Teaching Note—Meeting the Demand for Behavioral Health Clinicians: Innovative Training Through the GLOBE Project

ABSTRACT

The national move toward integrated mental health and substance abuse service delivery has a significant impact on social work education and necessitates changes in how we train students. To address this need, the Global Leaders of Behavioral Health Education (GLOBE) training project was developed. GLOBE is a student training and stipend program that prepares students for clinical behavioral health practice in integrated care. This teaching note describes GLOBE, reports challenges encountered in its implementation, and provides strategies for overcoming them. The challenges include assigning students to grant-compliant field placements, engaging other health care professionals in the educational efforts, and implementing curriculum changes. Suggestions for social work program administrators interested in integrated care training are provided.     

Substance Abuse among African-American Children: A Developmental Framework for Identifying Intervention Strategies

Abstract

Substance abuse has devastating effects on the lives of African-American children and adolescents who are both directly and indirectly victims of this problem. This article discusses child and adolescent substance abuse from a psychosocial developmental perspective within an Africentric paradigm. The authors explore contributing and intervention factors related to substance abuse that impact developmental milestones. They delineate preventive tactics for addressing the problem of substance abuse and delineate implications for social work practice.     

A Family Perspective for Substance Abuse: Implications from the Literature

SUMMARY

This paper calls for researchers and treatment providers to increase their recognition of the role that family and family functioning has for understanding the incidence and impact of substance abuse. Substance abuse is identified as a family problem by exploring its occurrence within families as well as its impact on marital relationship, family violence, and child abuse and neglect. The impact of substance abuse on the roles of spouses and parents are examined, as is the impact of substance abuse on children at various developmental stages. The role of the family as participant in active substance abuse as well as a valuable treatment resource is also explored. Finally, the authors present recommendations for increasing the focus on family in substance abuse research.     

Agency Practices Affecting Social Workers Who Treat Substance-Abusing Clients

Abstract

This study interviewed 115 MSWs with substance abuse training working in general social service agencies to determine if they viewed their settings as facilitating or hindering their work with substance-abusing clients. This study builds on the work of Lightfoot and Orford (1986) who found that social workers were more hindered than helped by their agencies' practices regarding substance-abusing clients.

Results: A majority of workers viewed their agencies as facilitating substance abuse-related work through support from supervisors and administrators, availability of substance abuse training, workers' freedom to choose clients, and opportunities to supervise others on substance abuse-related issues. Supervisor data corroborated these findings. This is a hopeful sign for the profession contrasting with considerable social work literature documenting the profession's historic ambivalence toward substance-abusing clients.     

Exploring the Nature of the Relationship Between Poverty and Substance Abuse

Abstract

Poverty and substance abuse are two serious social problems that are often assumed to be interrelated. This article explores what is currently known about the relationship between these two problems. Four possible models for describing the interrelationship are identified: causal, risk factor, exacerbation, and spurious. The theoretical explanations from both the substance and poverty literature are discussed in light of their implications for these types of models. The public health perspective is selected from the substance abuse theoretical literature as the model that best subsumes and directs thinking about the relationship between poverty and substance abuse, because its focus on agent, host, and environment draws attention to the range of factors that can influence both problems, as well as the ways in which they come together. Findings from the research literature are then discussed within the framework of the public health model. The article concludes by outlining the gaps in knowledge and an agenda for future research.     

Is Domestic Abuse an Adult Social Work Issue?

Within a global profession with a stated definition that includes ‘promoting social change and development, social cohesion and the empowerment and liberation of people’ (online), it would be expected that the issue of domestic abuse would be integral to the training and role of all social workers. This article reports on research, which highlighted both a lack of understanding of the role of adult social worker within cases of domestic abuse and also a desire for further training around the issue. However, this article sets out how the current UK (in particular, English) context of social work marginalises the issue of domestic abuse within practice with adults. This marginalisation has been achieved through the construction of domestic abuse as a children and families issue and limited duties, powers and resources within statutory work to support victims/survivors in their own right, rather than as ‘failing’ parents. However, the article argues that the role of social work education should be wider than teaching to the current policy or procedures and instead encourage a wider appreciation of the social, historical and political context. The article concludes with tentative suggestions for how domestic abuse could be considered within the social work curriculum for adult practitioners. This is in acknowledgement that social workers can be well positioned for the detection, investigation and support of those experiencing abuse.     

Reporting Suspected Child Maltreatment: Educating Social Work Students in Decision Making and Maintaining the Relationship

ABSTRACT

As future mandated reporters, social work students face the dual challenge of rendering accurate reporting decisions while concurrently maintaining the therapeutic relationship in an effort to decrease future child abuse and neglect. To address the paucity of training in this regard, 42 bachelor of social work (n=18) and master of social work (n=24) students participated in a workshop focused on decision making and the therapeutic relationship in mandatory reporting of child abuse and neglect. Participants were given a case vignette and responded in writing to structured questions. Two patterns emerged from the qualitative analysis: factors that centered on the case and those that centered on the social worker. Implications for social work education are suggested.     

Policy-Practice in Social Work: Models and Issues

Abstract

The emergence of policy—practice is a recent development in social work. In this article, policy—practice is defined as a direct social work practice mode with the potential to strengthen the social work profession's abilities to meet its century-long commitments of providing policy-informed services to those in need of them. At the same time, policy—practice advocates for and participates in policy implementation and change. This article examines policy—practice and places it within the context of the profession's historic cause—function debate and identifies several barriers that have complicated development. Most important, the article reviews five policy-practice models found in the literature: (1) social worker as policy expert, (2) social worker as change agent in external work environments, (3) social worker as change agent in internal work environments, (4) social worker as policy conduit, and (5) social worker as policy itself.     

Health Staff Responses to Domestic and Family Violence: The Case for Training to Build Confidence and Skills

ABSTRACT

Domestic and family violence (DFV) is a serious, worldwide public health concern and the literature suggests that women who have experienced violence identify health care providers as the professionals they would most trust with disclosure of abuse. Social work is well positioned to respond to women presenting in hospitals after experiencing DFV and in advocating for systems and policy initiatives to support health staff in becoming adequately trained and supported to detect and respond appropriately. This paper reports on research that surveyed health staff in two hospitals in Queensland, Australia, to identify what DFV training they had received, whether this training increased their knowledge, skills and confidence to address DFV and what services they would access to support women presenting with DFV. The results showed that the respondents were an experienced staff group who had worked in the health sector for 10–20 years but despite having access to State-based training, the majority of them had not completed any in-house training and only 12% had received face-to-face training, and when they did undertake training, it was usually only a two-hour session. Seventy-five per cent of respondents would refer to their hospital-based social worker and 40% would make referrals to other support services, primarily social work.

IMPLICATIONS

• Hospitals need to prioritise, commit to, and resource appropriate and regular training to better equip health staff to identify and respond to DFV.

• Training needs to build the knowledge and skills of staff members to address their confidence to intervene and offer support.

• Social work can provide an important role in advocating and developing training and procedures to sustain health staff members’ capacity to respond appropriately to DFV.

     

Homelessness and Substance Abuse: Which Comes First?

Abstract

The present paper uses a social selection and social adaptation framework to investigate whether problematic substance use normally precedes or follows homelessness. Clarifying temporal order is important for policy and program design. The paper uses information from a large dataset (n=4,291) gathered at two services in Melbourne, supplemented by 65 indepth interviews. We found that 43% of the sample had substance abuse problems. Of these people, one-third had substance abuse problems before they became homeless and two-thirds developed these problems after they became homeless. We also found that young people were more at risk of developing substance abuse problems after becoming homeless than older people and that most people with substance abuse issues remain homeless for 12 months or longer. The paper concludes with three policy recommendations.     

Assessing Social Work's Contribution to Controlled Studies of Adolescent Substance Abuse Treatment

ABSTRACT

Findings from a review of social work's contribution to the adolescent substance abuse treatment outcome literature between 1990 and 2001 are presented. Social work involvement in adolescent substance abuse treatment was evaluated through a computerized bibliographic search of medical and social science databases and by a manual search of 13 core social work journals. Results indicate that social work has contributed little to knowledge development in adolescent chemical dependency treatment. Investigators affiliated with a department or school of social work accounted for three of 15 controlled treatment outcome studies. Only one report was published in a core social work journal. Efforts to develop clinical guidelines in this important practice domain will founder until a sufficiently directive body of practice-relevant research accumulates to guide evidence-based substance abuse treatment for adolescents.     

Substance Abuse,Homelessness, Developmental Decision-Making and Spirituality: A Women's Health Issue

ABSTRACT

A qualitative methodology was used to examine the relationship between homeless women's spirituality, substance abuse, moral reasoning and developmental decision-making. Findings indicated that a lack of development in spirituality and the ability to make decisions in childhood is related to homeless, addicted women's inability to maintain abstinence and achieve social independence. Spirituality impacted decisions to abstain from substance abuse and increased the women's social independence. Findings suggest that treatment needs to incorporate spirituality, family of origin, and the development of skills for independent decision-making. The authors propose that childhood maltreatment, homelessness and substance abuse impede spiritual development. Therefore, substance abuse treatment needs to include a focus on spirituality and moral reasoning in the recovery process.     

Comparing the effectiveness of behavioral interventions in adults with co-occurring tobacco and substance use disorders: a systematic review of literature

ABSTRACT

This systematic literature review compares the e?ectiveness of various behavioral interventions delivered to persons with co-occurring tobacco and substance use disorders. It examines ?ndings of six randomized trials and three secondary analyses from randomized trials. Based on the ?ndings of this literature review, support is given to the following: (1) The consequences of tobacco use and smoking are deadly, costly, and can have an inhibitory e?ect on the progress of people in substance abuse treatment, (2) tobacco cessation options are a preventive intervention that can be easily incorporated into a treatment facility’s standard of practice and should be made available within the context of all substance abuse treatment facilities, and (3) concurrently treating tobacco use disorder and substance use disorder(s) is an e?ort that will help meet the social work profession’s Grand Challenge to ‘Close the Health Gap.’     

The Powerlessness of Control: A Unifying Model for the Treatment of Male Battering and Substance Addiction

ABSTRACT

The high incidence of partner abuse among substance addicted men calls for a unified model of treatment. Grace Therapy is an approach for the treatment of male batterers based on the 12-Step Program of AA/NA. Clinical evidence relates the internal processes of male batterers and substance-addicted men to similar issues in which feelings of powerlessness arise. Powerlessness has three levels: behavioral, mental, and spiritual. By addressing the behavioral and mental levels, men can become abstinent by avoiding the situations, behaviors, and mental motives that lead them to violence and substance abuse. Recovery and healing occur within the spiritual level through a transformation of the men's attitudes towards the world and themselves–a transformation from self-centeredness to God-centeredness, which produces a growing capacity within the men to care for others unconditionally.     

Interdisciplinary Practice in Developmental Disabilities

ABSTRACT

This article explores the development of interdisciplinary team practice within the field of development disabilities. Various interdisciplinary models are described, and the role of the social worker is specifically reviewed. As social workers practice as members of teams in a variety of contexts, a greater understanding of an interdisciplinary approach is warranted.     

Social work and pastoral counseling: Empowering each other

ABSTRACT

This article addresses the divergent outcomes which can result from counseling services offered pastorally versus clinically. As faith leaders often have greater direct access than social workers to supporting religious populations, it is important to explore the intersection between religious pastoral support and clinical social work. Presenting six scenarios from the author’s own experiences as both a rabbi and social worker, this article processes each scenario first through the pastoral lens of an Orthodox rabbi, followed by the clinical lens of a social worker or other mental health professional. The client outcomes which are produced from each modality are radically different. This contrast demonstrates the distinction between the goals, values, and training of each profession, and highlights importance for future work to be done in linking religious and pastoral training to mental health services, as well as broadening the scope of cultural competence for social workers and therapists who may engage with tight-knit religious populations.     

Family Unity Meetings: Decision Making and Placement Outcomes

ABSTRACT

The sample consisted of all families (747) who were invited to receive a Family Unity Meeting from a Public Child Welfare Agency in a large urban county. Data was derived from the review of agency case files. The design was a retrospective case review with an embedded prospective study. This study describes factors that distinguish between CPS clients who accept an invitation to participate in a Family Unity Meeting (FUM) and those clients who decline to participate. The meeting process is described, and logistic regression is used to identify variables that predicted successful outcomes FUM meetings.

Families with reunification as a goal were the most likely cases to agree to participate followed by Voluntary and Permanency Planning cases. Cases with severe neglect were the least likely group to participate in a meeting process. Approximately nine people attended an average meeting. Maternal relatives were more likely to attend than paternal relatives.

Empirical evidence was found to support the notion that FUM expands the notion of family. Only 38% of children were placed with a parent after a meeting, but 82% of children were placed with a family member. Children were not placed with either the parent or family if the social worker had placement as a goal before the meeting. Cases with permanency plans were also less likely to be placed with the family. Social workers were more likely to agree with a placement with relatives if they had a concern about parental drug abuse. Having a maternal aunt in attendance at the meeting was predictive of having a child placed with the family.

Social workers and families stated concerns prior to the meeting diverged. Families were more concerned with economic and financial issues than were the social workers. Social workers were more concerned with child protective service issues (type of abuse, placement issues, etc.) and the behavior of the parent (substance abuse, mental health, etc.) than was the family. Paying attention to family issues such as finances may be a necessary precursor to families focusing on more complex matters like substance abuse or parenting practices.

Placement outcomes were consistent with worker's goals stated before the meeting. If a social worker said they wanted to place a child with the family before the meeting, that placement was most likely the outcome of the meeting. Social workers may be guiding the decisions of the family. If this interpretation is correct then it raises questions about who makes decisions at the meeting. An alternative conclusion is that the social workers are good diagnosticians who know prior to the meeting if placement is necessary, and know what decisions the family will make.     

The Transtheoretical Model

ABSTRACT

This article examined the application of the Transtheoretical model of behavioral change to the welfare to work transition with public housing residents. Both quantitative and qualitative data were gathered and analyzed to demonstrate that the welfare to work process may indeed be considered a change process. These findings have implications for social policy development and public worker training in both the public housing and publicwelfare systems.     

Responding to children’s ‘emotion talk’: a conversation analysis of a therapeutic encounter between a social worker and two siblings using child-centred play therapy

ABSTRACT

Reflection of feelings is a hallmark strategy of non-directive child-centred play therapy that enhances children’s emotional awareness and equips them with emotionally expressive words. The case presented here describes the application of child-centred play therapy by a social worker with two young children (aged four and six) with sibling rivalry issues. One of the sessions was videotaped, which enabled the use of conversation analysis to dissect the language patterns used by both the clients and the social worker. This in-depth verbal analysis illuminated subtle nuances in the children’s interactions and behaviour while also providing the social worker with the opportunity to reflect on practice. This case discussion presents a snapshot of that session and allows readers to understand how such therapy occurs.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.