Self-care techniques for social workers: Achieving an ethical harmony between work and well-being

ABSTRACT

The prevalence of burnout in the field of social work is a significant challenge to staff retention. This paper addresses the necessity of self-care in the prevention and treatment of burnout amongst social workers. Self-care is important for social workers who wish to maintain healthy, balanced lives. It is also argued that social workers who do not practice self-care are not able to provide the best possible services to their clients. For these reasons, self-care is necessary both from an ethical and personal standpoint. Specific steps for developing an individualized self-care plan are presented. This begins with the creation of a self-inventoryutilizes the Holmes-Rahe Life Stress Inventory. This is followed by a sample of self-care techniques that social workers can use. The techniques are not meant to be an exhaustive list of all self-care practices, but rather a sample of practices from various areas of social worker’s lives to demonstrate the expansive and diverse nature of self-care.     

Integrating self-care into clinical practice with trauma clients

ABSTRACT

Self-care is recognized as an important aspect of social work practice. Beginning in educational settings, developing social workers are encouraged to learn about and practice self-care. However, self-care is typically promoted through strategies and approaches outside of the practice context. Social workers are oftentimes encouraged to use individualized self-care plans, which often feature a variety of relaxation and secondary techniques; focus on self-awareness and self-reflection; and have proper use of supervision. Although these strategies are invaluable, they do little to directly benefit the social worker during direct practice or while in session with a client which is a time period when clinicians are particularly vulnerable to distress or burnout. The importance of real-time self-care strategies is particularly critical for clinicians, especially those who engage in trauma work, given the sensitivity of topics that clients may have endured or benefit from assistance in processing. Further, little information has been published on the use of self-care techniques during a session with a client or in a clinical context. The purpose of the present paper is to discuss self-care strategies that can be useful both outside of and within a clinical setting and present a model of such strategies that focus on integrating self-care in clinical practice particularly for those engaging in trauma work. The paper will conclude by discussing the relevancy of the developed model in practice.     

Rethinking professional quality of life for social workers: Inclusion of ecological self-care barriers

ABSTRACT

This study conducted a survey among social workers in a mid-Atlantic state in the U.S. and examined the relationship between self-care behaviors, self-care barriers and compassion satisfaction, burnout, and secondary traumatic stress (STS) from an ecological perspective. The study found that social workers had a moderate level of compassion satisfaction, low risk of burnout, and low risk of STS. Bachelor-degree social workers had higher levels of burnout and lower levels of compassion satisfaction than others. Multiple regression results showed that self-care behaviors and self-care barriers did not predict compassion satisfaction. Self-care behaviors and self-care barriers were significantly associated with the level of burnout. Self-care barriers significantly contributed to STS, while self-care behaviors did not significantly decrease STS. This study implies that promoting self-care behaviors and decreasing self-care barriers can promote higher levels of professional quality of life. In addition to social workers’ individual-level self-care activities that are often stressed in prior research on STS and burnout, employers, supervisors, family members, and community members play a critical role in promoting a manageable work-life balance for social workers, thereby allowing them to use more self-care behaviors, while reducing barriers to self-care and ultimately reducing risk of burnout and STS.     

Global and everyday matters of consumption: on the productive assemblage of pharmaceuticals and obesity

This article analyzes changing formations of global and everyday culture—particularly those associated with health, medicine, and consumption—through a concrete investigation of the development and use of anti-obesity medications. The first half of the article elucidates some of the new local-global connections being forged between fat bodies and global orders by situating the production and circulation of a new class of such medications within a sociotechnical assemblage that includes, among other elements, scientific research, transnational corporations, overweight individuals and populations, and the internet. The second half of the article explores the forms of local and everyday pharmaceutical practice associated with these medications. Drawing upon in-depth interviews with medication users, I demonstrate that while biomedical models focus on the physiological and psychological effects of drug interventions, the significance of the medications in practices of everyday life is largely socio-spatial. I suggest that these medication provide a means of protecting individuals from a hostile modern environment—the obesogenic landscape of hyperconsumption—and argue that the practices associated with the use of obesity medications can be understood as part of the work of accommodating and reproducing contemporary consumer and capitalist culture.     

Social Work Student Self-Care and Academic Stress

The purpose of the present study was to investigate the relationship between self-care and academic stress in the hope that training social work students to practice self-care will start them on the right path to academic success and career longevity. The study surveyed 90 BASW and MSW students using the Academic Stress Scale. Students who practiced daily self-care had lower academic stress. In addition, with each year of progression through the program, students experienced minimally less academic stress. The type of self-care practiced was not a factor. Social work programs can be encouraged to teach self-care. Self-care theory and domains are also reviewed. More studies are needed to examine other factors that might reduce academic stress.     

Six domains of self-care: Attending to the whole person

ABSTRACT

Self-care has long been of concern to helping professionals at risk for burnout or vicarious traumatization. In this paper we argue that the need for self-care is broader than preventing these outcomes. Instead, it requires consideration of the whole person and mindful attention and intentional efforts to achieve two general aims: to guard against or manage stress and other negative states, and to maintain or enhance well-being and overall functioning. We propose and delineate six life domains—physical, professional, relational, emotional, psychological, and spiritual—that may require attention in each person’s self-care practice, and briefly summarize some empirical findings that support self-care practices within each. We observe that self-care practice in each domain is closely bound to practice and outcomes of other domains. Steps in developing an overall self-care plan, including both maintenance and emergency practices, are also outlined. Because we believe that self-care is not a one-size-fits-all pursuit, we contend that helping professionals would benefit from examining each area of their life, and defining for themselves what self-care means and how they plan to implement their own personal practice. Above all, self-care requires a commitment to one’s own well-being as a priority.     

Medicaid physician fees and the quality of medical care of Medicaid patients in the USA

When enacted in 1965, the original Medicaid legislation sought to finance access to mainstream medical care for the poor. I use data on visits to office-based physicians from the National Ambulatory Medical Care Survey in four years—1989, 1993, 1998 and 2003—to test the extent to which this goal has been achieved. Specifically, I test whether this goal has been achieved more in states that pay higher fees to physicians who treat Medicaid patients compared to states that pay lower fees. By comparing the treatment of Medicaid patients to that of privately-insured patients and by using state fixed effects, I am able to estimate the effects of changes in the generosity of Medicaid physician payment within a state on changes in access to care for Medicaid patients, therefore separating Medicaid’s effect on access to health care from any correlation between the Medicaid fee and other attributes of the state in which a patient lives. Using this method, I examine the effect of Medicaid fees on whether or not an office-based physician accepts Medicaid patients, on the fraction of a physician’s practice that is accounted for by Medicaid, and on the length of visit times with physicians. Results imply that higher Medicaid fees increase the number of private physicians, especially in medical and surgical specialties, who see Medicaid patients. Higher fees also lead to visit times with physicians that are more comparable to visit times with private pay patients.

Behavioral consequences of consumer dissatisfaction with medical care

The effects of consumer dissatisfaction with doctors and medical care services on intentions to seek care and subsequent behavior were estimated using data from four general population studies. Satisfaction was linked to reported intentions regarding care-seeking behavior (choices between self-care and seeking care from a regular doctor or emergency room) in response to both minor and serious medical problems. These results were replicated in two populations with diverse sociodemographic characteristics. Satisfaction scales also predicted subsequent changes in medical care providers and disenrollments from prepaid health plans independent field tests. These results suggest that the behavioral consequences of individual differences in satisfaction with doctors and health care services are noteworthy from both clinical and social perspectives.     

The Fatigue of Compassionate Social Workers: An Introduction to the Special Issue on Compassion Fatigue

The paper introduces the special issue by first discussing its purpose for the reader and the field of social work. Each article, in the order it appears, is discussed in terms of its contribution to the special issue and the field and linking conceptually each with others in the collection. These articles discuss the special challenges of social workers working with clients who live with the traumatic effects of disasters—both natural and human-caused or human-contributed, war combat, HIV/AIDS, and substance abuse. It is noted that far more research, education, and practice innovation should be devoted to compassion fatigue. The article ends with a final plea not only for such attention but also standards of self-care in addition to standards of professional practice.     

Grandmas' hands rocked the cradle

A considerable number of women find themselves serving as surrogate parents for their grandchildren. This issue is particularly salient for African-American women. This article highlights the experiences of African-American grandmothers who are rearing their grandchildren in a rural southern community. Data collection included in-depth interviewing, observation, and document review. Findings from the study underscore the need for policy makers and practitioners to understand the structural and cultural context in which grandparent caregiving occurs. Grandmothers serving as surrogate parents should have access to a comprehensive array of services some of which include financial, psychological, medical, and legal services. In addition to these services grandparent caregivers should be empowered to engage in activities which encourage support and self-care. Study findings generate ideas that will be of interest to those responsible for practice and policy decisions.     

Interaction Ritual Chains and the Mobilization of Conscientious Consumers

Markets for “socially responsible” products are comprised of activists who lead protests, organize boycotts, and promote the consumption of these goods. However, the ultimate success of these movements is dependent upon the support of a large number of consumers whose self-professed values often contradict with their own purchasing patterns. Consumer support of socially responsible products cannot be explained by consumer culture theories, which privilege identity, attitudes, and behavior, or mass consumption theories, which emphasize location and advertising’s influence on consumption patterns. These perspectives are informative but unable to explain why some consumers will only buy socially responsible products while others with similar value systems possess much more contradictory consumption patterns. I extend Collin’s theory of “Interaction Ritual chains” to show that rituals and emotions—more than identity or coercive advertising—explain how ethical consumers are mobilized. I show how face-to-face interactions between consumers and producers produce solidarity and motivate support for the Fair Trade movement. This paper employs a micro-sociological approach to contribute to studies of ethical consumption in three notable ways: 1) it emphasizes the importance of “contexts” and is able to explain contradictions in consumer behavior; 2), it contributes to our understanding of “brand communities” by describing the micro-sociological processes that both help to build these communities and create value within the products that organize these groups; and 3) it offers the potential to develop a predictive model for the purchasing patterns of consumers.     

Foundations in periods of political and economic uncertainty: The Latin American link and the Argentine case

Foundations — or proto-foundations — that had their roots in the western world in the Greek and Roman civilisations later found their way into ancient Spanish law. The early historical inheritance was transferred by Spain and Portugal to Latin America. Those first foundations were dedicated to a few activities in the areas of health, education and community services. In this article I briefly follow the transition from the traditional foundations to the contemporary one with their wider scope of activities. There is an attempt to follow the correspondence that may exist for the Argentine case between these foundations and extant theories that attempt to explain their role in a wider societal and economic context to conclude that the evidence is still limited for the various failure approaches discussed in the literature. Alternatively, we suggest that the retrenchment of the welfare state should be considered one of the factors that lead to the increase in the number of foundations and the diversification of their activities. The analysis incorporates the issue of discontinuities and crisis, and the strategies followed by different types of foundations under authoritarian rule and periods of high inflation. Surprisingly, during those periods the foundations continued to increase in numbers. I suggest that an adequate explanation for the dynamics of those foundations requires a socio-political approach complemented with the analysis of some economic factors.     

At the Eve of Convergence? Transformations of Social Service Provision in Denmark, Germany, and the United States

Increasing societal heterogeneity, changing demographics, and increasing public debt and fiscal constraints have recently challenged traditional “regime” approaches to welfare state development. Some scholars argue, against this background, that welfare states might plausibly move out of their “regime container” by opting in favor of similar solutions and responses. This potential trend toward “convergence” might, furthermore, be facilitated by the widespread use of new public management ideas and techniques for “reinventing government” by adopting market solutions to public problems. This article investigates whether such trends of convergence can be identified by comparing three different countries each traditionally looked upon as belonging to different welfare state regimes: Denmark, Germany, and the United States. More specifically the article looks at one important segment of welfare state activity, namely social services and related health care. To further focus the analysis, special attention is devoted to the changing role played by the third sector in delivering services. The research design, thus, differs from most comparative welfare state research. Instead of analyzing a broad set of quantitative indicators in a large number of countries, it is scrutinized how some of the same problem pressures and policy ideas are being interpreted and implemented in a small number of countries within one policy area. The analysis reveals that trends of convergence—conceptualized along four dimensions: ideas, regulation, mix of providers, and revenue mix—can be identified across the three cases, though this does not mean that the market share of nonprofit providers becomes the same. The study also reveals that fundamental aspects of state–nonprofit relations persist despite trends of convergence.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Practice Wisdom on Custodial Parenting with Mental Illness: A Strengths View

ABSTRACT

Social work principles of strengths, empowerment, and consumer-centered care for persons with mental illness are currently being adapted to broader contexts. This article presents study findings on practice wisdom about custodial parents with mental illness, a potentially increasing group of consumers in light of mental health reform. The research team organized thirty-six professionals with practice experience into five focus groups. Findings reflect strengths perspective categories of resilience, social support, family functioning, self-care, and parents' positive experience of their symptoms. Implications discuss how providers who work with custodial parents and their children can apply these findings in assessments and interventions.     

Being a service user and a social work academic: balancing expert identities

Abstract

I am a service user and academic working in a university social work department. My hybrid identity allows me to draw on different types of knowledge in all aspects of my work, including: academic, practice and experiential wisdom. Service user involvement is mandated across social work education but the scope and breadth of different kinds of participation is developed in diverse ways across university contexts. This article affirms the value of service user involvement in health and social care education, exploring its positive impact on students. When lecturers share personal experience of using services alongside practice and academic wisdom in the course of teaching, sometimes the value of experiential knowledge is doubted and its influence dismissed. I examine the importance of experiential wisdom in social work education, specifically when it is embedded in an academic role in a university social work department, and consider how it can be respected and valued. The parallel experiences of involving peer support workers in mental health services, who use their knowledge of recovery to mentor other service users, are then briefly examined, together with reflection of the concerns across mental health with professionals sharing their experiential wisdom with the people that they support.     

Informal Care Intensity and Caregiver Drug Utilization

Providing informal care has negative health consequences for informal caregivers. If these health consequences increase drug utilization among caregivers, estimates of health care savings from informal care—mainly realized through reductions in utilization among care recipients—should consider the increased drug costs incurred by informal caregivers. This paper evaluates whether more intensive informal caregivers have higher drug utilization than less intensive caregivers, controlling for initial health status and other factors. We find that informal care intensity is associated with higher drug consumption. An increase of 10% of total informal care per day is associated with a 0.7% increase in drugs. The small magnitudes indicate that, in this application, it is not important to consider caregiver drug utilization when quantifying the net savings to the health care system of informal care. For individual caregivers, such as those who take multiple drugs per month and/or have no drug coverage, the increase in drug utilization associated with intensive caregiving is likely to be costly.     

WEB SITES

Abstract

It would be useful to better understand the personal determinants of successful interventions in the community, especially those interventions already recognized for their efficacy and efficiency, such as elder home care telesurveillance. This is a modality of health care services that transmits, via a call center on a 24/7 basis, the clinical information necessary to follow elders outside medical centers. Community health workers refer elders to this service. A qualitative research design was realized to understand why so much difference in the implementation of this service had arisen in two comparable sites previously judged receptive. The research objectives were as follows: (1) to document the personal determinants associated with telesurveillance adoption by community health workers, in two sites previously judged receptive; and (2) to point out the personal determinants that can explain successful adoption of telesurveillance. According to the Theory of Interpersonal Behavior, the results showed that habits (e.g., community health workers' knowledge of new information technologies) and perceived barriers in clinical practice were fundamental determinants in the adoption of telesurveillance.     

Black Adoption Placement and Research Center at 25: placing African-American children in permanent homes (1983-2008)

The Black Adoption Research and Placement Center is a nonprofit organization delivering culturally specific adoption and foster care services. The organization developed as a response to concerns in the African-American community about the high numbers of African-American children entering and not exiting the public foster care system. The organization has undergone significant transformations over its 25-year history in relation to social, political, and economic changes that have altered the ways that the agency finances and delivers services. The history of Black Adoption Research and Placement Center presents an organization that has weathered many challenges because of its strong leadership, its committed governing body, its external relationships, and its internal operations.