Catheleen Jordan and Cynthia Franklin
Assessment is an ongoing process of data collection aimed at identifying client strengths and problems. Early assessment models were based on psychoanalytic theory; however, current assessment is based on brief, evidence-based practice models. Both quantitative and qualitative methods may be used to create an integrative skills approach that links assessment to intervention. Specifically, assessment guides treatment planning, as well as informs intervention selection and monitoring.
Steven P. Segal
Social workers are increasingly working in authoritative settings—that is, settings where they have the power to mandate conformity by the client to the normative and often legal requirements of the organization. Such settings may be residential, such as jails, prisons, and rehabilitation facilities, or community-based organizations that are part of the criminal justice system, the mental health system, the health system, and the child welfare system. The exercise of power derived from the authority vested in the setting’s objectives may and often does alter the total life situation of an individual, such as when a client is compelled to move to supervised care without the client’s consent. Under an outpatient civil commitment order or mental health court supervision, the patient may be told where to live and with whom to associate as well as be required to participate in interactive treatment and to take medication. In authoritative settings, social workers are working with “involuntary” clients—clients who understand, whether or not it is explicitly stated, that the social worker possesses the power to effect unwanted change in their life circumstance. Since the early 1990s, the field has been developing new ideas and skills that are equally useful in working with voluntary and involuntary clients. In the process, social worker authority is now viewed less as a way to gain client compliance and, instead, is understood more as an opportunity to build partnerships with clients that lead to changes that are enduring and more meaningful to clients.
Edward J. Mullen, Jennifer L. Bellamy, and Sarah E. Bledsoe
This entry describes best practices as these are used in social work. The term best practices originated in the organizational management literature in the context of performance measurement and quality improvement where best practices are defined as the preferred technique or approach for achieving a valued outcome. Identification of best practices requires measurement, benchmarking, and identification of processes that result in better outcomes. The identification of best practices requires that organizations put in place quality data collection systems, quality improvement processes, and methods for analyzing and benchmarking pooled provider data. Through this process, organizational learning and organizational performance can be improved.
Larry W. Foster
Bioethics and biomedical ethics are defined. Common bioethical concepts, exemplary moral values, fundamental ethical principles, general ethical theories, and approaches to moral reasoning are reviewed. The scope of topics and issues, the nature of practice situations in bioethics, and social work roles on organizational bodies that monitor and respond to bioethical issues are summarized, as are trends in bioethics. Practice contexts, from beginning to end of life, are highlighted with biopsychosocial facts, ethical questions and issues, and implications for social work—a profession uniquely positioned in giving bioethics a social context.
The historical development of the borderline concept is traced up through the development of the diagnosis of borderline personality disorder (BPD). Treatments for BPD during the 1970s and 1980s are discussed, including the object relations theories of Margaret Mahler and James Masterson, as well as trauma theory described by Judith Herman. Three evidence-based treatments (EBTs) that have emerged from the 1990s to the present time are described, as well as findings from brain imaging techniques and how new EBTs and neuroimaging have changed the view of this disorder.
June Simmons, Sandy Atkins, Janice Lynch Schuster, and Melissa Jones
Transitions in care occur when a patient moves from an institutional setting, such as a hospital or nursing home, to home or community, often with the hope or expectation of improving health status. At the very least, patients, clinicians, and caregivers aim to achieve stability and avoid complications that would precipitate a return to the emergency department (ED) or hospital. For some groups of vulnerable people, especially the very old and frail, such transitions often require specific, targeted coaching and supports that enable them to make the change successfully. Too often, as research indicates, these transitions are poorly executed and trigger a cycle of hospital readmissions and worsening health, even death. In recognizing these perils, organizations have begun to see that by improving the care transition process, they can improve health outcomes and reduce costs while ensuring safety, consistency, and continuity. While some of this improvement relies on medical care, coaching, social services and supports are often also essential. Lack of timely medical follow-up, transportation, inadequate nutrition, medication issues, low health literacy, and poverty present barriers to optimal health outcomes. By addressing social and environmental determinants of health and chronic disease self-management, social workers who make home visits or other proven timely interventions to assess and coach patients and their caregivers are demonstrating real results. This article describes care transitions interventions, research into barriers and opportunities, and specific programs aimed at improvement.
A generic set of case management functions are performed in most practice settings. To improve outcomes within a complex service delivery system, case managers need to collaboratively work with clients and care providers. By incorporating the paradigm of evidence-based practice, case managers can improve decision making through integrating their practice expertise with the best available evidence, and by considering the characteristics, circumstances, values, preferences, and expectations of clients, as well as their involvement in the decision making.
Chaos theory and complexity theory, collectively known as nonlinear dynamics or dynamical systems theory, provide a mathematical framework for thinking about change over time. Chaos theory seeks an understanding of simple systems that may change in a sudden, unexpected, or irregular way. Complexity theory focuses on complex systems involving numerous interacting parts, which often give rise to unexpected order. The framework that encompasses both theories is one of nonlinear interactions between variables that give rise to outcomes that are not easily predictable. This entry provides a nonmathematical introduction, discussion of current research, and references for further reading.
Anthony N. Maluccio
Social work has a long tradition of direct practice with children in a range of settings, such as child welfare, child guidance, hospitals, schools, and neighborhood centers. This entry focuses on general principles and strategies for direct social work practice with preadolescents and, to a lesser extent, their families, within an eclectic conceptual framework.
Patricia A. Fennell and Sara Rieder Bennett
There is a paradigm shift occurring in medicine, from models focused on treating acute illnesses to those concerned with managing chronic conditions. This shift coincides with the higher prevalence of chronic illnesses resulting from factors such as lower mortality from formerly fatal illnesses and an aging population. The chronically ill do not fare well in an acute care model, and as a result, it has become imperative to develop new models effective for these chronic conditions. These new care models will require comprehensive, coordinated case management, an activity in which social workers can play a significant role.