10.6 Social Worker
Karen Piette, MHS, CMA
A rewarding career that focuses on improving the well-being of individuals, families, and communities, social work utilizes various disciplines, including sociology, psychology, healthcare, community development, and policy. Social workers conduct assessments, develop interventions, and work to improve social functioning within communities. Their focus on well-being often includes empowering individuals and advocating for social justice.
Social work is a practice-based profession, with social workers working on the following three levels:
- Micro-level: Social workers at this level work directly with individuals and families, addressing issues such as housing, mental health disorders, behavioral health, and access to healthcare and social services.
- Mezzo-level: At this level, social workers target organizations, such as neighborhoods, nonprofits, schools, and other small communities. The goal is to bring about positive changes that benefit a larger group of people.
- Macro-level: Social workers at the macro level implement systemic changes, including influencing laws, advocating for government petitions, and changing social policies to benefit communities on a larger scale.
These three levels are interrelated and wide-reaching. Social workers need a comprehensive understanding of all three to perform their jobs effectively.
Social workers may work in medical settings such as hospitals and medical centers, where they can specialize in pediatrics, oncology, nephrology, or transplant care. They may also serve in roles such as hospital administrators, managers of allied health programs, or leaders in mental and behavioral health services and community outreach programs.
Skill Stitch: Motivational Interviewing
A common evidence-based approach to behavior change is motivational interviewing. Motivational interviewing is a communication style that emphasizes respectful guidance and empowerment. The healthcare professional must have strong listening skills and refrain from offering unsolicited advice. Instead, they engage the patient or client as an equal partner in the process. This collaborative approach prioritizes partnership, acceptance, compassion, and evocation (providing resources for change).
Motivational interviewing is applied across various settings—healthcare, human services, and education—and with diverse populations, including different age groups, ethnicities, and gender identities. It is commonly used with patients or clients in behavioral health clinics, physician’s offices, and hospitals, addressing issues such as medication adherence, substance use, illegal behaviors, gambling, parenting, risky sexual behavior, and mental health conditions.
Key skills of healthcare professionals during motivational interviewing include:
- Using open ended questions to explore the individual’s experiences, perspectives and ideas
- Providing affirmations of strengths to build the individual’s confidence
- Expressing empathy
Ultimately, motivational interviewing is a client-centered counseling style, often used by social workers and SUDPs, to facilitate behavior change. By helping clients explore their thoughts and behaviors regarding a specific issue, the goal is to reduce internal contradictions and encourage positive change.
Hospital social workers perform a range of crucial functions, including assisting patients and their families during hospital admissions, conducting psychosocial assessments, educating hospital staff about specific patients’ psychosocial needs, facilitating communication among healthcare teams, and employing crisis intervention. According to the Washington State Department of Social and Health Services (n.d.), a crisis is defined as a disruption or breakdown in a person’s or family’s usual pattern of functioning. The three basic elements of a crisis are:
- A stressful situation
- Coping difficulties
- The timing of intervention
It is important to understand that every crisis is unique, and social workers take a flexible, individualized approach to helping the person or family navigate the situation.
Hospital social work often includes addressing conditions related to behavioral health, such as substance use disorders and mental health issues. According to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2018), one in five adults in the United States experienced a significant mental health or substance use disorder in 2017. Social workers play an integral role in treating patients dealing with illicit drug use, alcoholism, depression, suicidal thoughts/behaviors, and mental illnesses such as major depressive disorder, schizophrenia, and bipolar disorder.
Comorbidities—defined as the presence of two or more disorders in the same person, either simultaneously or sequentially—are common in behavioral health settings. According to Han, B., et al. (2017), 7.7 million adults in the U.S. have both mental health and substance use disorders. Comorbidities pose challenges for healthcare providers, as it is often difficult to determine which disorder originated first.
Disease Dissection: Mental and Behavioral Health
As discussed above, comorbidities in behavioral health are common. Social workers, along with SUDPs, play a critical role in treating individuals with substance use disorder. When mental health conditions such as major depressive disorder, bipolar disorder, or schizophrenia are present alongside substance use disorder, patients may seek treatment at a behavioral health clinic. However, it is important to note that these three disorders are not the only mental health conditions commonly seen in behavioral health settings.
The American Medical Association (AMA, 2022) defines behavioral health as encompassing mental health and substance use disorders, life stressors, crises, and stress-related physical symptoms. Behavioral healthcare involves the prevention, diagnosis, and treatment of these conditions. In behavioral health settings, patients often interact with a range of professionals, including counselors, SUDPs, social workers, and medical physicians.
In recent years, there has been a growing movement to incorporate behavioral health services into primary care settings. This initiative, known as behavioral health integration (BHI), involves 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 a primary goal in behavioral health settings. Professionals in these environments assist patients or clients in altering unhealthy behaviors, such as improving medication adherence, enhancing hygiene, finding stable employment, and accessing affordable housing. In many cases, healthcare professionals in behavioral health focus on modifying detrimental behaviors and habits to improve overall well-being and functioning.
Unfortunately, several barriers often hinder individuals from receiving the appropriate treatment. These barriers can include a shortage of behavioral health practitioners, high treatment costs, fear of involuntary commitment, and lack of awareness about where to access care. Social workers assist in reducing these barriers.
Social Worker Requirements and Qualifications
The requirements for social workers vary from state to state, but most states require a minimum of a bachelor’s degree as well as supervised work experience following graduation. The work experience allows new social workers to develop essential skills under the supervision of a licensed professional. During this period, they typically practice under someone else’s license until they gain the experience needed to practice independently. Some states require a master’s degree or doctorate 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, bachelor’s, or master’s degree holders. The second is the Advanced Generalist or Clinical exam, which is required by most states for clinical social work.
Washington State offers the following two social worker licenses:
- Licensed Advanced Social Worker (LASW): These professionals typically work in healthcare or other settings as part of a treatment team, providing social work services. An LASW is required to pass the Advanced Generalist Clinical Exam and complete 3,200 hours of supervised experience.
- Licensed Independent Clinical Social Worker (LICSW): This license allows individuals to practice independently, providing psychotherapeutic services. An LICSW must pass the clinical exam and complete 4,000 hours of supervised clinical experience.
Social worker associates are individuals who hold a graduate degree in a mental health field but have not yet obtained the required hours of supervised experience to achieve full licensure. They work toward becoming a licensed independent clinical social worker (LICSW), advanced social worker (LASW), or other related licensed professionals. Social worker associates do not require an exam or supervised experience.
For those wishing to work as a social worker in Washington State, a master’s degree is the minimum educational requirement, though many social workers pursue doctorate degrees to expand their qualifications and career options. Some individuals may first earn a bachelor’s degree in social work (BSW) before progressing to a graduate-level degree in the field.
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.
