and group counseling, although pre- workers to differentiate between individual and
dicting the use of more systemic practice factors system concerns. This shift in thinking contin-
was more difficult. ues to build on the path that is being paved by
Taking this further, Frey et al. (2013) have evidence-based practice. Understanding which
presented the beginning framework for a factors help make students successful allows
model that provides a guide for the types of school social workers to partner with families
services that school social workers should be and other systems in addressing those areas
expected to perform. Their goal is to present that present as risks for academic and behavioral
a broad model that relays school social work success.
roles, skills, and competencies. Specifically they
propose the four constructs of social justice,
HELPFUL WEBSITES
home-school-community linkages, ethical-legal
practice, and data-informed decisions in prac-
School Social Work Association of America
tice as the foundation for the new model.
(SSWAA)—http://sswaa.org/
Additionally, they see school social work prac-
American Council on School Social Work
tice as focused on educationally relevant mental
(ACSSW)—http://acssw.org/
health services, healthy school climate, healthy
National Association of Social Workers, School
cultural learning environment, and utilizing
Social Work Practice Section—http://www
access to resources. This new framework serves
.socialworkers.org/practice/school/default.asp
as a guide to where interventions can be focused
to target the greatest chances of impact and suc-
References
cess. It also gives school social workers a tool to
expand their services to the system level while Allen-Meares, P., Montgomery, K. L., & Kim, J. S.
still embracing their clinical strengths. (2012). School-based social work interven-
tions: A cross-national systemic review. Social
Work in Education, 58(3), 253–262.
CONCLUSION Atkins, M., Hoagwood, K., Kutash, K., & Seidman, E.
(2010). Toward the integration of education and
Recent calls have been made in social work for mental health in schools. Administration and
more scientific and evidence-based research in Policy in Mental Health and Mental Health
social work and social work education (Corcoran, Services Research, 37, 40–47.
Bartlett, H. (1959). The generic-specific con-
2007; Shaw, 2003; Zlotnik & Solt, 2006). Having
cept in social work education and practice. In
a solid knowledge base and clear role expecta-
A. E. Kahn (Ed.), Issues in American social
tions, using data to inform student interven- work (pp. 159–190). New York, NY: Columbia
tions, incorporating evidence-based practices, University Press.
and using a clear practice model are critical com- Bureau of Exceptional Education and Student Services.
ponents for the school social work profession (2006). The Response to Intervention (RtI)
to continue moving forward. Although school model: Florida Department of Education.
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Bye, L., Shepard, M., Partridge, J., & Alvarez, M. school social workers for the future: An update of
(2009). School social work outcomes: Perspectives school social workers’ tasks in Iowa. Children &
of school social workers and school administra- Schools, 35(1), 9–17.
tors. Children & Schools, 31(2), 97–108. Phillippo, K., & Stone, S. (2011). Toward a broader
Colorado Department of Education. (2005). Fast view: A call to integrate knowledge about schools
facts: Evidence Based Practice. Retrieved from into school social work research. Children &
http://www.cde.state.co.us/cdesped/download/ Schools, 33(2), 71–82.
pdf/ff-EvidenceBasedPractice_Intro.pdf. Raines, J. C. (2004). Evidence-based practice in school
Corcoran, K. (2007). From the scientific revolution to social work: A process in perspective. Children &
evidence-based practice: Teaching a short his- Schools, 26(2), 71–85.
tory with a long past. Research on Social Work Ringeisen, H., Henderson, K., & Hoagwood, K. (2003).
Practice, 17(5), 548–552. Context matters: Schools and the “research to
Dupper, D. R. (2003). School social work: Skills and practice gap” in children’s mental health. School
interventions for effective practice. Hoboken, Psychology Review, 32(2), 153–168.
NJ: John Wiley & Sons, Inc. Shaw, I. F. (2003). Critical commentary: Cutting edge
Frey, A. J., Alvarez, M. E., Dupper, D. R., Sabatino, issues in social work research. British Journal of
C. A., Lindsey, B. C., Raines, J. C., . . . Norris, Social Work, 33, 107–116.
M. A. (2013). School Social Work Practice Spectrum K12. (2009). Response to intervention
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cfm?an=1&subarticlenbr=459 file/RTI_2009_Adoption_Survey_Final_Report.
Kelly, M. S., Berzin, S. C., Frey, A., Alvarez, M., Shaffer, pdf
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 6 Social Work Practice and Leadership

Michael J. Holosko

INTRODUCTION perceive reality and the principles by which they

conduct themselves. (p. 87)
Social work has a rather long and storied history
of not defining core concepts that either direct Despite the fact that leadership was a core
and inform its practitioners or educate and train concern of the Council of Social Work Education
its students (Holosko, 2009). Social work leader- (CSWE) some 15 years ago, as indicated in its
ship is an example of one such core concept. The Strategic Plan 1998–2000, and the NASW, who
history of North American social work is charac- sponsored the “Leadership Academy” from 1994
terized by many altruistic leaders who, through to 1997, and conducted an annual meeting on lead-
their compassion for vulnerable individuals, acted ership development, Brilliant (1986) referred to
humanely and made a difference in those individ- leadership as essentially a “missing ingredient” in
uals’ lives. William James’s (1907) classic essay on social work education and training. After reviewing
pragmatism makes the point more succinctly, as its sporadic attention in our professional literature,
“seeking the difference that makes the difference.” she concluded it was essentially a “non-theme” in
These early, turn-of-the-century pioneers led by social work training and education. Later, Reamer
advocating, reforming, transforming, reflect- (1993) emphatically concluded that we do little to
ing, and most importantly—giving names, voice, educate for leadership in social work. Then, Stoesz
hope, and inspiration to the clients and communi- (1997) lamented that social work professionals
ties they served. They included the likes of: Jane are often forced to rise to positions of leadership
Addams, Dorothea Dix, Josephine Shaw Lowell, within the profession with little to no mentoring.
Mary Richmond, Ellen Gates Starr, Frances Rank and Hutchinson (2000) investigated
Perkins, Florence Kelly, Ida Cannon, Grace Abbott, individuals (N = 75) who held leadership posi-
Lillian Wald, Paul Kellogg, Anita Rose Williams, tions within the CSWE and the NASW, and con-
and Sarah A. Collins—to name just a few. cluded that their education and training in this
Our profession’s legacy of leaders is much area fell short of both the demands for leadership
longer than its conceptualization or research in the field, and our curricula’s ability to teach and
about leadership, and this reality is typical of educate students about the concept adequately.
other disciplines that similarly embrace the con- Their comprehensive analysis made a cogent case
cept. As Graham (2002) stated: for the uniqueness of social work leadership, and
they offered a number of constructive sugges-
. . . research into leadership is a young and still rather tions to direct social work in this regard into the
shapeless discipline. While leaders and leadership
twenty-first century. It appears that the profession
may provide the stuff of bar-room wisdom to glean
has had better success in “taking the concept for-
analytical insights and perspective value at a level
approaching normal academic standards. Although ward,” when it responded to the leadership needs
some literature exists offering unfalsifiable theories expressed by its clients and practicing profession-
about leadership behavior and personality, there is als in its fields of practice (Holosko, 2009). For
a dearth of primary empirical information about example, the National Network for Social Work
leaders, the philosophical prisms through which they Managers established in the mid-1980s developed

45
46 Part II • Roles, Functions, and Fields

a curriculum focused on core competencies in our field in the past decade, only five articles sim-
needed to run well-functioning, high-quality ilarly linked these two terms in their titles.
health care human service agencies/organiza- Where this conceptual fuzziness has poten-
tions. Their Academy grants the Certified Social tially a more deleterious effect is in our formal
Work Manager (CSWM) credential to social education and training (Nesoff, 2007). However
work managers who meet criteria that minimally one looks at the issue from this standpoint, we are
include education, training, experience, demon- professionally remiss in this regard, and it appears
strated competency in 12 core areas, and approval that we have a rather long and comfortable his-
by the Academy (Wimpfheimer, 2004). tory of evolving without clearly defining either
Similarly, the John A. Hartford Foundation who we are, or how we should practice (Bartlett,
(www.jhartfound.org) in conjunction with 1970; Boehm, 1958; Flexner, 1915; Gitterman &
CSWE, has been integral in facilitating and ele- Germain, 1980; Gordon, 1962; Pincus & Minahan,
vating the profession’s leadership role in geron- 1973; Reid & Epstein, 1972). Indeed, educators,
tology in the United States. Since about 1996 to accrediting bodies, and legitimizing organizations
2009, they have spent some $48 million dollars on (e.g., license boards, the NSAW) should take it
a variety of initiatives that have promoted social upon themselves to better define the very con-
work to a national leadership position through cepts we promote and use (Holosko, 2009).
gerontological education, training, research, colla-
tions, collaborations, scholarships, and curriculum
ON BECOMING A SOCIAL WORK
development, etc. In this burgeoning world-
LEADER
wide population growth area (www.jhartfound.
com), the curious irony is that we routinely tout Leadership versus Management
the importance of leadership within the profes-
sion. Social work’s enthusiasm for the concept, For a number of years in many academic fields of
however, supersedes its meaningful inclusion in study, the terms “leadership” and “management”
education or training. For instance, in CSWE’s have been: (a) defined in many ways; (b) defined in
Educational Policy and Accreditation Standards various ways; (c) used as “garbage can” terms—to
(EPAS) (2009), among 10 competency standards describe anything and everything about this con-
leadership is only mentioned once. Similarly, a tent; (d) often overlapped, blurred, and not differ-
word search count conducted for this chapter of entiated from one another; and (e) defined in rather
the school mission statements of the top-ranked nebulous and unclear ways. In addition: (a) more
schools of social work (N = 50) cited in U.S. News literature is published about the concept of man-
and World Report (2012), and the corresponding agement as opposed to the concept of leadership;
titles of courses offered on their respective web- (b) good leaders have a very different skill set than
sites, revealed: (a) 51% of the schools included the do good managers; (c) very few leaders are effective
word “leadership” in their mission statements; managers—and vice versa; (d) it appears easier to
however, (b) only 27% of these same schools used educate and train social workers and allied profes-
the word “leadership” in any of the titles of their sionals to become managers—rather than leaders;
advertised web-listed school courses. In summary, and (e) recently, there seems to be more concern
as previously indicated, from a variety of educa- about the importance of management in nonprofit
tional perspectives, social workers seem much and educational settings rather than leadership
more enamored with the topic of leadership, and (Hafford-Letchfield & Lawler, 2010; Holosko, 2009;
less enamored with developing its educational Holosko & Skinner, 2013; Kamaria & Lewis, 2009;
potential more meaningfully in their schools. Paton, Mordaunt, & Cornforth, 2007).
Finally here, for this chapter, a review of social Each of these will now be defined in consensual
work leadership literature sources only two texts, ways: (a) leadership is a process whereby an indi-
“Facilitative Leadership in Social Work Practice” vidual influences a group of persons to achieve
(2013) by E. Breshars and R. Volker, and “Social a common goal, and b) management exercises
Work Management and Leadership: Managing executive, administrative, and supervisory direc-
Complexity with Creativity” by A. Lawler and tion of a group or organization. It requires goal
J. Bilson (2010), which used the words “social setting, defined objectives and targets, a focus
work” and “leadership” together in the same title. on consistently producing results through plan-
Similarly, in a Google search (Google Scholar) of ning and budgeting, and organization and staff-
“social work” and “leadership” of scholarly journals ing, as well as coordination and problem-solving
 6 • Practice and Leadership 47

4. Problem-solving capacity—To both

The Person The Position anticipate problems and act decisively on
them when they occur.
Leadership 5. Creating positive change—Moving people
in organizations to a better place than where
they once were.

The Process Having these attributes certainly is important,

but being able to use them effectively in set-
Figure 6.1 The synergistic conceptual framing
tings to influence change is the real litmus test
components of leadership: The 3 P’s of Person,
(Holosko & Skinner, 2013).
Position, and Process.
Leaders achieve these core attributes through
an ongoing interactive transformational applica-
tion of (a) their personal attributes and (b) their
(Holosko & Skinner, 2013; Kotter, 1990; Pickett various skill competencies, and (c) by developing
& Kennedy, 2003). This chapter is about the for- a leadership intuition about the attributes indi-
mer term, not the latter one. cated in Table 6.1. Thus, there is a process that
defines one’s leadership style and imprints one’s
operational footprint in moving the organization
Core Leadership Attributes
forward in overtime, by presently using any or
At a simple level, leadership is a synergis- all of these five core attributes.
tic, transformational, and interactive process As indicated in Table 6.1, effective leaders use
anchored in the “3 P’s”—the person, the posi- various attributes and competencies in a vari-
tion, and the process (Hartley & Allison, 2002). ety of intuitive ways for different situations as
The “person” refers to the traits or personal they arise within an organization. As indicated
characteristics of an individual; the “position” by Snowden and Boone (2007) “truly adept lead-
involves the use of authority, governance, and ers know not only how to identify the context
guidance to influence individuals; and the “pro- they’re working in, but also how to change their
cess” involves how leaders shape events, moti- behavior to match” (p. 7). Given this, it becomes
vate and influence people, and achieve outcomes easier to understand how learning and imparting
(Taylor, 2007). management skills that are fairly nonambiguous,
Holosko (2009) conducted one of the few straightforward, and less complex is simpler than
empirical studies identifying core attributes learning and imparting the many interactive and
of leadership in the social work literature. He interrelated social work leadership characteristics
content-analyzed disciplinary journals (N = 70) noted in Table 6.1.
published in the social and behavioral sci-
ence databases to sift out its main attributes. Using Social Work Attributes to
Ranked in descending order of importance, their
Analyze Leadership Effectiveness
frequencies were:
As noted in this chapter, the author has consciously
1. Vision not promoted the notion that leaders are always
a. Having one—To have a description of a those in an organization who hold upper level
desired condition at some point in the positions of power and/or authority. Although we
future. traditionally think of most leaders as positioned
b. Implementing one—To plan and put in atop the organizational pecking order, social work
place strategic steps to enact the vision. has clearly promoted the stance that all practicing
2. Influencing others to act—To inspire and Bachelor’s in Social Work (BSW) and Master’s in
enable others to take initiative, have a Social Work (MSW) social workers should strive
belief in a cause, and perform duties and to lead clients, individuals, colleagues and other
responsibilities. stakeholders, wherever they practice in the orga-
3. Teamwork/collaboration—To work nization’s hierarchy, be it in its upper, middle, or
collectively and in partnership with others lower ranks. This is reiterated in one of CSWE’s
toward achieving a goal. (EPAS, 2009) 10 core competencies. Specifically,
48 Part II • Roles, Functions, and Fields

Table 6.1 Leadership Necessities: The Synergy of Personal Attributes, Skill

Competencies & Leadership Intuition
1. Selective Main Personal Attributes
Integrity Role Modeling Charisma
• Honesty • Personal • Promote positive energy
• Ethics • Professional
• Transparency

Decisive Physical Presence Self-Confidence

• Easy decisions Have one Exuding not over-bearing
• Difficult decisions “What would . . . do?” Contagion effect
• Be assertive Come to work
2. Creative Use of Main Skill Competencies
Communication Knowledge Competence
• Oral and written • Specialized and also broad
• Sender and receiver • Develop “$ Eyes”
• Pleasant • Factual and researched
• Diplomatic • “I also don’t know” is OK
• Appropriate • Thinking smarter

Empowering Inspiring/Influencing/Persuading
• Difference between empowering and • Group vs. individual strategies
disempowering • Motivating
• Enabling • Timing
• Consciousness raising • Negotiating
• Believing in others

Managing Others Using Power and Authority Judiciously

• Administering • Nonauthoritative
• Collaborating • Tact and discretion
• Coordinating • Devoid of personal agenda
• Task orientation • Do not apologize for using power/
• Respecting governance authority
• Focusing on the goal • Share power and authority
• Personal issues are not as important as
organizational ones
3. Developing One’s Leadership Intuition
Know When To Know How To
• Pick your spots for expending resources • Lead vs. manage
• Defer power and authority • Transform vs. transact
• Manage conflicts • Admit you were wrong
• Use your strengths • Unlearn bad responding habits
• Acknowledge your weaknesses • Make lemonade from lemons
• Deal with troubled employees • Provide feedback
• Provide positive reinforcement

in Competency 9—Respond to Contexts That (https://www.usi.edu/libarts/socialwork/docs/

Shape Practice, sub-section (b) states: [social Ten-Core-Competencies-current.pdf). Thus, all
workers] “provide leadership in promoting sus- social workers must strive to achieve leadership
tainable changes in service delivery and prac- in our profession, regardless of where they work
tice to improve the quality of social services” in their organizational settings.
 6 • Practice and Leadership 49

Table 6.2 The Leadership Attribute Grid (LAG)—Applied at All

Organization Levels

Core Leadership Attributes Various Practice Levels

Front Middle Upper Level
Line Managers Individuals
1. Vision
a. Having one
b. Implementing one
2. Problem-solving capacity
3. Team work/collaboration
4. Creating positive change
5. Influencing others to act
Minor Attributes
1. Skills
2. Personal characteristics
3. Leadership intuition

In 2006, while teaching a graduate class at the roles in promoting various aspects within the
School of Social Work, University of Windsor, profession, recently the CSWE (www.cswe.org)
in Canada, the author took this notion—”social has identified leadership as a renewed educa-
work leaders need to lead any level in the organi- tional priority. In February 2007, CSWE spon-
zation” seriously, and developed a useful teach- sored a two-day conference entitled “Building
ing tool interfacing the aforementioned five core Leaders in Social Work Education: Pathways to
social work attributes, across the three main hier- Success” in Mesa, Arizona. This entire confer-
archical levels of an organization as illustrated in ence was devoted to social work leadership in
the Leadership Analysis Grid (LAG) presented in areas of teaching, classroom and field educa-
Table 6.2. tion, training, research, and practice. In 2009,
As displayed in Table 6.2, MSW students were CSWE’s EPAS standard articulating the 10
asked to identify three person(s) in their places core competencies that shape accreditation spe-
of social service employment who were in front- cifically targeted leadership (in competency
line, middle, or upper levels, and then identify #9) as an important educational area for BSW
at least three of the five core attributes (in Table & MSW students. Given this reality, it appears
6.2), and two additional minor attributes (from that social work is slowly embracing leadership
Table 6.1), and provide examples of how these as something that holds legitimate promise for
social workers provided leadership within their education, training, practice, and professional
organization. Students were taught to explore development. That being the case, the responsi-
and think creatively “outside of the manage- bility for defining social work leadership in ways
ment box” while using the LAG. In doing so, that are simple, clear, timely, and consensually
they provided rich case examples of how social accepted and relevant is not only important, but
work leadership is both taught and promoted in essential. Hopefully, this chapter has assisted
our profession. with this concern.

WEB RESOURCES
Concluding Remarks

Although some of our professional associations 1. Trimberger, G. (2012). Developing

and bodies, such as the Society for Social Work leaders: Empowering human service
and Research (www.sswr.org) and the Institute practitioners. http://www.uwgb.edu/
for the Advancement of Social Work Research outreach/socialwork/assets/pdf/
(www.iasw.soton.ac.uk), have taken proactive DevelopingLeaders%20(2).pdf
50 Part II • Roles, Functions, and Fields

2. Social Work Leadership Institute http:// Quality Social Work Field Education: A Field
www.nyam.org/social-work-leadership- Director’s Guide. Chicago, IL: Lyceum Books.
institute-v2/ James, W. (1907). What pragmatism means. In F.
3. New York Academy of Medicine http://www Burkhardt, F. Bowers, I. Skrupskelis (Eds.),
Pragmatism and other essays (pp. 22–28).
.nyam.org/about-us/social-work-leadership/
Cambridge, MA: Harvard University Press.
4. Motivation and Leadership in Social Work. Kamaria, K., & Lewis, A. (2009). The not-for-profit
A Review of Theories and Related Studies. general management responsive capability com-
http://www.tandfonline.com/doi/abs/ petencies: A strategic management perspec-
10.1080/03643100902769160#preview tive. Business Strategy Series, 10(5), 296–310.
doi:10.1108/17515630910989196
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of Social Workers. ment and leadership: Managing complexity with
Boehm, W. W. (1958). The nature of social work. Social creativity. London: Routledge.
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Gitterman A., & Germain, C. B. (1980). The life model of Pincus, A., & Minahan, A. (1973). Social work prac-
social work practice. Advances in theory and prac- tice: Model and method. Itasca, IL: F. E. Peacock.
tice. New York, NY: Columbia University Press. Rank, M. G., & Hutchinson, W. S. (2000). An analy-
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Graham, K. (2002). Studies in vision and manage- 487–502.
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 7 Essentials of Private Practice

Raymond D. Fox

INTRODUCTION THE PROFESSIONAL DIMENSION

Personal Aspect
Ups and downs, rewards and challenges, merits
and limitations in private practice emanate from Only when you are alert to who you are and what
its nature—being at the same time a professional you are doing are you sufficiently relaxed, clear,
endeavor and a business venture. Private prac- and open-minded to establish and maintain a pri-
titioners assume total responsibility for every vate practice and better understand clients. It is not
aspect of practice. This includes such diverse con- possible to be tuned into the feelings of others with-
stituents as observing ethical standards, setting out first being attuned to your own. Your constant
hours and fees, obtaining insurance, assessing challenge is to understand the interplay between
and, most importantly, evaluating their effective- your personal and professional roles and responses.
ness. In my view, social workers are particularly Your personality, values, and sensitivity are the
well educated as practitioners, but poorly pre- very tools that make you an effective therapeutic
pared as entrepreneurs. Cox (2009) emphasizes instrument. Take time to inventory your unique
this point. attributes and skills. Your personhood, in other
Consistent with the definition of social work words, is the essential feature in the establishment
from the International Federation of Social and maintenance of the therapeutic alliance.
Workers, private practice “bases its methodology Because you can react only from what is within
on a systematic body of evidence-based knowl- yourself, you must know yourself so that your
edge derived from research and practice evalua- capacity for being in relationship is increased,
tion, including local and indigenous knowledge your ability to react consciously is intensified,
specific to its context. It recognizes the complex- and you are freer to make deliberate choices
ity of interactions between human beings and about how to respond to clients. Only by knowing
their environment, and the capacity of people yourself are you in a position to make active and
both to be affected by and to alter the multiple creative use of feelings, thoughts, intentions, and
influences upon them including bio-psychosocial motives to optimize the helping process. Only by
factors (2000). knowing your assets and shortcomings in terms
A practitioner for the past 40 years and a of a knowledge and skill base, professionally and
teacher, consultant, and supervisor for 35 years, entrepreneurially, are you in a reasonable posi-
I have come to appreciate the need for a tion to choose to practice privately.
common-sense and down-to-earth approach to Awareness leads to more disciplined and
private practice. Theoretical frameworks and clearly directed work as reported in numerous
research findings provide a scientific basis for studies. In brief, do what you expect clients to
practice, but little guidance by way of its art and do. Take a hard look at yourself. What is your
craft. A creative leap is required to bridge abstract motivation? Being your own boss? Status?
theory and concrete reality. Another creative leap Growing professionally? Earning more money?
is required to close the gap between the profes- Minimizing bureaucracy? Maximizing auton-
sional and the business dimensions of private omy and independence? Selecting your own cli-
practice. ent population? Being more creative?

51
52 Part II • Roles, Functions, and Fields

Will you specialize in a method? With a popu- Joan’s frightening nightmares dissipated, her
lation? With a symptom? Are you fully qualified? neck problems and migraines ceased. Her alco-
Licensed? Do you want a full- or part-time practice? hol use to self medicate when feeling “on edge”
How will you further hone your skills? Advance desisted. This innovative method promoted her
your knowledge? Do you fully appreciate the con- healing.
sequences in terms of the commitment of time,
energy, and money involved in such an enterprise?
Evidence Base for Practice

Social work literature promoting evidence-based

Creativity and Fluidity
practice (Pollio, 2006; Proctor, 2003; Rosen,
I encourage a fluid and personal approach to respond 2003) challenges unexamined and unsystematic
differentially and effectively to a wide range of cli- clinical interventions. Practitioners are induced
ents with a broad array of problems. As an auton- to employ empirically validated interventions,
omous practitioner you can enjoy the freedom, whenever possible, linked to clients’ goals and
within the bounds of accepted ethical and empirical objectives and to evaluate outcome effectiveness.
standards, to employ innovative methods for help- Self-reflection constitutes one form of evalu-
ing clients fathom their lives and gain deeper under- ation. Almost axiomatic is supervision. Case con-
standing. I utilize a variety of distinctive strategies ferences and consultation are additional types of
more fully described elsewhere (Fox, 2013). One quality control and evaluation. These approaches
method, however, which I have found indispensable, rely almost exclusively upon subjective assess-
particularly when working with trauma survivors, is ment and should be part of every practitioner’s
journal keeping. The following sketch of Joan, who routine. An array of other means can serve as
used this approach, serves as one illustration. supplements—practice logs, intensive case stud-
Joan experienced extraordinary trauma ies, and critical incident analysis. Process record-
throughout her life. Abandoned by her father at ing is yet another method for self-reflection
three, his infrequent contact with her was sexually (Fox & Gutheil, 2000). All of these enable you
abusive. Her mother suffered a paralyzing auto- to conceptualize all stages of practice interaction
mobile accident leaving her disabled and shifting through the exercise of reconsidering and analyz-
excessive responsibility to Joan and her younger ing your contact with clients. All enhance your
brother. Joan had serious knee problems, which, ability to discern efficiency. Especially in urban
treated by a family physician, worsened as a result areas, often having a glut of practitioners, aug-
of his injecting it with an unknown substance, mented advanced training leading toward a spe-
causing excruciating pain intended to disguise his cialization provides an additional welcome edge.
having sodomized her at age twelve; as a result she Qualitative methods are refined when com-
underwent a series of major and painful surger- bined with objective forms of evaluation. Just as
ies for her disabled knee. During our contact she your treatment strategies need to be tailored to
oversaw the nursing home care of her mother, meet the unique needs of individual clients, so,
who suffered from Alzheimer’s disease. And too, should your evaluation methods be selected
Joan’s mother died at a critical juncture in therapy. with care. Observations of a client over time
Finding it almost impossible to acknowledge constitute a single-subject or single-system
her multiple traumas and articulate their emo- design for evaluation. Such a quantitative design
tional impact, Joan painted. Her’s was an art requires that client behaviors or events be speci-
journal (Carey, Fox, & Penney, 2002). An integral fied in measurable terms. Goals provide this
facet of her treatment, it contributed significantly reference point against which change can be com-
her progress. She attributed, as did I, her steady pared. Also emphasized are: (1) specifying target
improvement to my serious attention to her vivid behaviors, (2) identifying a suitable measure,
entries. In these entries she portrayed unspeak- (3) employing it systematically, (4) analyzing
able memories and depicted their emotional resi- observations over time, and (5) charting change.
due through the medium of water color. During Two discrete methods—Single Subject/System
our face-to-face contact she struggled, and strug- Design and Practice Outcome Inventory stress
gled successfully, to translate these artful images establishing a clear and quantifiable “before–
into words. The journal served as a source of after” picture of interventions.
intense catharsis for her and a source of insight Charts or graphs help to track client progress.
for both of us. These make it possible to individualize evaluation
 7 • Private Practice 53

to the unique characteristics, needs, and dilemmas of Perusing his journal, I arrived at a separate third
your clients. They provide ready visual gauges for score, a composite weekly score, by averaging the
both you and the client to track change. Decisions daily entries. Such a procedure provided three
can follow as to whether or not there is significant independent comparative measures of his depres-
change in a desired direction meeting the expressed sion level over the 12-week course of treatment.
purpose of treatment. Corrective adjustments can These three separate indices were graphed.
then be rationally and realistically taken. Remarkable correspondence was noted among
Easy-to-use prepackaged standardized scales the separate scores—his own, his wife’s, and mine.
are also available to incorporate into your prac- For the first nine weeks of treatment Mr. H’s level
tice. From analysis of the information gleaned remained severe; nevertheless, it was steadily
over a series of time intervals, you can make declining. The tenth and twelfth weeks marked a
reasonable assessments about treatment success, sharp decrease in the level of depression. It was
discuss options for continuing or discontinuing evident that Mr. H was recovering and making
treatment based on these results, alter interven- healthier adaptations in his life. Most impor-
tions, make a referral, or terminate. When such tantly, it vividly demonstrated to him that feel-
methods are incorporated directly into treatment, ings of despair could be overcome even though he
they actually propel clinical work. No attempt is initially believed that “nothing could really help.”
made here to detail either Single Subject/System For me it affirmed that selected cognitive inter-
Design or Practice Outcome Inventory, which can ventions, journal-keeping, homework, maintain-
encompass sophisticated variations or statisti- ing the Beck Inventory, had a positive result.
cal procedures. Rather, the following illustration The graph made it immediately evident by
is offered, with an appeal to seriously consider charting the three separate indices that Mr. H
incorporating some structured and standardized had made substantial headway over the 12 weeks
form of evaluation into your practice. toward overcoming his depression. Added diag-
Cognitive therapy focuses on correcting cli- nostic and clinical advantages accrue from using
ents’ negatively distorted thoughts and helping such a visual method for tracking progress.
them to think more realistically. Already in a Beyond being a tangible sign for everyone of
depression, Mr. H’s sudden loss of employment progress, it became a catalyst for further inten-
as a middle manager activated dysfunctional sive discussion about other adjustments Mr. H
automatic thoughts such as “never being able to needed to make in his treatment as well as in his
do anything right,” accompanied by feelings of life. These discussions, in turn, led to identify-
dejection and devaluation and a sense of paraly- ing supplementary goals for treatment, includ-
sis of never being able to work again. Accepting ing the development of strategies for finding
these skewed thoughts as a foregone conclusion, employment.
his depression deepened. After I had explained the
cognitive approach and we had identified goals
for both of us, Mr. H agreed to utilize the Beck SIGNIFICANT ADVANCES
Depression Inventory (BDI) within sessions and Neuroscience and Genetics
as homework over a three-month period in order
to meet his need for recognizing progress and my The advances in neuroscience (brain structure,
need to monitor the success of selected cognitive function, and chemistry), and genetics have
interventions. Originally intended to be practitio- considerable impact on present-day practice.
ner administered, the BDI is consumer-friendly. Understanding the brain and the influence of the
I, therefore, encourage clients, and selected others genome alters the process of therapy (Ilg et al.,
(e.g., family, friends, other involved profession- 2008). We now know that comprehending their
als) to complete it along with the client them- impact along with the therapeutic relationship
selves after obtaining instruction and gaining actually serves to create and alter neural circuits.
practice in its application. Mr. H completed one As a consequence, we appreciate more fully what
copy of the inventory each day. A weekly com- we can and cannot deliver in terms of change
posite score of his level of depression was calcu- (Fox, 2013). It is necessary to stress that even
lated by averaging his daily ratings. Mr. H’s wife the most sophisticated biologically based thera-
completed the Inventory weekly for that same pies will work best when combined with helping
time period. Mr. H also kept a mood log each clients explore the subjective experience of their
day, which he gave me at our scheduled session. behavior and symptoms.
54 Part II • Roles, Functions, and Fields

Mindfulness is one powerful method given from colleagues, I have recently acceded to devel-
credence by extant biological research. Its incorpo- oping a personal website. It promises to provide
ration into practice may alleviate emotional and/ a beneficial addition to clinical venture. I encour-
or physical suffering, improve the ability to make age you to do the same.
decisions informed by compassion and kindness, Especially because various electronic apparatus
and take responsibility for choices (Sanders, 2010; is constantly emerging (e.g., the Cloud), and you
Turner, 2009; Davis & Hayes, 2011; Ludwig & are bound to face yet unheard of more sophisti-
Kabat-Zinn, 2008; Siegel, D., 2010). The benefits cated advances, become familiar with the present
of mindfulness include stress-reduction, improved array of technological enhancements even though
self-control, affect tolerance and flexibility, by the time you have mastered them, they likely
enhanced concentration, and mental clarity, as well will have been surpassed by more novel ones. I do
as fostering kindness, acceptance, and compassion not advocate becoming technologically depen-
towards others and one’s self (Davis & Hayes, dent. Rather, I recommend that you embark on a
2011). Bruce, Manber, Shapiro, and Constantino pursuit to integrate into your practice those strat-
(2010) examine the benefits of mindfulness train- egies with which you are comfortable and which
ing for mental health clinicians themselves. serve to enhance client interaction.
As ubiquitous, prevalent, and constructive
DSM 5 as it might be, technology is not without limi-
tations and reservations. There is a hazard of
The DSM 5 (2014) has met with considerable over-reliance on it, particularly in a practice
controversy. Despite its shortcomings, it is cen- profession such as ours. Technology is no sub-
tral to private practice. Criticized as lacking sci- stitute for face-to-face discourse. I prefer a blend
entific validity in terms of biological influences, of methods, conventional and novel, distant and
it remains the best tool available to guide you on proximate, computer-based and personal-based.
diagnosing disorders. Moreover, insurance com- Technology alone does not make a difference.
panies, governmental agencies, and the courts Employed judiciously and selectively, however,
rely on it for determining benefits, statistics, in combination with direct person-to-person con-
evidence, and testimony. Although it fails to tact, a hybrid as it were, it has great advantages.
point the way to specific effective treatment, it
serves as the passport to mental health coverage,
and among other things, special educational and SELF CARE
behavioral services and disability benefits. It also
provides a common language for you to employ By virtue of our being fellow human beings, but
when discussing clients with colleagues, supervi- more so by virtue of our role as practitioners,
sors, etc. Get to know it, and get to know it well. we are affected deeply by others’ suffering and
pain. Such resonance is exacerbated by our own
exposure to the same incomprehensible events
Technology
that affect our clients. Take time for solitude and
I would be remiss in not referring to the perva- reflection. Periodically attend to and take care of
sive and accelerating use of technology. It does “self.” It has been my experience as a practitio-
not supplant, but instead supplements more ner, supervisor, and consultant that private prac-
conventional clinical tools. Augment your reper- tice can often be a rather solitary and isolating
toire with the already available and ever evolv- pursuit. It can make you vulnerable to discour-
ing electronic resources. The Internet has been agement, even disillusionment.
instrumental in creating a continually updated Repeatedly dealing with others’ stress,
and livelier means of contact. It also offers data- anguish, and unexpected crises throughout a
bases that provide highly developed methods career can lead to “compassion fatigue” (Fox,
tools for searching and analyzing literature and 2003), which has the potential to impact your
research on recent diagnostic and evidence-based ability to give fully in your work and extract
treatment developments. Online platforms such more from you than is emotionally healthy
as Skype and texting are constructive adjuncts to when listening and absorbing (Figley & Bender,
real time face-to-face therapy, and promote ongo- 2012; Newell & MacNeil, 2010). Refuel your-
ing connection, communication, and interaction. self in healthy ways. Be sure to involve your-
After much deliberation and encouragement self regularly with sources of professional and
 7 • Private Practice 55

personal support, learn to step back and put lim- of your personal practice is as critical as diversifi-
its on yourself, make a commitment to seek out cation of your personal finances.
supervision and, when needed, counseling, before
depletion sets in and compromises your confi-
Marketing
dence and competence. Consciously endeavor to
involve yourself in satisfying experiences out- Marketing is a further major consideration. From
side of work. Avoid the tendency to disengage, my observation, social workers are uncomfort-
not only from clients but from peers and from able with identity, image management, and pub-
your “self” as well. Foster associations with col- lic relations. How do you present yourself? As a
leagues so as to be affirmed, glean support, and therapist? A counselor? A social worker?
create avenues to share experience. Remember Exposure is central to boosting a practice
that you cannot fix everything and everyone. and requires comfort in self-promotion and
marketing. Steady and reliable referral sources
are the life blood of practice. Of paramount
ENTREPRENEURIAL DIMENSION importance is networking with colleagues, with
like-minded practitioners from allied profes-
General Issues
sions, and with community organizations.
Practitioners seem ill prepared for the business Networking is time consuming and costly.
side of private practice. They rarely receive rel- Some questions may guide your thinking. Do
evant education in money matters. Many social you offer presentations at a local library? Join
workers have special difficulty reconciling their a speaker’s bureau? Submit an ad to a local
backgrounds with a profit motive and with stick- newspaper or the “yellow pages”? Do you place
ing to operating procedures based on manage- flyers and announcements in churches or with
ment principles. Dealing with a host of financial community merchants? Do you develop a web-
issues, setting fees, collecting fees, dealing with site? Affiliations of every sort are required to
nonpayment, setting policies for missed appoint- initiate and sustain a private practice and pro-
ments, and maintaining financial records, all add vide ongoing support for your own professional
to a discomfort level. Issues abound having to endeavors. Do you connect with clinics, hospi-
do with establishing and supporting an office. tals, employee assistance programs, hotlines,
Options are many—developing a home office, mental health agencies, day care facilities? Do
renting shared space in or separate from a group you offer training seminars to a range of pro-
practice, subletting a workplace. Accompanying fessionals? Teaching and writing also increase
these concerns are those focusing on how to your exposure. Do you offer workshops to
furnish, lay out, and keep up the office. Beyond groups such as AARP, PTA, or the Elks? Do you
rent, routine ordinary expenses include utilities, “make the rounds” of doctors, chiropractors,
phone, computer, and cleaning. In addition, other, physical therapists, and attorneys to acquaint
more remarkable factors need to be considered. them with your services? Do you speak pub-
Among them are whether to offer your services licly in libraries and community meetings?
as an independent provider, as part of a group Over and above being recognized and opening
practice along with social work or interdisciplin- a private practice, you need to build arrangements
ary colleagues, or as a professional corporation. with other experts with whom to consult about
Obtaining insurance of all types—disability, the special predicaments that inevitably arise.
accident, dwelling, and malpractice absorbs extra Relationships with other experts, those not in
attention. the field, are required to assist in the day-to-day
Valuable assistance in developing preliminary operation of your practice. These might include
plans and preparing a prospective budget can be certified public accountants (CPAs), attorneys,
obtained by logging onto: www.bplans.com/dp/ and insurance agents. Will you choose to employ
and www.socialworker.com. support personnel, such as receptionists, secre-
Especially in these times of a changing and taries, and office cleaners? What will your busi-
restrictive economy, be cautioned that setting up ness cards look like? What will they say? How
a practice, as is already evident, is complex and will you cover vacations? All of these points are
multifaceted. It requires a hefty investment of integral to approaching practice as a commercial
time and money. Be prepared and deliberate in operation based on business principles, with con-
moving forward. Recognize that diversification tractual operations clearly defined and in writing.
56 Part II • Roles, Functions, and Fields

Managed Care without up-to-date records it would be impos-

sible for you to construct a case retrospectively
A further important factor entails managed
and thereby mount a defense.
care with its attendant benefits and liabilities.
Although enrollment in such an organization
promises a steady source of referrals, often these ETHICAL DIMENSION
are promises only. Frequently, financial remu-
Basics
neration is reduced.
Be cautioned that, increasingly, insurance Forcefully stated: Vigilantly observe the Code
covers only a minimal number of sessions; pro- of Ethics www.socialworkers.org/pubs/code
spective clients may not have the necessary Become intimately acquainted with HIPPA,
out-of-pocket financial resources to proceed. the Health Insurance Portability and
In addition, issues of privacy, confidentiality, Accountability Act of 1996 (www.hhs.gov/
and freedom of choice in selecting intervention ocr/privacy/).
strategies accompany being on the managed
care roster. All these issues can affect, possibly
Malpractice
negatively, your client-practitioner relationship.
It has been my experience that practitioners are It is possible, but not probable, that you will be
frequently forced into a position of having to accused of malpractice. It is prudent, however, to
adjust client contact to suit the managed care keep in mind, the following: To be sued for mal-
company’s conditions. Negotiating the type and practice, there must first be demonstrable proof
extent of treatment, advocating for clients’ best that a legal duty existed between you and the
interests, obtaining reimbursement for your best client; that you violated that duty by failing to
efforts constitute major predicaments and often conform to professional standards of care; that
spark ethical dilemmas. evidence exists showing you to be negligent in
As you think about becoming a managed care not conforming to an accepted standard of care,
provider, become intimately familiar with its and it can be demonstrated that the client has
regulations about capitation, coinsurance, and been harmed or injured in some way and that you
copayment. Health maintenance organizations were the proximate cause of the injury for which
(HMOs), created by insurance companies, pro- damages are sought. Possible infractions include
vide a package of services for a premium usually abandonment of service, mismanagement of the
paid by employers. They make serious demands relationship, breach of confidentiality, failure to
on the practitioner. These mostly involve provide appropriate treatment, and prevention of
accountability. harm to third parties. Other causes are failure to
Record keeping is fundamental in any man- consult with a specialist, defamation, violation of
ner of practice, but especially so in managed civil rights, failure to be available when needed,
care. More importantly, as an autonomous prac- untimely termination of treatment, and inap-
titioner you are morally answerable and legally propriate bill collecting methods. Malpractice
responsible. Documentation of differential diag- insurance is requisite even though being sued
nosis, medical necessity, treatment plan, expla- is extremely unlikely, especially for social work
nation of what occurred in contact, under what practitioners.
circumstances, and with what results needs to be
in compliance with requirements of regulatory
Fundamentals
and fiscal bodies to assure accuracy and provision
of what is defined as appropriate treatment. Be Be clear about your specialty niches—those
sure to include in your files referral sources, brief areas of your own expertise as well as those
history, medication if indicated, dates, and out- that require involving other experts. Honor
comes. Always keep privileged communication in your requirement to garner full informed
a completely secure area, under lock and key. consent from clients. Honor your obligation
It is a mistake to believe that not keeping notes toward suicidal clients and your duty to warn
will protect client confidences and avert subpoena. potential victims of clients who make threats.
Do not attempt to out-think or second-guess Acknowledge and follow through with your
contractual entities or legal systems. On a differ- duty in cases of suspected or actual child or
ent note, if legal action is brought against you, elder abuse and neglect. Grasp requirements
 7 • Private Practice 57

for court testimony and the elements of sub- marks of, and satisfaction in, accomplishment as
poena. Present danger overrides confidentiality. you move forward.
Protection trumps jeopardy.
Be honest with yourself and with your cli-
Being Fair
ents—there are no guarantees and there are no
relationships, including practitioner-client rela- Establish reasonable fees, consider a sliding scale,
tionships, that are totally risk free for either party. accommodate to contingencies in clients’ lives
such as unemployment, illness, disability.
ELEMENTS OF PRIVATE PRACTICE
Believing
What works? What should you keep in mind?
Believing in the purposefulness of practice, in
What are key elements gleaned from my active
yourself, and in clients’ strengths leads to mean-
and deep reflection on 40 years of practice? These
ingful exploration and examination, as well as
interwoven guideposts build upon and enhance
recognition of choice.
each other:

Creating “Safety”
Relating
Meet clients’ basic needs for security and affir-
Research into practice effectiveness across modal-
mation. This fosters their ability to master their
ities and theories identifies relationship as the
lives, face the challenge of self-discovery and the
foremost ingredient for success and effectiveness.
triumph of ownership.

Hearing Their Story

Taking an Active Stance
Accompany clients through their life story. It
creates a structure for catharsis of disturbing Concentrate on clients’ aspirations and resiliency,
affects, cleansing of disquieting memories, and engaging in active and genuine collaboration
discovery of new perspectives. toward interrupting dysfunctional patterns and
fostering empowerment.

Naming Things for What They Are

Confrontation
Avoid euphemisms and name the
“un-nameable”— abuse, rape, assault, victimiza- Challenge any discrepancy directly. Even though
tion, and trauma because honesty grounds prac- it is risky, it keeps both of you on track toward
tice and propels the process forward. advancing true insight.

Balancing
Blending Seriousness and Fun
Maintain a dynamic equilibrium between the
Neither shy away from difficult material nor be
interdependent features of professional stan-
too intrusive. Spontaneity, humor, and paradox
dards of care and entrepreneurial realities.
advance change and provide, simultaneously,
caring and challenge.
A FINAL REMARK

Educating
Finally, what brings success in private practice
Offer practical information, advice, alterna- is integrity and reputation. Develop referral
tive viewpoints. Teach self-soothing techniques. sources, confer with other professionals from a
Counter distorted thinking patterns. variety of related disciplines, market your pro-
fessional attributes, cultivate small business
skills, keep abreast of the changing care environ-
Setting Goals
ment and trends, preserve the nature of your
Mutually set goals to give you and your clients client relationships, obtain medical and psychi-
impetus to carry on, direction for the future, and atric consultation when relevant, keep accurate
58 Part II • Roles, Functions, and Fields

records, and document, document, document. To _____ (2003). “Traumaphobia: Traumatized therapists
reiterate, success in private practice arises from working with trauma,” Psychoanalytic Social
integrity and reputation. Work, 10(2), 43–55.
Fox, R., & Gutheil, I. (2000). Process Recording: A means
for conceptualizing and evaluating practice.
WEBSITES Journal of Teaching in Social Work, 20(1/2),
39–56.
www.bplans.com/dp/ Ilg, R., Wohlschlager, A. M., Gaser, C., Liebau, Y.,
www.hhs.gov/ocr/privacy/ Dauner, R., Woller, A., et al. (2008). Gray mat-
www.socialworker.com ter increase induced by practice correlates with
www.socialworkers.org/pubs/code talk-specific activation: A combined func-
tional and morphometric magnetic resonance
imaging study. Journal of Neuroscience, 28,
References
4210–4215.
Bruce, N. G., Manber, R., Shapiro, S. L., & Constantine, Ludwig, D. S., & Kabat-Zinn, J. (2008). Mindfulness in
M. J. (2010). Psychotherapist mindfulness and medicine. JAMA, 300(11), 1350–1352.
the psychotherapy process. Psychotherapy Newell, J., & MacNeil, G. (2010). Professional burnout,
Theory, Research, Practice, Training, 47(1), vicarious trauma, secondary traumatic stress, and
83–97. compassion fatigue: A review of theoretical terms,
Carey, M., Fox, R., & Penney, J. (2002). The artful jour- risk factors, and preventive methods for clinicians
nal: A spiritual quest. New York, NY: Watson/ and researchers. Best Practices in Mental Health,
Gupthil. 6(2), 57–68.
Cox, K. (2009). Redefining private practice: Smart Pollio, D. E. (2006). The art of evidence-based prac-
ideas for a changing economy. Social Work tice. Research on Social Work Practice, 16,
Today, 9(6), 12. 224–232.
Davis, D. M., & Hayes, J. A. (2011). What are the Proctor, E. K. (2003). Evidence for practice: Challenges,
benefits of mindfulness? A practice review of opportunities, and access. Social Work Research,
psychotherapy-related research. Journal of 27(4), 195–197.
Psychotherapy, 48(2), 198–208. Rosen, A. (2003). Evidence-based social work
American Psychiatric Association. (2014). Diagnostic practice: Challenges and promise. Social Work
and Statistical Manual of Mental Disorders Research, 27(4), 197–208.
(5th ed). Arlington, VA: American Psychiatric Sanders, K. (2010). Mindfulness and psychotherapy.
Association Press. The Journal of Lifelong Learning in Psychiatry,
Figley, C., & Bender, J. (2012). The cost of caring 8(1), 19–24.
requires self-care. In J. Bender (Ed.), Advances in Siegel, D. (2010). The mindful therapist: A clinician’s
social work practice with the military. New York, guide to mindsight and neural integration.
NY: Routledge. New York, NY: W. W. Norton & Company, Inc.
Fox, R. (2013). Elements of the helping pro- Turner, K. (2009). Mindfulness: The present moment
cess: A guide for clinicians (3rd ed). New York, in clinical social work. Clinical Social Work
NY: Routledge. Journal, 37, 95–103.
 Social Work Practice and the
8 Affordable Care Act

Stephen Gorin, Julie S. Darnell, &

Christina M. Andrews

BACKGROUND and Medicaid. The “architects” of this effort

viewed it as a “step toward universal national
The call for national health insurance (NHI) health insurance” (Ball, 1995, p. 63).
was raised as far back as 1912, when Theodore Efforts for NHI emerged again during the
Roosevelt, the presidential candidate of the late 1980s and early 1990s. In 1993, Bill Clinton
Progressive Party, called for the introduction of introduced his Health Security Act (HSA), which
“ ‘a system of social insurance,’ ” including the “sought a middle path between a Canadian-style
“ ‘protection of home life against the hazards of single-payer health care system . . . and the
sickness’ ” (cited in Birn et al., 2003). Jane Addams, largely unregulated approaches advocated by
an NASW Social Work Pioneer, played a leading conservatives” (Gorin & Moniz, 2014, p. 412).
role in Roosevelt’s unsuccessful campaign. The HSA provoked strong opposition from both
NHI emerged again as an issue in 1934, when the left and right and the administration pulled it
President Franklin D. Roosevelt appointed a without bringing it to a vote.
Committee on Economic Security, headed by During the 2008 presidential campaign, Barack
Frances Perkins, the Secretary of Labor, and Obama advocated an approach to health care that
another NASW Social Work Pioneer (NASW built “on the current system of mixed private
Foundation, n.d.) to address the economic crisis. and public group insurance” (Collins, Nicholson,
Their work culminated in the enactment of Social Rustgi, & Davis, 2008). After a year of fierce
Security. Perkins and others, including Harry debate, Congress enacted the Affordable Care Act
Hopkins, also an NASW Social Work Pioneer, (ACA), or “Obamacare” as it became known, in
had hoped to incorporate health insurance into March 2010. Although many social workers were
the bill, but they soon discovered that this would disappointed that the final version of the ACA did
be impossible due to strong opposition from the not include a government-run public insurance
AMA, whose members “bombarded members option, NASW recognized the ACA as a critical
of Congress with letters, postcards, and phone step forward in the century-long struggle for NHI
calls decrying compulsory health insurance” and a victory for social workers (Gorin, 2011).
(Quadagno, 2006. Although Roosevelt “pulled the The ACA is too complex to summarize in a
plug” on the NHI component of Social Security, short article; however, broadly speaking, it can be
the final legislation did include funds for maternal viewed as “a three-legged stool” (Krugman, 2013).
and child health, public health, and assistance to The first leg is community rating, which requires
children with disabilities (Downey, 2010, p. 243). insurers to “issue policies without regard to an
After the failure of NHI during the 1940s and individual’s medical history” (Krugman, 2013).
1950s, many activists concluded that it was politi- The second leg is the individual mandate, which
cally unfeasible and began focusing on expanding requires all citizens to have insurance. Although
coverage to older adults. Wilbur Cohen played a the mandate is controversial, without it, health-
central role in the enactment in 1965 of Medicare ier and younger individuals could avoid buying

59
60 Part II • Roles, Functions, and Fields

coverage, “leaving a relatively bad risk pool, lead- (Beck, 2012). The ACA also provides incentives for
ing to high premiums that drive out even more hospitals to reduce readmission rates for chroni-
healthy people” (Krugman, 2013). The third leg cally ill patients (Gorin & Moniz, 2014).
consists of subsidies to enable individuals with low Understood in its proper context, the ACA is
incomes to buy coverage. These pieces are inter- the outcome of a century-long effort to introduce
dependent; take away one and the stool collapses. NHI. It realizes Franklin D. Roosevelt’s plan to
The ACA is consistent with the “Triple Aim” incorporate NHI into Social Security and, in a
of expanded coverage, cost control, and improved real sense, is Social Security’s missing leg.
quality that Berwick, Nolan and Wittington
(2008) identified as being critical to health care
NEW ROLES AND REALITIES UNDER
reform. In terms of coverage, the Congressional
Budget Office (CBO) projected that between 2013 THE ACA: A CLOSER LOOK
and 2023, the share of the nonelderly population Eligibility and Enrollment
(excluding individuals without documentation)
with insurance will increase from 82% to 92%. By 2018, the ACA is estimated to nearly halve the
The ACA originally required states to extend number of uninsured individuals, from 55 million
Medicaid coverage to individuals with incomes at to 30 million (Congressional Budget Office, 2013a).
or below 138% of the federal poverty line (FPL). Twelve million additional adults and children are
States refusing to expand coverage would be expected to obtain coverage through Medicaid and
denied all funding for Medicaid (Gorin & Moniz, the Children’s Health Insurance Program (CHIP)
2012). In 2012, the Supreme Court found this and 25 million through the new Health Insurance
section unconstitutional and left it to the states Marketplaces (also known as exchanges) where
to expand Medicaid without risk of losing all individuals and small businesses can purchase
Medicaid funding. This decision places individuals health insurance coverage from among an array
living below the FPL at risk of having no coverage of plans. States have the option to run their own
because they are not eligible for assistance to buy state-based exchange, partner with the federal
insurance in the marketplace. Individuals between government, or default into a federally facilitated
100% and 133% of the FPL will be eligible for exchange. Overall, the ACA is anticipated to result
subsidies, but they still may not be able to find in 92% of Americans having insurance coverage.
affordable coverage (Community Catalyst, 2012). Achieving the goal of near-universal health
The ACA also addresses the difficult issue of insurance coverage will require, however, that
controlling costs. Aaron (2011) noted that the millions of people who are eligible for coverage
legislation incorporated almost every “rational” actually enroll. Enrolling newly eligible people
approach “analysts have advanced for slowing into health insurance plans will be a difficult
growth of spending” (p. 2379). The CBO (2013b) task. Previous research estimating the size of the
and Congress’ Joint Committee on Taxation esti- Medicaid eligible-but-not-enrolled population
mated that the ACA will “reduce deficits over the suggests that between 17% and 68% of eligible
next 10 years and in the subsequent decade.” people do not enroll (B. Sommers et al., 2012;
Finally, the ACA addresses the issue of quality Sommers, Tomasi, Swartz, & Epstein, 2012; U.S.
(Gorin & Moniz, 2014). Concerns about the qual- Government Accountability Office, 2005). The
ity of health care in the United States have been reasons for failing to enroll are wide-ranging
raised for more than a decade, and it remains a and include lack of awareness, stigma, and
serious issue (Swenson et al., 2010). A central con- administrative complexity. Among these, the
cern here is the fragmented nature of our system, lack of awareness appears to be a particularly
which is “essentially a cottage industry of non- acute problem facing the ACA; evidence from
integrated, dedicated artisans who eschew stan- public opinion polls, focus groups, and research
dardization” (Swenson et al., 2010). In an effort to studies documents that most Americans have
address this, the ACA promotes the introduction little awareness of the ACA, and that what they
into Medicare of Accountable Care Organizations have heard makes them wary of it (Altman,
(ACOs), which provide incentives for “doctors, 2011; Kaiser Family Foundation, 2013b; Perry,
hospitals and other health care providers to form Muligan, Artiga, & Stephens, 2012).
networks to coordinate care better” (Gold, 2013). Recognizing these key challenges, the ACA
Although some have heralded ACOs as the wave contains several provisions intended to improve
of the future, their record thus far has been mixed participation. First, the ACA mandates that
 8 • the Affordable Care Act 61

almost everyone purchase insurance or pay a information about, and help individuals enroll in,
penalty. Second, the law has a “no wrong door’ Medicaid and CHIP.
policy in which individuals will be screened Finally, the ACA created consumer assistance
jointly for Medicaid, CHIP, and private cover- programs to help consumers enroll in plans and
age offered through the marketplace using a carry out ombudsman-related activities, such as
single, streamlined application. Third, it creates helping consumers file grievances and appeals,
or expands numerous consumer assistance pro- tracking and resolving problems, and educating
grams that will help uninsured individuals enroll consumers about their rights and responsibilities.
in new coverage options. They include: (1) navi- Many states established these programs with
gators, (2) in-person assisters, (3) certified appli- federal monies, though some have ceased these
cation counselors, and (4) consumer assistance activities due to reductions in federal funding
program (CAP) workers. (Kaiser Family Foundation, 2013a).
The ACA requires that all marketplaces What kind of consumer assistance is avail-
establish a navigator program to assist con- able, and how much, depends on where one
sumers with eligibility, plan selection, and lives, because the responsibilities for consumer
enrollment. Navigators will help consum- assistance functions differ by marketplace. In
ers determine their eligibility for subsidies or state-based exchanges, the state takes respon-
Medicaid. Navigators also will help consumers sibility for implementing the core marketplace
understand the differences between the plati- functions. In partnership exchanges, plan man-
num, gold, silver, and bronze plans. Navigators agement and consumer assistance functions are
may handle grievances and complaints. States shared. In federally facilitated exchanges, the
have flexibility in designing and operating their U.S. Department of Health and Human Services
navigator programs, but they must conform to performs all marketplace functions, including
the federal minimum standards related to the consumer assistance. As of September 2013, just
scope of activities, types of entities allowed to over half of the states (n = 27) have defaulted into
perform navigation tasks, and the competencies the federal exchange, 17 states and the District of
and training of navigators. Columbia have declared a state-based exchange,
In-person assisters will play roles similar and seven states have entered into a partner-
to navigators. Though conceived of as “non-­ ship exchange (see http://kff.org/health-reform/
navigator” assistance, in reality, in-person state-indicator/health-insurance-exchanges/).
assisters share many of the same functions All states regardless of type of marketplace
as navigators and receive comparable train- must operate a navigator program and a cer-
ing of about 20–30 hours. This program is tified application counselor program in the
state-administered and its availability depends exchange. In-person assistance is required only
on the type of marketplace: required in partner- in partnership exchanges and is not available in
ship exchanges that take on consumer assistance, federally facilitated marketplaces. Statewide con-
optional in state-based exchanges, and not avail- sumer assistance programs and certified appli-
able in federally facilitated exchanges. cation counselors for the Medicaid program are
Beyond navigators and assisters, community- optional. As a result, the amount of consumer
based organizations and providers that have assistance resources available to educate unin-
experience providing social services in their com- sured individuals about the new coverage options
munities are eligible to apply to become desig- and enroll them into plans will vary greatly state
nated as certified application counselors (CACs). by state.
In turn, their staff and volunteers may become
certified to help their clients complete applica- Care Coordination The ACA includes two
tions for coverage. CACs are required to pro- major provisions designed to enhance care
vide information on the full range of coverage coordination and improve integration of pri-
options. CACs must comply with privacy and mary care and behavioral health services. First,
security standards, complete approximately five it establishes a new Medicaid option to estab-
hours of required online training, and pass a cer- lish patient-centered medical homes (PCMHs)
tification exam. Though exchanges must have a for enrollees with complex health care needs.
CAC program, the marketplaces do not provide The PCMH is an enhanced model of primary
funding for it. In addition to the Exchange CACs, care that provides accessible, comprehensive,
states may establish Medicaid CACs to provide ongoing, and coordinated patient-centered care
62 Part II • Roles, Functions, and Fields

that addresses the needs of the whole person services system. Insurance coverage provided
(Patient-Centered Primary Care Collaborative, through the newly established Health Insurance
2013). PCHMs seek to achieve these ends by Exchanges (HIEs) and Medicaid benchmark plans
organizing physician-led, interprofessional will be subject to the Mental Health Parity and
teams that provide continuous and coordi- Addiction Equity Act (MHPAEA). When passed
nated care, emphasize prevention and effective in 2008, MHPAEA requirements were restricted
management of chronic illness, and strive for to health insurance plans for large employers
improved access and communication. To date, (i.e., organizations that employed more than
the ACA has promoted the establishment of 50 employees) that already covered behavioral
PCMHs in several ways. First, the ACA provides health services, defined as services to treat men-
state Medicaid programs with the option to tal health and substance abuse disorders. The
allow providers to create “health homes” based MHPAEA required that large employers ensure
upon the PCMH model for enrollees with cer- that their limits on behavioral health services
tain chronic conditions. States that participate were no more restrictive than that of other
received up to two years of an enhanced match- health services offered by the plan. The ACA
ing rate for the services they provided through extends the MHPAEA by requiring Medicaid
health homes (Kaiser Family Foundation, 2011). benchmark plans and state HIE plans to cover
At present, 25 states have implemented health behavioral health services in compliance with the
homes within their Medicaid programs. Second, parity guidelines established by the MHPAEA.
through the ACA-established CMS Innovation Consequently, it is projected that approximately
Center, new demonstration projects aim to test 30 million people will gain coverage for behav-
the effectiveness of PCMH models. ioral health services through the ACA (Buck,
Accountable Care Organizations (ACOs) 2011). A significant proportion of these people
are the second major model of care coordina- are already insured, but are covered under pro-
tion promoted by the ACA. Established through grams that do not provide coverage for behav-
the Medicare Shared Savings Program (MSSP), ioral health services.
ACOs are defined as organizations of health care These coverage expansions are expected to
providers that are accountable for the quality, trigger significant growth in demand for behav-
cost, and overall care of Medicare beneficiaries ioral health services because the proportion of
(Centers for Medicare and Medicaid Services, Americans with behavioral health disorders is
2013c). The ACO model is less structured than high. At present, an estimated 20% of Americans
the PCMH, encouraging providers to develop cre- have a mental health disorder, 5% have a seri-
ative approaches to providing more cost-effective, ous mental illness, and 12% have a substance
quality care that incorporates best practices in use disorder (Substance Abuse and Mental
improving health care quality and reducing costs Health Service Administration, 2012). And, the
through prevention, care coordination, and elim- co-occurrence of these disorders/conditions is
ination of unnecessary services. ACOs that meet extraordinarily high. Among adults with sub-
specified quality performance standards are eli- stance use disorder, 43%—nearly 9 million—
gible to receive a percentage of savings incurred had a co-occurring mental illness. Medicaid
if the expenses for care are sufficiently low com- enrollment alone is estimated to increase by
pared with cost expectations set by MSSP. The 82% among states expected to participate in the
program has established five domains in which expansion (Banthin et al., 2012). This is espe-
ACOs must achieve high-quality ratings to earn cially important because those newly eligible
bonus payments: patient and caregiver expe- for coverage through the Medicaid expansion
rience, care coordination, safety, preventative exhibit higher rates of almost every behavioral
health, and health of at-risk populations and frail health disorder than the general population
older adults. (Garfield, Lave, & Donahue, 2012). There may
also be a major spike in help seeking behavioral
health disorders as these coverage expansions are
Behavioral Health Treatment
implemented due to pent up demand—that is,
The ACA also will expand coverage for mental people who may have wanted to seek out behav-
health and substance abuse treatment services ioral health services, but have not done so in the
significantly, creating new opportunities for social past due to lack of health insurance coverage for
workers within an expanded behavioral health these services.
 8 • the Affordable Care Act 63

Although primary care providers will provide application counselors, or consumer assistance
some treatment, the need for staff to provide program workers. Because of their specialized
specialty behavioral health services is expected knowledge, training, and code of ethics, social
to grow significantly. These new additions to workers are uniquely qualified to assume any
the workforce will be needed in greater numbers of the new consumer assistance roles created by
within traditional health care settings, as they the ACA (Darnell, 2013, Andrews et al., 2013).
strive to provide more comprehensive care, as The consumer assistance positions merit seri-
well as in traditional specialty settings for indi- ous attention from the social work profession;
viduals. The Bureau of Labor Statistics (2013) at their core, these new consumer assistance jobs
projects that the health care system increas- are about linking individuals to resources, a cen-
ingly will rely on social workers to provide these tral activity of social work practice. Furthermore,
services. Their most recent estimates suggest employment opportunities related to helping
that demand for social workers specializing in uninsured people understand, apply for, and
the provision of behavioral health services will enroll in health insurance coverage should be
increase by 31% between 2010 and 2020, faster plentiful, given that navigator programs and cer-
than psychology (22%), behavioral health para- tified application counselors are required in all 50
professionals (27%), and even medicine (24%) states, and other kinds of consumer assistance are
and nursing (26%). The biggest increases in jobs available in many states.
for the social work profession are expected in The resources targeted to consumer assistance
health social work, gerontology, and behavioral will vary state to state, with some states operat-
health; in each of these areas, the Bureau of Labor ing with limited resources and in political cli-
Statistics is projecting growth rates above 30%. mates that are hostile to the ACA (Goodnough,
It remains unclear how the ACA will impact 2013). These conditions likely will have a nega-
social workers providing behavioral health tive impact on their state’s effectiveness in enroll-
services in private practice. On the one hand, ing the uninsured into coverage. Social workers
because insurance coverage for behavioral will be needed to step in to serve as “watchdogs”
health treatment will rise, there is expected to to assess whether the training is adequate and
be increased demand for behavioral health ser- whether the size, composition, and geographic
vices. This surge in demand could lead to growth distribution of the consumer assistance workforce
in behavioral health services provided in private is sufficient to serve the state’s uninsured popula-
practice settings. On the other hand, the ACA is tion. Social workers who are working with unin-
likely to result in a contraction in the specialty sured clients will be in favored positions to judge
behavioral health services treatment sector over and report on whether the system is working.
time as a result of its drive to integrate behav- A related watchdog role for social workers
ioral health into primary care and other medi- is to monitor access to care for the uninsured
cal settings. Reducing emphasis on treatment as well as for the newly insured. There are two
modalities that are separate from primary care reasons why the remaining uninsured may face
settings—including private practices—is an even greater difficulties in obtaining needed ser-
implicit goal of the ACA. vices when they attempt to seek care: primary
care providers are expected to be dealing with
high levels of pent-up demand from the newly
GETTING IN THE GAME insured and hospitals will have fewer resources
Health Insurance Coverage than before to serve the uninsured. A portion
of the newly insured population might also be
Social workers can play an important role in unable to get the care they need due to high
helping to ensure that all uninsured individuals deductibles or co-pays, limited drug formularies,
(especially the most vulnerable) get the health limited provider networks, and the like.
insurance coverage for which they are eligible. At
a minimum, social workers need to know what Coordinated Care Social workers are particularly
consumer assistance programs are available in well equipped to assist in the design and imple-
their state and how to connect their uninsured mentation of coordinated care models. They
clients to these resources. Social workers ought receive in-depth training in identifying and
to consider, however, a larger and more active addressing social determinants of health critical
role: becoming navigators, assisters, certified to achieving long-term health and well-being
64 Part II • Roles, Functions, and Fields

and to do so within the social and environmental not moved to fully capitated models of financing
contexts in which patients are embedded. Social (Buck, 2011). These decisions will greatly influ-
workers have specialized knowledge of commu- ence the size and scope of the behavioral health
nity and social systems and training in case man- workforce expansion resulting from the ACA
agement that is sensitive to cultural beliefs and and the relative role of social workers. It will be
health literacy (Andrews et al., 2013). Finally, critical for social worker advocates and research-
social workers have training in implementing ers to work together to cultivate strong ties to
models of behavior change that can help pro- understand the changing role of Medicaid and
mote effective disease management and pre- the new roles of the HIEs in financing behavioral
vent illnesses from occurring or reaching stages health treatment, and to be aware of key policy
in which acute medical treatment is needed. decisions that will or can influence social work-
Research demonstrates these areas of knowledge ers, especially as they relate to the profession’s
and training are particularly effective in meeting role in newly emerging models of integrated
the needs of a population referred to as “high uti- care. These tasks will need to be carried out on a
lizers” of health care, which includes individuals state-by-state basis.
with complex health needs, such as co-occurring
physical and behavioral health disorders. Social Advocating for the Most Vulnerable Social
workers have a key role to play in creating the workers have a professional responsibility to
new model of health care to which the ACA advocate for social justice. In keeping with this
aspires, in which prevention, attention to social mandate, social workers ought to be advocat-
determinants of health, and well-coordinated ing for Medicaid expansions in states that have
care are all central aims. The ACA presents a rejected extensions as a result of a 2012 ruling
unique opportunity for social workers to enhance by the Supreme Court on the ACA (National
collaborative activities with medicine and allied Federation of Independent Business v. Sebelius
health professions to maximize the profession’s and Florida v. United States Department of
role in shaping these emerging models of inte- Health and Human Services). By October 2013,
grative, collaborative, and coordinated care. only 24 states plus the District of Columbia had
agreed to expand Medicaid. The CBO (2012)
Behavioral Health Social workers have a long has estimated that 3 million fewer people will
history in behavioral health and are already gain insurance coverage as a consequence of the
the predominant professionals providing these Supreme Court decision. Moreover, the states
services (U.S. Department of Labor, Bureau not expanding Medicaid account for 60% of the
of Labor Statistics, 2013). Yet, to expand this nation’s “uninsured working poor people” and
role, the profession must be responsive to “68% of poor, uninsured blacks and single moth-
shifts in decision-making power resulting from ers” (Tavernise & Gebeloff, 2013).
ACA-driven insurance expansions. Medicaid is In addition, an estimated 11 million undocu-
poised to become the primary payer of behavioral mented immigrants are excluded from the new
health services, and in states that take the expan- coverage options. The 5-year ban on Medicaid
sion option, Medicaid agencies will become the and CHIP for newly arrived legal immigrants set
single most powerful decision makers in behav- forth by the Personal Responsibility and Work
ioral health. Concomitantly, state agencies that Opportunity Reconciliation Act of 1996 remains
have administered the majority of public behav- in effect. These disparities in coverage hinder
ioral health funding through state and federal immigrants’ ability to obtain health care. Social
block grants are likely to decline in importance. workers ought to advocate for health insurance
These changes in the financing of behav- for every individual living in the United States,
ioral health services are likely to result in major regardless of immigration status. They must also
changes in the distribution of decision-making work to ensure that care is culturally and linguis-
power. Although the ACA requires all states to tically appropriate.
include behavioral health services in their essen-
tial benefits packages, state Medicaid agencies
and HIEs will have broad discretion in determin- CONCLUSION
ing which behavioral health services will be cov-
ered and who can be reimbursed for providing The enactment of the ACA marked a critical step
them—at least among those providers that have forward in the century-long effort to achieve
 8 • the Affordable Care Act 65

universal health care coverage in the United Berwick, D., Nolan, T. W., & Wittington, J. (2008). The
States. Social workers have long supported, and triple aim: Care, health, and cost. Health Affairs,
at times played a leading role, in this effort. 27(3), 759–769. Retrieved from http://content.
The ACA includes “several provisions that will healthaffairs.org/content/27/3/759.full.
Birn, A. E., Brown, T. M., Fee, E., & Lear, W. J. (2003).
directly benefit” social workers (Malamud, 2010).
Struggles for national health reform in the United
Much remains to be done, however. When fully States. American Journal of Public Health, 93(1),
implemented, the ACA will not achieve universal 86–91.
coverage, and whether it will succeed in bringing Buck, J. A. (2011). The looming expansion and trans-
costs under control remains an open question. It formation of public substance abuse treatment
is also unclear how social workers will fare in the under the Affordable Care Act. Health Affairs,
transition from a largely fee-for-service system 30(8), 1402–1410.
to one based on coordinated care. In a real sense, Centers for Medicare and Medicaid Services. (2013c).
the ACA is a work–in-progress and is best under- Shared savings program. Retrieved from
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Service-Payment/sharedsavingsprogram/index.
html?redirect=/sharedsavingsprogram/
WEBSITES Collins, S. R., Nicholson, J. L., Rustgi, S. D., & David, K.
(2008,October 2).The 2008 presidential candidates’
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www.innovations-cms.gov www.commonwealthfund.org/Publications/
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 Social Work Practice in
9 Home-based Services

Martha Morrison Dore & Charlene Zuffante

ANOTHER DAY ON THE JOB

The following reflects a typical day in the life of a social worker delivering home-based services to
families and their children.

8:30–9:30 a.m.: Arrive at office. Hunt for Carrie is also entering into
a parking space. Check adolescence, which requires
phone messages, return its own set of developmental
calls to clients, colleagues, adjustments. She also has a
and community partners. very conflicted relationship
Find out from a call to the with her father who has
middle school social worker also reacted badly to Anna’s
that Robbie McDonald has involvement with Ellie and
skipped school for two days feeds Carrie’s insecurities
in a row. about her changing
9:30–9:45 a.m.: Head off to Dobson family relationship with her mom.
home for treatment ses- The focus of treatment at
sion with Anna Dobson, her present is on the relationship
partner, Ellie, and Anna’s between mother and daugh-
daughter, Carrie Dobson, 13, ter, as well as negotiating the
who has just returned home role of Ellie in the family,
from two weeks in residen- particularly with regard to
tial treatment for a suicide Carrie.
attempt. 11:30–12:00 Travel to ML King
9:45–11:30 a.m.: Home-based session with noon: elementary school.
the Dobson family. The 12:00–1:00 p.m.: Attend Individual Education
relationship between Anna Plan (IEP) meeting at King
and Ellie is a relatively new school for Keisha Harold,
one and Carrie, who has age 8, who is experienc-
been alone with her mom ing serious attention and
since her parents’ divorce behavior problems in second
five years before, is hav- grade. Support Keisha’s
ing a great deal of difficulty mom, who is requesting
adjusting to sharing her additional testing by an out-
mom with Ellie. side evaluator.

67
68 Part II • Roles, Functions, and Fields

1:00–1:30 p.m.: Travel back to office. Hunt 7:30–8:30 p.m.: Treatment session with Mr.
for parking space. and Mrs. McDonald and
1:30–2:00 p.m.: Check messages, return more their four children, including
phone calls, set up next day’s 13-year-old Robbie, who has
home visits. recently been skipping school
to hang out with a group of
2:00–3:00 p.m.: Write progress notes in
delinquent older teens. The
Dobson file document-
parents suspect he is using
ing morning’s home-based
drugs and alcohol and may be
treatment session. Write up
committing burglaries with
summary of IEP meeting
the teens. The session focused
and document next steps in
on bringing Mr. McDonald
Harold case file.
back into the family system.
3:00–3:30 p.m.: Travel to el Bassel family
He travels constantly in his
home.
job as a long-distance truck
3:30–5:00 p.m.: Accompany Mr. and Mrs. driver and is often gone for
el Bassel, recent Palestinian days at a time, leaving Mrs.
immigrants, to the hous- McDonald to manage the
ing office to apply for an household alone, an over-
emergency transfer because whelming task for a working
their current neighbors are mother. Robbie, the oldest
verbally threatening them child, has functioned as the
because they are Muslims father surrogate, managing
from the Middle East. the younger children and
During travel and wait- even disciplining them when
ing time, talk with parents his parents are absent. Now
regarding their manage- that Robbie is becoming
ment of son, age 11, who is a teenager, he is rebelling
having extreme difficulty against these responsibilities
adjusting to current school by separating himself from
placement. the family as much as pos-
sible, leading to his involve-
5:00–5:30 p.m.: Travel back to office. No
ment with antisocial peers.
problem finding parking.
Reconnecting father and son,
5:30–6:00 p.m.: Work on additional case docu- who had a very positive rela-
mentation needed for reim- tionship when Robbie was
bursement under state contract. younger, removing Robbie
from the parenting role, and
6:00–7:00 p.m.: Assist colleague with a establishing Mr. and Mrs.
domestic violence (DV) cri- McDonald as a couple and
sis unfolding in one of her as heads of the family are
home-based cases. Her client the focus of work with this
has called her to report that family.
her boyfriend has beaten her
and is threatening to harm 8:30–9:00 p.m.: Travel to office.
her child unless she agrees to
move to Tennessee with him. 9:00–10:00 p.m.: Check phone messages,
Work phones to obtain help check on colleague with DV
while colleague keeps client crisis, return phone calls,
talking on phone. write progress notes on
family therapy session with
7:00–7:30 p.m.: Travel to the McDonald fam- McDonald family, and docu-
ily home. ment next steps with Robbie.
 9 • Home-based Services 69

As she thinks about her work feelings of being a third

in her clients’ homes and in wheel in her mom’s new
the community during this relationship and gave the
day, the home-based social family something to talk
worker realizes just how about in terms of the cur-
much she has learned about rent apartment’s physical
her families and their func- space and need for privacy
tioning by observing them of a teenaged girl. Tasking
interacting in their homes and Anna, Ellie, and Carrie with
in the school settings. Those looking together for a new
fishing poles stacked against apartment might be a posi-
the wall near the McDonald’s tive experience that helps to
back door led to a discussion reorganize the family sys-
of an activity that Robbie and tem. The home-based social
his dad used to enjoy together worker smiled to herself
nearly every weekend and as she thought about how
gave her some ideas about satisfying it was to work
how to get them reconnected with families to help them
now. Seeing Carrie’s clothes change their dynamics and
stacked near the pull-out move forward in a more
couch in the living room said positive direction. Whew,
everything about the girl’s what a day!

INTRODUCTION TO HOME-BASED the home; (c) Its provision of natural openings for
SERVICES a frank exchange of experiences (p. 107).”
A review of the current literature on
Social work has a long tradition of home-based home-based practice reveals that not much has
service delivery, dating back over one hundred changed since Mary Richmond wrote these words.
years to the friendly visitors of the Charity The value of working with clients in their own
Organization Society. Although much has homes still emphasizes the importance of estab-
changed since that time with regard to knowl- lishing a working relationship or “helping alliance”
edge for practice with individuals, families, and and the greater ease with which the therapeutic
children in their own homes, these earliest social relationship develops when the client is in famil-
workers, like present-day practitioners, recog- iar surroundings (Damashek, Doughty, Ware, &
nized that engaging with family members in the Silovsky, 2011; Johnson, Wright, & Ketring, 2002;
context of their daily lives greatly enriched their Thompson, Bender, Windsor, & Flynn, 2009).
understanding of the forces that influence current Home-based work provides a ready window
functioning and of the strengths and resources into the daily lives of clients. Although it may
that may be engaged to bring about change. be possible to keep up a pretense that all is well
In the first textbook for training aspiring for an hour a week in an out-patient clinic, it is
social workers, Social Diagnosis, published in much more difficult to hide evidence of clinical
1917, Mary Richmond presented her arguments depression or ongoing substance abuse when
in support of working with clients in their own one’s living environment is filthy and in disarray.
homes: “(a) Its challenge to the case worker at It is possible for the home-based social worker
the outset to establish a human relation . . . (b) Its to understand quickly why a child is failing in
avoidance of the need of so many questions, some school when there is no time or space set aside in
of which are answered unasked by the commu- a cramped and noisy apartment for homework,
nicative hostess and by her surroundings. To the where the television blares 18 hours a day, and
quiet observer, the photographs on the wall . . . the where no adult takes responsibility for ensuring
household arrangements are all eloquent. And far that homework is done correctly.
more revealing than these material items are the The DelBlasio family consisted of Rachel, a
apparent relations of the members of the house- 33-year-old mother, and her 10 children ranging
hold to one another—the whole atmosphere of in age from 3 months to 14 years. The identified
70 Part II • Roles, Functions, and Fields

patient in the family was 9-year-old Billy, who mental health center for assessment and treat-
was sexually molested by a 26-year-old cousin. ment, only the mother and, occasionally, a sibling
Billy revealed the molestation to a school nurse or two accompany the child to the clinic. Yet, as
and Child Protective Services (CPS) was notified. family social workers have noted for years, it is
The case was referred by CPS to a home-based nearly impossible to understand the function-
family treatment program in an effort to ing of an individual family member, especially a
strengthen the family’s functioning and prevent child, without also understanding the dynamics
an out-of-home placement for Billy. of family interaction. What better way to observe
When the home-based social worker, Susan, these dynamics firsthand than by providing
arrived at the DelBlasio home, she found a mom, home-based services? What better way to find out
Rachel, who was reluctant to become involved that a family’s life together is totally disrupted by
in treatment and a living environment that was the demands of caring for grandpa who is 87 years
chaotic at best. Cockroaches scurried across the old and has advanced Alzheimer’s disease? What
trash-strewn floor. At the first family session, it better way to find out that mother’s paramour is
was clear that the older two children, both girls, a violent and abusive man who has punched holes
were carrying a great deal of the responsibility in the apartment wall and kicked the family dog
for managing the home and younger children when the children’s noisy play awakened him?
and that Rachel suffered from severe depression, What better way to discover that the parents of
unable to get out of bed to get her children off a boy diagnosed with ADHD are uncertain how
to school most days. The extreme attention seek- to manage his frequently disruptive behavior and
ing behavior of the younger children with Susan that their inability to set appropriate limits has
suggested emotional neglect. allowed the child to “rule the roost?” Although an
Rachel insisted that she could handle the situa- outpatient clinician may learn of any of these situ-
tion with Billy on her own by confronting the per- ations in due course, the home-based practitioner
petrator’s mother and not allowing Billy to have witnesses the interaction immediately, and first-
any further contact with his cousin. Efforts to help hand, and understands implicitly its impact on the
Rachel help Billy with the emotional effects of the family system and on individual family members.
abuse were met with stubborn denial. After a few Carlos, a Spanish-speaking social worker in a
home visits, Billy took matters into his own hands by home-based program, was assigned to a family
requesting to meet with Susan alone. He led her into of Puerto Rican descent, the Rodriquez family,
the bedroom he shared with five of his siblings. The whose 13-year-old son, Jose, had been given the
six children all slept together on two queen-sized diagnosis of Bi-Polar Disorder. The parents were
mattresses pushed together on the floor. confused about the meaning of this diagnosis and
Small for his age and rail thin, Billy summoned understandably concerned about its implications
all of his strength to push a large dresser up against for the future of their child. As Carlos met with
the bedroom door to keep out his brothers and sis- Mr. and Mrs. Rodriquez, Jose, his older brother,
ters who banged at the door repeatedly, begging to 15, and younger brother, 10, in their own home, a
come into the room to see what was going on. Billy picture began to emerge of loving, well-meaning
motioned for Susan to sit on the floor where cock- parents who were frightened by their middle son’s
roaches scurried about. Feeling her commitment to frequent rages, which seemed to occur primarily
the child was being tested, she joined him in his life when Jose was asked to carry out a chore such as
at that moment, and the two of them sat together, cleaning his room or completing his homework.
flicking the bugs away, while Billy talked of his life During these rages, which Mr. and Mrs. Rodriquez
at home, at school, and of the sexual molestation attributed to his Bi-Polar illness, Jose would
experience. In a clinic setting, without this oppor- appear out-of-control, throwing things and break-
tunity to enter into the child’s life as he lived it on ing up furnishings. Once, when asked to go to his
a daily basis, it is doubtful that the social worker room when he became enraged, Jose refused and
could have gained such a full and complete under- proceeded to kick the bedroom door in.
standing of the client in his situation so quickly. In discussing their parenting styles, his mother
As Mary Richmond noted in 1917, home- readily admitted that she was intimidated by Jose
based work also provides an essential opportunity when he was enraged and would retreat to her room
to observe the interactions of those living in the until the storm was over. His father, who was a
home with one another. Very often when a child very large man, saw his role as de-escalating Jose’s
is referred by a school or medical provider to a rages through physical intimidation, although
 9 • Home-based Services 71

he denied ever using actual physical force with Another important advantage of home-based
the boy. Neither parent believed in setting lim- practice is its ability to deliver services to cli-
its with their sons, or in having a set structure in ents who might otherwise be inaccessible to
the home, such as specific times for homework or social work clinicians (Boyd-Franklin & Bry,
family meals. Both felt that this more laissez-faire 2000; Carrasco & Fox, 2012; Chaffin, Hecht,
approach to parenting had worked well with their Bard, Silovsky, & Beasley, 2012). One of the
other two boys and did not understand why Jose first home-based programs described in the
could not handle it also, again attributing his contemporary social work literature grew out
behavior problems to his illness. of a study in the 1950s by social workers in St.
It was quickly apparent from observing the Paul, Minnesota, who had observed that a small
family in their own home that Jose had learned number of families created a high proportion of
how to use his illness to control his parents to the demands on the child welfare system there.
his own benefit. Helping Mr. and Mrs. Rodriguez These families demonstrated a myriad of dif-
examine their ineffective laissez-faire parenting ficulties including domestic violence, substance
style and identify alternative approaches in which abuse, mental health problems, as well as child
they both could participate was a clear focus of the abuse and neglect. Engaging these families in
work with this family. In addition, the importance efforts to address their difficulties and make sub-
of structure to a vulnerable child like Jose was part stantial changes in their often-chaotic function-
of educating the family about Bi-Polar Disorder. ing proved frustrating and futile for the St. Paul
Setting up a schedule for homework and meal- social workers until it was decided to take ser-
times, as well as for completing chores around the vices to these families in their own homes rather
house, would help Jose anticipate in advance what than wait for them to seek and accept therapeutic
he needed to do rather than always feeling like services on their own. In this way, many of these
“things were coming at him out of the blue” as he families were engaged in treatment and changes
expressed in one family session. Trying alternative in their overall functioning were observed.
ways of doing things, while receiving the support The St. Paul Family-Centered Project, as it was
and encouragement of their home-based worker, called, and others like it that sprang up around the
helped the Rodriquez family, which had many country in the ensuing years, focused on families
inherent strengths including their commitment to known to the child welfare system, and worked to
one another, make positive changes that benefited ensure family stability and improve family func-
all members of the family system. tioning in order to keep children at home and out
In Social Diagnosis, Mary Richmond also of foster care. These early home-based programs
noted that home-based practice provides a mul- contributed to the development of what came to be
titude of opportunities for “frank exchanges.” known as family preservation services. Although
The home environment is replete with “conver- there were several different models of family pres-
sation starters” for clinicians who bring aspects ervation services, perhaps the most widely known
of the environment into the therapeutic process and utilized was Homebuilders, developed by two
(Macchi & O’Connor, 2010; Reiter, 2006). A pic- psychologists in Tacoma, Washington, in the early
ture of mother’s parents on the mantel can initiate 1970s.
a discussion of mother’s childhood, revealing that The Homebuilders model is a brief, six-week
her father was a longtime alcoholic who was emo- intervention that works with families in crisis
tionally unavailable and that her mother com- who are about to lose their children to foster
pensated for his emotional absence by becoming care (Kinney, Haapala, & Booth, 1991). The work
emotionally enmeshed with her only child. This is done almost entirely in the family’s home or
may help the home-based clinician better under- in other community locations such as schools
stand her client’s difficulties in developing healthy or work settings. Homebuilders clinicians carry
intimate partner relationships and her inability very small caseloads, are available on call 24
to set appropriate limits and expectations for her hours a day, and spend as much time as necessary
11-year-old son. Helping a mother to relate her working with the family in the home, especially
own childhood experiences to her current parent- during the first days or weeks of treatment when
ing practices, using elements available in the home the family is in a crisis state. In addition to crisis
environment such as the picture on the mantel, is a theory, the model draws heavily on social learn-
strategy available to home-based clinicians that is ing theory to bring about changes in families’
seldom accessible to practitioners in clinic settings. functioning.
72 Part II • Roles, Functions, and Fields

Evaluations of the Homebuilders model families an intergenerational perspective on fam-

suggested that it was effective in reducing the ily functioning, now captured so eloquently by
number of out-of-home placements of children the intergenerational family genogram, a staple
as compared with usual child welfare services. in the armamentarium of the home-based prac-
Homebuilders participation also shortened the titioner (McGoldrick, Gerson, & Shellenberger,
length of foster care placement and facilitated chil- 1999).
dren’s return to their families (Schwartz, 1995). From family therapist Salvador Minuchin,
During the 1980s and 1990s, variations on the working at the Philadelphia Child Guidance
Homebuilders model were adopted throughout Clinic, came the focus on family structure and its
the United States by state child welfare agencies importance in understanding and treating fami-
as a result of federal legislation providing fund- lies in which the parents had lost control of their
ing to states to strengthen families and prevent children. Minuchin’s structural family therapy
out of home placement of children. Home-based approach taught home-based practitioners to
services intended to prevent child placement, and observe the family’s structure and seek to under-
to reunify families when placement has occurred, stand the patterns of alliances and coalitions that
are currently a staple of most state child welfare color a family’s daily life (Lindblad-Goldberg,
systems (Macchi & O’Connor, 2010). Dore, & Stern, 1998). For instance, in families
Home-based treatment models have been with a delinquent son or daughter, clinicians
developed to serve families and children involved often see adults who have given up on authori-
with the juvenile justice and mental health tative parenting for a variety of reasons, which
systems as well as with child welfare. Perhaps might include their own substance abuse, clini-
the best known home-based model for work- cal depression, marital conflict, or simply being
ing with delinquent youth and their families overwhelmed by life stressors. Helping the
is Multisystemic Therapy, or MST. MST was adults in such families address their own dif-
developed in the early 1990s by Scott Henggeler ficulties in order to resume their role as parent
and his colleagues at the Medical College of the is a frequent focus of structural family therapy
University of South Carolina to address the (Lindblad-Goldberg et al., 1998).
externalizing behaviors of conduct disordered Jay Haley, Chloe Madanes, and other strate-
youth (Borduin, Mann, Cone, et al., 1995). As gic family therapists gave home-based clinicians
the name of the model suggests, the focus of useful tools such as enactments, or brief playlets,
treatment is on the multiple systems involved in to illuminate a specific sequence of events in the
delinquent behavior: the youth, the family, peers, family, such as having the children in the fam-
and community institutions such as the school. ily act out what happens when father gives an
MST clinicians work primarily with youth and order to teenage son that is ignored, or what hap-
their families in their own homes and, as in the pens when the family goes on an outing together.
Homebuilders model, they carry low caseloads, These dramatizations of incidents in family life
are available 24 hours a day, seven days a week highlight commonly occurring negative inter-
to their clients, and the service is time-limited actions among family members as in no other
(3–5 months). Unlike Homebuilders, but similar way. They also give the home-based practitioner
to many other home-based intervention mod- substantive material with which to initiate an
els, MST draws heavily for its theoretical base alternative behavioral sequence to bring about
and practice approach on family systems theory change. If a particular sequence of events in a
and its applications in family therapy (Borduin, family customarily ends badly for some or all of
Mann, Cone, et al., 1995). the participants, illustrating this with the family,
The growth of the family therapy move- then having the family brainstorm and act out an
ment in the 1960s and 1970s gave social work- alternative sequence has the potential for meet-
ers working with families in their own homes ing the needs of all participants. And, rehearsing
new tools and strategies with which to approach the sequence in an in-home session makes it more
home-based work. Family systems theory, which likely that family members will remember and
underpinned the family therapy movement, try it out the next time the opportunity arises.
guided the interpretation of family dynamics. For Family therapy, no matter what the theoreti-
example, Murray Bowen, one of the preeminent cal orientation or school of thought, has given
early theoreticians and family therapy practitio- home-based practitioners significant permis-
ners, gave home-based clinicians working with sion to use themselves creatively to bring about
 9 • Home-based Services 73

change in a family’s problematic ways of func- in the family, who suffers from a chronic illness.
tioning. Doing something differently, whether This way of understanding family functioning
its interacting in a new way with a partner or moves away from the practice of blaming specific
child, or accessing new community resources family members for problems in the family and
together with a parent and observing how the provides the clinician with a point of interven-
parent interacts with a resource provider in a tion and change. Circular feedback loops become
community setting, differentiates home-based apparent very quickly when a clinician spends
from clinic-based practice. In traditional time with the family in the comfort zone of their
clinic-based practice, the focus of interaction own home, and opportunities to challenge these
between the social worker and client is limited customary ways of behaving are readily available.
to what the client brings into the session, which Other models of home-based treatment for
represents his construction of the reality of his children and families involved with the men-
life. Helping the client construct a more accurate tal health system have been developed as well.
interpretation can take many weeks or months Beginning in the mid-1990s, clinicians at the Yale
of treatment. Home-based work speeds this pro- Child Study Center have developed and tested a
cess greatly by giving the clinician immediate manualized model of in-home psychiatric ser-
access to alternative perspectives, which he can vices called IICAPS (Intensive In-home Child
then use to help the client experience her situa- and Adolescent Psychiatric Services) (Woolston,
tion in a different way. Adnopoz, & Berkowitz, 2007). The model pro-
In addition to home-based interventions vides for home-based assessment and treatment
with families in the child welfare and juve- planning, as well as brief family therapy, parent
nile justice systems, this approach has been education in child behavior management, social
extended to families in the mental health sys- skills development for children, and intervention
tem. Spurred in the early 1980s by the federal with environmental resources to build support
Child and Adolescent Service System Program for the child and family in the community. Each
(CASSP) initiative, which funded development phase of the intervention process is well-defined
of new models of community-based children’s and is accompanied by a series of measures of its
mental health services, the state of Pennsylvania effectiveness. IICAPS is a team-delivered inter-
invested in developing and implementing a vention. Clinicians are expected to spend up to
model of home-based services that treated chil- five hours per week in the family home and the
dren’s mental health needs in the context of their model calls for a six-month treatment duration.
families (Lindblad-Goldberg et al., 1998). The IICAPS is currently a Medicaid-approved treat-
Pennsylvania model was based on an ecological ment for children with DSM Axis I and Axis II
and systemic understanding of factors that con- diagnoses in the state of Connecticut.
tributed to serious emotional and behavioral dis- Another home-based intervention designed
turbances in children and drew upon structural to support children and adolescents with seri-
family therapy to inform its intervention. All of ous emotional disturbances in their own homes
the treatment was done in the home and com- and communities is the Wrap-around model,
munity and was intended to prevent psychiatric in which social workers work intensively with
hospitalization and long-term residential care. families to identify and put in place all of the
One of the systems concepts that the resources and services needed to maximize the
Pennsylvania home-based model emphasized is child’s psychosocial functioning. In this model,
that of circular causality. This concept focuses the treatment plan is developed collaboratively
clinicians’ attention on the circular feedback by a care planning team that includes social
loops of communication and behavior among workers from the Wrap-around program, one of
family members. These highlight repetitive pat- whom acts as the primary care coordinator; rep-
terns of family interaction that illustrate the resentatives of community resources such as a
structural difficulties the family is experiencing. school social worker or therapist from the local
For example, a mother subtly counteracts every outpatient mental health clinic; members of the
request her husband makes of their son by negat- child’s current household and others the family
ing his authority with the child, or two siblings may wish to include such as grandparents, close
enter into a covert alliance to act out behavior- friends or neighbors; and representatives of the
ally to draw a response from their mother who referring agency, frequently the juvenile court or
is over-involved emotionally with the third child state child welfare agency. A primary focus of the
74 Part II • Roles, Functions, and Fields

Wrap-around approach is to end the fragmented in about eight treatment sessions and that chil-
way services are often provided to children with dren’s problem behaviors can be observed to
serious emotional and behavior disturbances and improve dramatically as a result (Carrasco & Fox,
their families. 2012).
The Wrap-around model emphasizes honor- As Mary Richmond recognized early in the
ing the family’s voice in care planning. Part of profession’s development, home-based services
the care coordinator’s role is to ensure that team have historically been a key component of social
meetings are safe and blame-free for all par- work practice in a variety of domains. Social
ticipants. There is also an emphasis on ensuring workers, with their eco-systemic understanding
that cultural differences are acknowledged and of human functioning and their trained capac-
respected in the Wrap-around treatment process. ity to interpret person/situation interaction, are
The care planning team is charged with develop- ideally suited to be home-based clinicians. Social
ing the goals and strategies necessary to achieve workers have long appreciated the importance of
the outcomes the family seeks with regard to observing and engaging their clients where they
maintaining the child in the home and commu- live, in their own homes and community settings.
nity. These goals often include helping parents or Contemporary home-based programs build on
other family members address their own prob- the unique knowledge and skills of social workers
lems or issues that impact the family’s ability to developed and refined in over one hundred years
provide the care the child needs. of home-based practice to help individuals, fami-
In recent years, as increased attention has lies, and children achieve their goals and improve
been paid to preventing social and emotional their psychosocial functioning.
difficulties in young children, particularly as
they impact a child’s capacity to learn in school,
home-based programs for at-risk infants and WEBSITES
toddlers have sprung up across the United States.
Nationally, programs such as Early Head Start www.nwi.pdx.edu—Wraparound services site
and Healthy Families focus on the function- www.mstservices.com—Multisystemic Therapy
ing of the whole family and may rely on social site
workers specially trained in early child devel- www.institutefamily.org—Homebuilders site
opment to engage, assess, and treat vulner- www.nfpn.org—National Family Preservation
able families in their own homes (Love, Kisker, Network site
Ross, Constantine, Boller et al., 2005; Rodriguez, www.healthyfamiliesamerica.org—Healthy
Dumont, Mitchell-Herzfeld, Walden, & Greene, Families site
2010). A recent national study of Early Head
Start found that families and children treated in References
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Family Therapy, 32, 444–458. University Press.

10 Social Work Practice in Disasters

Daphne S. Cain

SOCIAL WORK INTERVENTION IN 1992) (Cherry & Cherry, 1996; Sanders, Bowie,
DISASTERS & Bowie, 2003); The Great Flood of 1993 (Sundet
& Mermelstein, 1996); and the Oklahoma City
The History of Social Work Bombing (April 1995) (Levine, 1996; North,
Intervention in Disasters Tivis, McMillen, Pfefferbaum et al., 2002). Over
Although interest in traumatic reactions and the past two decades, social work intervention in
social support following disaster has been evi- disaster has become a specialization with intense
dent in the American literature for decades, social interest on best practices and evidence-informed
work practices and intervention during and sub- intervention. This is evident in the consider-
sequent to disaster did not receive much attention able social work literature from the 9/11 Attacks
until the 1990s and Hurricane Andrew (August (September 2001) (Adams, Figley, & Boscarino,
76 Part II • Roles, Functions, and Fields

2008; Bauwens & Tosone, 2010; Henley, Marshall, in a crisis state. These reactions may include
& Vetter, 2010; Pulido, 2012), and Hurricane symptoms of shock, exhaustion, disorientation,
Katrina (August 2005) (Bliss & Meehan, 2008; irrationality, racing thoughts, and uncontrol-
Cain, Plummer, Fisher, & Bankston, 2010; Coker lable emotions (Brymer, Jacobs, Layne, Pynoos,
et al., 2006; Elliott & Pais, 2006; Hoffpauir & Ruzek, Steinberg, Vernberg, & Watson, 2006).
Woodruff, 2008; Legerski, Vernberg, & Noland, Most disaster survivors recover from initial
2012; Plummer, Cain, Fisher, & Bankston, 2008; reactions and symptoms with little or no psycho-
Pyles, 2007; Terranova, Boxer, & Morris, 2009). logical intervention (Norris, Friedman, Watson,
Additionally, there is growing interest in inter- Byrne, Diaz, & Kaniasty, 2002). However, some
national social work intervention in disaster. survivors have more acute reactions that may
Rapid population growth, unplanned urbaniza- develop into Post Traumatic Stress Disorder
tion and environmental degradation (especially (PTSD) or another major psychiatric disorder,
in disaster-prone and impoverished areas), and including major depressive disorder, dysthy-
climate change have impacted the frequency and mia, agoraphobia, specific phobia, social anxi-
severity of natural disasters globally (American ety disorder, and panic disorder (Aziz & Aslam,
Red Cross, 2013). Subsequently, social work has 2012; Carroll, Balogh, Morbey, & Araoz, 2010;
responded to the widespread flooding, earth- Hussain, Weisaeth, & Heir, 2011). Individuals
quakes, tsunamis, and national conflicts and who are directly impacted by disaster—those
hostilities around the world (Aziz & Aslam, who have lost property or a loved one, or who
2012; Bourassa, 2009; Busaspathumrong, 2006; have been injured or dislocated—are more at
Dominelli, 2013; Goenjian, 1993; Huang, Zhou, & risk for developing long-term psychosocial con-
Wei, 2011; Javadian, 2007; Nikku, 2012; Pockett, ditions such as PTSD (Kreuger & Stretch, 2003).
2006; Takahashi, Lijima, Kuzuya, Hattori, Yokono,
& Morimoto, 2011; Yanay & Benjamin, 2005).
The National Association of Social Workers TYPES OF DISASTER AND BARRIERS
(NASW) adopted a national disaster policy in TO DISASTER WORK
2000, which asserts that, among “all the allied
health and human services professionals, social Disasters can be defined as “events that disable
work is uniquely suited to interpret the disaster community social functioning” (Soliman &
context, to advocate for effective services, and Rogge, 2002, p. 2). There are natural disasters
to provide leadership in essential collaborations (tornados, hurricanes, earthquakes, fires, and
among institutions and other organizations” floods), human-initiated disasters (air disasters,
(NASW Press, 2000, p. 4). The social work profes- nuclear reactor explosions), and human-initiated
sion is particularly appropriate for disaster work disasters that are intentionally caused (war, ter-
because of our holistic epistemology at the gener- rorism, shootings). And, while there is exten-
alist social work level, our ecological framework sive research into natural and human-initiated
and emphasis on the person-in-environment, disasters, there is limited research specific to
our values regarding respect for diversity and social work responses to such things as terrorism
empowerment and the role of relationships in (Sweifach, LaPorte, & Linzer, 2010).
the delivery of successful interventions, and our At the same time, there are many barriers to
strengths-based approach (Bliss & Meehan, 2008; social work interventions during and subsequent
Cronin, Ryan, & Brier, 2007; Rowlands, 2013). to disasters. These include a lack of disaster/crisis
More specifically, social workers are trained to training and preparedness among workers, a lack
apply a community oriented strengths perspec- of adequate training in cultural competence, and
tive that builds upon existing capacity in a disas- contextual challenges including the characteris-
ter affected area (Dominelli, 2013; Mathbor, 2007; tics and location of the incident(s) and the scale
Pyles, 2007; Rowlands, 2013; Tan, 2013). of destruction (Davis, 2013; Legerski, Vernberg,
& Noland, 2012).

DISASTER REACTIONS
CULTURE AND DISASTER
Although post-disaster reactions and behaviors
may appear to be symptoms of psychopathol- Being culturally sensitive is crucial in disaster
ogy, in fact, many of these reactions are normal work. In particular, transnational disaster social
 10 • Social Work Practice in Disasters 77

workers need to be highly sensitive to ethical Around the world, disasters have forced
cultural adaptation standards in order to avert children into armed conflict, prostitution, and
cross-cultural errors and/or harm (Bourassa, 2009; drug trafficking (Nikku, 2012; Phua, 2008).
Puig & Glynn, 2003; Rowlands, 2013; Shah, 2011; Immediately after a disaster, attend to children