Clinical and Direct Practice

Clinical social work is a derivative profession, drawing its knowledge and practice base from several theoretical schools. The four primary theoretical schools contributing to social-work philosophy are psychodynamic, humanist, cognitive–behavioral, and postmodern. Acceptance and commitment therapy (ACT), although considered one of the third-wave behavioral approaches, draws from all four theoretical schools of clinical intervention. This entry gives an overview of ACT development, its essential features, empirical base, tenets and techniques, and relevance to the social-work profession.

This chapter summarizes literature and research related to advances in direct practice work with adolescents. Social workers are on the forefront of developing and utilizing a variety of evidence-based practices to address complex client and community needs.

Adult Protective Services (APS) are empowered by states and local communities to respond to reports and cases of vulnerable adult abuse, neglect, and self-neglect. While incorporating legal, medical, and mental health services, APS programs are part of the social services delivery system and incorporate principles and practices of the social work profession.

African Americans number about 35 million or 12% of the U.S. population. Their life expectancy is lower than that of White Americans, and despite the educational gains made since mid-1980s, the unemployment gap between African Americans and Whites has increased. Similarly, although the number of African Americans working in white-collar occupations has increased, the disparity in wage earnings between African American and White workers continues. Regardless of social class African Americans are made to be cognizant of their race at all times. Today they are still at risk for social issues such as substance abuse, teen pregnancy, incarceration, poverty, high rates of female headed households, infant mortality that is twice as high as Whites, residential segregation, racism, and discrimination. As daunting as these problems are, the strengths of the African American community have allowed it to thrive even amid arduous circumstances.

Social workers address older adult issues at all levels of service planning, policy-making, and delivery and across a wide range of community and institutional settings. While various models of practice intervention with older adults exist, more recently the focus is on the integration of micro and macro strategies with an emphasis on strength-based perspectives to geriatric social work practice. The older adult population will expand dramatically and become increasingly culturally, racially, and ethnically diverse in the future and social work services will need to be sensitive to the variety of issues faced by a more heterogeneous and sophisticated older adult population.

Despite high levels of functioning among older adults, chronic health conditions lead to impairment and the need for help. Family members provide most of the assistance; yet formal services such as in-home personal and homemaker services, congregate and home-delivered meals, adult day services, employment and educational services, transportation, nursing homes, assisted and supportive living facilities, legal and financial services, and case management are available. Even with the growing number and type of services, unequal access and uneven quality persist. In these settings, social workers develop and administer programs, provide clinical care, offer case management and discharge planning, and contribute to policy development.

Alaska Natives represent less than 1% of the U.S. population but reside in more than 229 Native villages and account for 40% of federally recognized tribes. Most Alaska Native communities shared common Euro-American contact experiences: exposure to western religions, education, and disease. Historical trauma contributes to many of the social welfare problems Natives experience today: low educational attainment, unemployment, inadequate health care, substance abuse, and violence. Service delivery mechanisms, lack of cultural appropriateness, and isolation compound these pressing issues. Locally delivered social welfare services that take into account traditional Native worldviews, values, languages, and intergenerational relationships are effective in addressing many of these issues.

This entry focuses on practice interventions for working with families and individuals including behavioral marital therapy, transitional family therapy, and the developmental model of recovery, as well as motivational interviewing, cognitive-behavioral therapy, relapse prevention training, and harm reduction therapy. A commonality in these intervention frameworks is their view of the therapeutic work in stages—from active drinking and drug use, to deciding on change, to movement toward change and recovery. We also identify skills that equip social work practitioners to make a special contribution to alcohol and other drug (AOD) interventions and highlight factors to consider in choosing interventions.

There are a range of practice interventions for clients with AOD problems based on well-controlled research.

This entry describes the diversity among Asian American populations, setting the context to understand the need for different practice interventions. It explains the role of cultural values in the underpinnings of the selection of theoretical frameworks that guide chosen practice interventions. Indigenous and biculturalizations of interventions (Fong, Boyd, & Browne, 1997) are discussed as they relate to general and specific problems relevant to this population. Challenges and dilemmas are raised as ethical decisions are made among practitioners, who serve the Asian American native born, immigrant, and refugee populations.