10.6 Social Worker
Karen Piette, MHS, CMA
A rewarding career that focuses on helping individuals, families and communities with their well-being is social work. Social work utilizes various disciplines such as sociology, psychology, healthcare, community development and policy to conduct assessments, develop interventions and improve social functioning within the community. The focus on well-being may include improving and empowering the lives of individuals and communities as well as advocating for social justice.
Social work is a practice-based profession. Social workers focus on three levels of social work: 1) micro-work, 2) mezzo-work and 3) macro-work. At the micro level, social workers work directly with individuals and families. This work may include housing, social services to treat various disorders (mental, emotional, behavioral) and healthcare access. The next level, mezzo, occurs when social workers target organizations (neighborhoods, nonprofits, schools/colleges and other small communities) to incorporate change for a larger population. The last level targeted by social workers is the macro level. The macro level involves the implementation of systemic change. This may occur with the implementation of laws, government petitions, and the changes to social policy. Each of these three levels are interrelated and wide-reaching. A social worker needs to have a comprehensive understanding of all three levels to perform their jobs to the best of their ability.
Specific to allied health, social workers may work in hospitals and medical centers. These qualified social workers may work in settings such as pediatrics, oncology, nephrology and transplant specializations. They may also be employed in hospital administrator roles or serve as managers for allied health programming, mental and behavioral health settings, and/or community outreach.
Skill Stitch: Motivational Interviewing
A common evidence-based approach to behavior change is Motivational Interviewing. motivational interviewing is a style of communication focused on respectful guidance and empowerment. The healthcare professional must have good listening skills and refrain from giving unsolicited advice. The professional engages the patient, or client, as an equal partner. This collaborative practice focuses on partnership, acceptance, compassion and evocation (providing resources for change).
Motivational interviewing encompasses evidence-based approaches across extensive settings (health, human services, education), populations (age, ethnicity, gender identities), and languages. Patients or clients may present in the behavioral health clinic, physician’s office or hospital with concerns of medication adherence, substance use, illegal behaviors, gambling, parenting, risky sex behavior, and mental health conditions.
Motivational interviewing core skills utilized by healthcare professionals include using open ended questions to delve into the individual’s experiences, perspectives and ideas. Providing affirmations of strengths to build the individuals confidence, expressing empathy, shared understanding are core skills as well.
Ultimately, motivational interviewing is a client-centered counseling style utilized by social workers (and SUDP’s) for eliciting behavior change. By helping clients explore their thoughts, behaviors towards a behavior, the goal result is to reduce contradiction.
Hospital social workers have various job functions including assisting patients and families with hospital admission, psychosocial assessment of patients, educating hospital employees on a specific patient’s psychosocial challenges, promoting communication among the healthcare team, and employing crisis intervention. TheWashington State Department of Social and Health Services defines a crisis as a disruption or breakdown in a person’s or family’s normal or usual pattern of functioning. There are three basic elements of a crisis:
- A stressful situation
- Coping difficulties
- Timing of intervention
It is important to know that every crisis is different and social workers aim to take a flexible approach to assisting the individual or family.
Included in hospital social work are conditions associated with behavioral health such as substance use disorder and mental health. In 2017, one in five adults were found to have a significant mental health or substance use disorder in the United States according to the 2017 National Survey on Drug Use and Health published by the substance abuse and mental health services administration (SAMHSA). Social workers play an integral role in treating patients with illicit drug use, alcoholism, depression, suicidal thoughts/behaviors and mental illnesses such as major depressive disorder, schizophrenia and bipolar disorder.
Comorbidities are common in behavioral health settings. A comorbidity is defined as the co-occurrence or presence of more than one disorder in one person at the same time or one after the other. According to the National Institute on Drug Abuse, 7.7 million adults have co-occurring mental health and substance use disorders in the United States Comorbidities are challenging for healthcare providers because it is difficult to know which disease/condition came first.
Disease Dissection: Mental and Behavioral Health
Previously, we discussed the concept of comorbidities and the fact that substance use disorder and mental health conditions are common together. Social Workers along with SUDP’s both treat individuals with substance use disorder. When a mental health condition, such as major depressive disorder, bipolar disorder or schizophrenia are also present the patient may seek treatment at a behavioral health clinic. It is important to note that major depressive disorder, bipolar disorder and schizophrenia are not the only three diseases that could be present in the behavioral health setting. There are many others that have devastating effects on the lives of individuals and families.
The American Medical Association refers to behavioral health as mental health and substance use disorders, life stressors, crises, and stress-related physical symptoms. Behavioral healthcare refers to the prevention, diagnosis and treatment of these conditions. In behavioral health settings, you may encounter counselors, SUDP’s, social workers and medical physicians. There has been a movement in which medical entities are trying to incorporate behavioral health in primary care settings. Behavioral Health Integration (BHI) is defined as the integration of mental and physical healthcare services to promote accessibility and equitable treatment of a patient’s mental and physical well-being.
Behavior change is often the goal in behavioral health settings. Assisting patients/clients in changing unhealthy behaviors, medication adherence, improving hygiene, finding employment, and references to affordable housing are commonplace. Health professionals in behavioral health settings often focus on behavior change of unhealthy behaviors and habits.
Unfortunately, there are numerous barriers to these individuals getting appropriate treatment. Common barriers include lack of behavioral health practitioners, excessive cost, fear of being committed, and lack of knowledge as to where to get treatment. Social workers attempt to assist in diminishing these barriers. Next, let’s take a look at an evidence-based approach commonly seen within behavioral health settings.
Social Work Requirements and Qualifications
The requirements for Social Workers vary from state to state. Most states require a minimum of a Bachelor’s degree as well as supervised work experience following graduation. Work experience includes valuable hands-on experience to develop skills needed to practice in the community. Social workers will work under someone else’s license while acquiring the required work experience hours. While some states require a minimum of a Bachelor’s degree, some states require a Masters or Doctorate degree in Social Work to practice clinically.
The Association of Social Work Boards (ASWB) offers two examinations in social work. The first is an exam for associate, bachelors or Masters degree holders. The second is the Advanced Generalist or Clinical exam which is required by most states for clinical social work.
Washington state offers two social worker licenses – the Advanced Social Worker and the Independent Clinical Social Worker. Advanced Social Workers typically work in a healthcare setting as part of a care team providing social work treatment. Independent clinical social workers are able to practice independently and provide psychotherapeutic treatment.
A licensed Advanced Social Worker must take the Advanced Generalist Clinical Exam and requires 3,200 hours of supervised experience. The licensed Independent Clinical Social Worker must take and pass a clinical exam and needs 4,000 hours of supervised experience.
There is also the Social Worker Associate who is a pre-licensure candidate with a graduate degree in a mental health field. A social worker associate is a license gaining the professional experience necessary to become a licensed independent clinical social worker, licensed advanced social worker, licensed mental health counselor, or licensed marriage and family therapist. The Social Worker Associate does not require an exam or supervised experience.
In order to work as a Social worker in Washington state, a minimum of a Master’s degree is required and many Social Workers have Doctorate degrees as well. Some individuals earn a Bachelor’s degree in Social Work prior to attaining a graduate degree.
Attributions
- Figure 10.3: Mental Health Portrait.jpg by Rigos101 is released under Creative Commons Attribution-Share Akile 4.0
A style of communication focused on respectful guidance and empowerment to produce behavior change.
Immediate emergency response to emotional, mental, behavioral, and/or physical distress.
Abbreviated as SAMHSA. agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation.
A disorder that consists of symptoms of depressed mood or loss of interest for at least 2 weeks, that interfere with daily activities.
A serious mental illness that affects how a person feels, thinks, and behaves. People with schizophrenia may seem like they have lost touch with reality.
A manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration.
