Direct Social Work Practice
Abstract and Keywords
Direct social work practice is the application of social work theory and/or methods to the resolution and prevention of psychosocial problems experienced by individuals, families, and groups. In this article, direct practice is discussed in the context of social work values, empowerment, diversity, and multiculturalism, as well as with attention to client strengths, spirituality, and risk and resilience influences. The challenges of practice evaluation are also considered.
Direct social work practice can be defined as the application of social work theory and/or methods to the resolution and prevention of psychosocial problems experienced by individuals, families, and groups (Walsh, 2013). These problems may include challenges, disabilities, or impairments, including mental, emotional, and behavioral disorders. The client populations for which direct practice is typically provided include children and their families, older adults, persons experiencing health or mental health problems, persons of all ages in school systems, persons who abuse substances, victims and perpetrators of violence and criminal behavior, and persons who have experienced crises, trauma, and disasters (Segal, Gerdes, & Steiner, 2015). Direct social work practice is grounded in the values of the social work profession and, as such, promotes social and economic justice by empowering clients who experience oppression or vulnerability to problem situations. It is based on an application of human development theories within a psychosocial context and is sensitive to issues of human diversity.
In direct practice, social workers help clients to enact psychological and interpersonal change, increase their access to social and economic resources, and maintain or enhance their capacities and strengths. Assessment always incorporates the impact of social and political systems on client functioning. Interventions may include therapeutic, supportive, educational, and advocacy activities. Such services may be provided in person, by phone, and increasingly, through cyber-communication technologies (Dombo, Kays, & Weller, 2014). There are many theories and models for direct social work practice, but over the years researchers have tried to identify effectiveness factors that may be common to all practice approaches (Borden, 2010). According to Cameron and Keenan (2010), decisions about intervention should be based on client characteristics, practitioner characteristics, the nature of the worker/client relationship, and social network factors related to both the social worker and client.
The Value Base of Social Work Practice
All professions espouse distinct value bases that define their purposes and guide the actions of their members. Values are principles concerning what is right and good, while ethics are principles concerning rules of conduct to which social workers should adhere in upholding their values (Dolgoff, Harrington, & Loewenberg, 2012). Professional values and ethics are the obligations of social workers in relationships with other persons encountered in the course of their work, including clients, other professionals, and the general public. Social workers routinely experience ethical dilemmas; for example, around issues of confidentiality and participating in mandated interventions.
The National Association of Social Workers’ (NASW, 2015) “Code of Ethics” is “intended to serve as a guide to the everyday professional conduct of social workers.” The primary mission of the social work profession, according to the Code, is “to enhance the human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of those who are vulnerable, oppressed, and living in poverty” (p. 1). The six core values of the profession relate to service, social justice, dignity and worth of the person, the importance of human relationships, integrity, and competence. The Code of Ethics further states that social workers should challenge social injustice and that they should “pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people” (p. 6). This can be done through change activities, particularly with vulnerable and oppressed individuals and groups, around such issues as poverty, unemployment, and discrimination. Social workers can help their clients develop the resources required for a fulfilling life. They should strive to ensure clients’ access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making. The major implication of the social worker’s obligation to uphold professional values with regard to direct practice is that the practitioner’s activities should promote the mission of the profession.
Several of the direct practice topics discussed below derive specifically from the social work profession’s value base.
In keeping with the profession’s values and mission, social work practitioners at all levels desire to enhance the capacity, or power, of clients to address their life concerns. Power can be understood as including a positive sense of self-worth and competence, the ability to influence the course of one’s life, the capacity to work with others to control aspects of public life, and an ability to access the mechanisms of public decision making (Lee, 2001). Many clients do not, or perceive that they do not, have power over themselves, their significant others, or the agencies and communities in which they reside. This sense of powerlessness underlies many problems in living and can lead to learned helplessness and alienation from one’s community. An empowerment practice orientation represents the social worker’s efforts to combat the alienation, isolation, and poverty of substantive content in clients’ lives. In every case of empowerment practice, the social worker helps clients become aware of the conflicts, within themselves and the environment, that oppress or limit them, and the social worker helps clients become better able to free themselves from those constraints.
The perspective of critical social work (Weiss-Gal, Levin, and Krumer-Nevo, 2014) emphasizes that social workers, certainly in public agencies, are often tasked with the job of maintaining an oppressive status quo; as such, they may not be aware of how their actions may serve to disempower clients. Social workers, with their holistic person-in-environment perspective, must look for connections between client’s presenting problems and the effects of an oppressive social environment. Further, there is an institutionalized power imbalance between social workers and their clients, and to minimize the negative effects of this imbalance, social workers must see clients as partners in addressing presenting problems. In a similar vein, the liberation perspective of Martinez and Fleck-Henderson (2014) asserts that client problems always develop in the context of social conditions and that interventions should always have both an individual and social focus. Clients should be helped to see themselves as potential actors in their problem situations, rather than objects of forces outside themselves.
Clients may be empowered at the personal (changing patterns of thinking, feeling, and behaving), interpersonal (managing relationships more effectively), or environmental (changing their manner of interacting with larger systems) levels (Gutierrez, Parsons, & Cox, 2003). Direct practitioners are generally more inclined to address a client’s personal and interpersonal concerns. Empowerment at the individual level is a process by which clients gain mastery and control over their lives and a critical understanding of their environment. Aspects of the empowerment process that social workers should assess in their clients include the client’s sense of self-efficacy, knowledge, competence, and ability and willingness to take action (Cattaneo & Chapman, 2010). The social worker’s specific actions toward empowerment ends are less important than the general orientation toward helping clients become more involved in their communities (however defined) and feeling more capable of exerting influence there.
The concept of empowerment has implications for intervention at all levels. From the person-in-environment perspective, even the most individual of problems, such as physical and mental illness, have intervention implications that may include helping the client create an environment conducive to recovery. For the process to be effective, direct practitioners must possess knowledge about how organizations function, and they must be administratively and inter-professionally empowered themselves in ways that give them the competence to act with clients.
Strengths-based practice implies that social workers should assess clients in light of their talents, competencies, possibilities, visions, values, and hopes (Saleebey, 2013). This perspective emphasizes human resilience, or the skills, abilities, knowledge, and insight that people accumulate over time as they struggle to meet life challenges. The major assumptions of strengths practice are that problems can be a source of opportunity, practitioners can never know the “upper levels” of clients’ growth potentials, there should be active collaboration between practitioners and clients, and every environment includes both formal and informal resources that can be mobilized to help clients change. By the time some clients seek help from a social worker, the problem may have preoccupied them to an extent that they have lost sight of their resources. The social worker identifies these strengths and openly conveys them to clients. The social worker must be alert to the strengths clients bring to other contexts, such as their work settings, hobbies, and pastimes.
When clients talk about the challenges and problems they face, their full range of thoughts and feelings must be validated, and only then should they be asked about resilient qualities they may possess. The social worker can, for example, inquire about the aspects of the client’s life that are still intact despite the problem and explore for resources that were drawn upon in these areas. One research review found that, when people are able to find and articulate their resources after a major stressor, they experience less depression and a greater sense of well being (Helgeson, Reynolds, & Tomich, 2006).
A Risk and Resilience Framework for Practice
The risk and resilience framework provides a basis for direct practitioners to identify and bolster client strengths and reduce their risk influences (Corcoran & Walsh, 2015). It considers the balance of risk and protective mechanisms that interact to determine a client’s ability to function adaptively despite stressful life events (Gest & Davidson, 2011). Risks can be understood as hazards in the individual or the environment that increase the likelihood of a problem occurring. The presence of a risk influence does not guarantee a negative outcome, but it increases the odds of one occurring. Resilience refers to the absence of significant developmental delays or serious learning and behavior problems, and the mastery of developmental tasks that are appropriate for one’s age and culture, in spite of exposure to adversity. Protective mechanisms involve the personal, familial, community, and institutional resources that cultivate individuals’ aptitudes and abilities while diminishing the possibility of problem behaviors (Fraser, 2004). Protective influences may buffer against risk and are sometimes the converse of risk. For example, poor physical health presents risks, while good health is protective.
Social work researchers have expanded risk and resilience into a biopsychosocial framework (Greene, 2014). Relevant influences are considered with regard to the client’s biological constitution, psychological status, and social environment. The processes within each level interact, prompting the occurrence of risks for various problems in functioning and propensities toward resilience. The nature of systems is such that the factors within and between them have transactional influences on one another, with early risk mechanisms setting the stage for greater vulnerability to subsequent risks. The biopsychosocial framework provides a theoretical basis for direct practitioners to conceptualize human behavior at several levels, and it can assist them in identifying and bolstering strengths as well as reducing risks. Individual factors encompass the biological and psychological realms, including genes, neurotransmitters, temperament, physical health, developmental stage, and intelligence. Psychological mechanisms include self-efficacy, self-esteem, self-regulation and emotion regulation, and coping strategies. Social factors include family characteristics and functioning, traumatic events and loss, neighborhood, church, school, social support networks, societal conditions (social, political, legal, and value patterns), poverty, race, and ethnicity.
The risk and resilience framework fits well with social work’s emphasis on empowerment and client strengths. The strength perspective underlies the concepts of protective influences and resilience, in that people are not only able to survive and endure but can triumph over difficult life circumstances.
Diversity and Multiculturalism
A hallmark of the social work profession is its commitment to working with diverse, underserved, and marginalized populations. Social globalism has brought increased attention to the international nature of professional practice. Direct practitioners are well aware that some traditional practice methods are not helpful for clients representing diverse populations and might in fact be damaging to them. Multiculturalism, or a social worker’s ability to understand and work from the perspective of a variety of cultures, represents an advance from the more generic “self-awareness” that has always been a feature of the profession (Hugman, 2013). The development of culturally competent perspectives is based on the principle that persons of different racial and ethnic groups, gender, age, immigrant status, geographic background, sexual orientation, and disability have their own ways of seeking and receiving assistance, and these should be respected. Further, members of some cultures experience barriers to treatment due to providers’ lack of awareness of cultural issues, bias, inability to speak the client’s language, and the client’s mistrust of the process. Two dimensions of competence, including cultural knowledge and cultural sensitivity, are involved in providing effective transcultural intervention (Lee, 2001). Cultural knowledge refers to the practitioner’s ability to acquire specific knowledge about his or her clients’ cultural background, experiences, values, spiritual beliefs, world-view, customs, communication patterns, thinking patterns, and coping practices. Cultural sensitivity refers to a social worker’s attitudes and values about cross-cultural direct practice, and his or her ability to effectively intervene with members of different cultures.
There is at present a shortage of research on treatment outcomes for clients of various ethnic groups, although this is changing through the efforts of some scholars and practitioners to culturally adapt what is known about evidence-based practice (Bernal & Rodriguez, 2012; Zayas, Drake, & Jonson-Reid, 2011). One model of cross-cultural competence describes a process by which direct practitioners can connect with clients from different backgrounds (Lee, 2011). This model considers cultural competence not as a practitioner trait that is applicable across a range of clients, but a process that arises between social workers and clients in each practice situation. It refers to a practitioner’s capacity to be attuned to each client’s unique lived experience and to create shared moments of curiosity and disclosure with the client. It assumes that there will be occasional ruptures between the parties due to misunderstandings, biases, or lack of knowledge, and encourages the social worker to openly acknowledge these situations and work with the client to repair them. Through this process, both parties increase their cultural sensitivities. The social worker can make practice judgments from an informed point of view, become more sensitive in the cross-cultural helping situation, connect empathically with clients, and maintain awareness of his or her own personal experiences that might distort judgment.
Spirituality in Direct Practice
With its holistic perspective on human functioning, direct practitioners should be attentive to their client’s spiritual values as well as their biological, psychological, and social functioning. The term spirituality has many definitions, but it can generally be understood as a person’s search for, and adherence to, meanings, purposes, and commitments that lie outside the self (Barker & Floersch, 2010). Religion is a narrower term that refers to an institutionalized pattern of values, beliefs, and symbols that include not just spirituality but also a community of adherents, traditions, and community support functions. Both spirituality and religion merit attention in practice situations because they pertain to a client’s search for a sense of meaning and well-being in relationship with the self, others, and ultimate reality (Sheridan, 2015). While client spirituality should always be a part of a comprehensive assessment (Coates & Schiff, 2011), it is not appropriate to address with clients in all practice situations; for example, with clients who are absorbed in immediate problems for which they are seeking practical assistance. On the other hand, spirituality may be appropriate for attention when the client is troubled by anxiety, guilt, and shame, or demonstrates inclinations to look beyond the self and the immediate situation in understanding and resolving personal dilemmas.
It is always possible that a person’s problems and needs contribute to, or result from, struggles with a broad life concern. Spiritual interventions can encourage the client’s investment in constructive life activity, encourage the client to look externally for solutions to problems (rather than be preoccupied with internal emotions), and encourage the client to care about something outside the self (Lantz & Walsh, 2007). Still, a recent literature review has shown that few ethical guidelines exist within the profession for spiritually based intervention (Oxhandler & Pargament, 2014). One issue of concern is the social worker’s ability to maintain a distinction between his or her role as a spiritually sensitive practitioner and a spiritual director. Certain practice principles may serve as guidelines for effective and ethical intervention with regard to a client’s spirituality, including considering client functioning within a broad context of meaning (bringing consistency to a client’s present and ultimate concerns), encouraging client disclosure of spiritual concerns when appropriate, helping clients identify meanings and purposes that can guide them in growth-enhancing decisions, being respectful of different spiritual paths, being willing to learn about their roles and meanings in the lives of clients, and developing a working knowledge of the beliefs and practices encountered in one’s work, especially those of newly arriving immigrants and refugees. As a part of spiritually sensitive practice, practitioners should be open to examining their own values, beliefs, and biases concerning spirituality and be willing to work through any unresolved or negative feelings that may adversely affect their work with clients.
The evaluation of one’s practice is of course an important component of the helping process. The methods by which social work interventions are tested for effectiveness have evolved during the past sixty years. During the 1950s and 1960s, nonspecific theories and strategies were applied to heterogeneous client populations and examined for evidence of impact. Case studies were common in the professional literature. Though informative, these studies were rarely based on structured research designs. Still, a literature review by Mullen and Shuluk (2010) concluded that, since the 1960s, approximately two thirds of clients served by social workers have benefitted in measurable ways. While this result is encouraging, it does not provide accounts of effectiveness based on different theories and interventions, common factors, or cost-effectiveness criteria. The more recent movement toward evidence-based practice (EBP) reflects social work’s increased emphasis on accountability to clients and third-party payers and its desire to further the knowledge base of the profession. EBP can be understood as the social worker’s integration of the best available research with his or her practice expertise and client values when preparing for intervention (Drisko, 2014). Practice expertise refers to the social worker’s accumulated skills in assessing each client’s unique presentation and the risks and benefits of potential interventions. Client values refer to the preferences and expectations that each client brings to the professional encounter (Thyer & Pignotti, 2011). EPB is thus a decision-making process that promotes client input and feedback.
Efforts to identify evidence-based practice models have been controversial for a number of reasons (Beutler, Forrester, Gallagher-Thompson, Thompson, & Tomlins, 2012). First, EPB is sometimes criticized for relying on a hierarchy of research designs that promote some research approaches while devaluing others that may also be informative. Second, it is often said that replicating controlled research conditions is not feasible in agency practice. Further, the personal characteristics of social workers, such as their experience with particular problem areas and overall competence in carrying out particular interventions, are often overlooked. Finally, many research methodologies have not examined relationship factors in direct practice, which are considered fundamental in many theories. Recently a series of meta-analyses has systematically evaluated the significance of the practitioner/client relationship and concluded that several relationship variables are demonstrably effective (Norcross & Wampold, 2011). Another review concluded that the quality of the worker/client relationship, in combination with the resources of the client, accounts for a majority of the variance in intervention outcomes (Miller, Duncan, & Hubble, 2005). Of course, while large-scale research on best practices continues, all social worker can evaluate their own practices through the use of single-subject research designs (Rubin & Babbie, 2013).
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