Trauma Focused Cognitive Behavioral Therapy with Children of Incarcerated Parents

This paper explores children’s trauma symptoms related to parental incarceration and lays the groundwork for the implementation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) within a clinical community-based setting treating children and adolescents affected by parental incarceration. Children and adolescents who experience parental incarceration are more likely to develop symptoms of post-traumatic stress disorder (PTSD): depression, anger, aggression, and isolating and self-harming behaviors. Although parental incarceration is a known source of trauma, there are no documented studies examining effective clinical treatments to reduce the effects of the trauma experienced by these children and adolescents. Except for children and adolescents affected by parental incarceration, TF-CBT, a promising model for treating and reducing the symptoms of PTSD, has been successfully applied to various populations affected by trauma. Children of incarcerated parents resemble populations treated with TF-CBT in earlier applications. In this paper, we present a case illustration that examines the application of TF-CBT with one child who experienced trauma symptoms related to parental incarceration, while discussing the results of that application and the potential for broader applicability of TF-CBT within community-based organizations that treat the population of children and families affected by parental incarceration.     

Social Constructivist Practice with Youth

Social constructivism is an important and creative perspective for helping social workers in their work with adolescents. This paper demonstrates how theoretical orientations and clinical techniques that adhere to a social constructivist perspective can be integrated with the developmental realities of adolescence to provide effective social work interventions. Fundamental assumptions are discussed and are related to problems of practice. Case studies are utilized to demonstrate social constructivist principles in clinical work with adolescents.     

Raising the Titanic: Rescuing Social Work Documentation from the Sea of Ethical Risk

Abstract

One of the most contentious issues in social work practice concerns what should be written about people who access social work services, how comprehensively, and in what format social work assessments, interventions, and outcomes should be documented. The present paper describes a structured approach linked to an action research project that was undertaken by hospital-based social workers to identify and minimise problems associated with documentation in the medical record. The Social Work Ethics Audit provided social work staff with a risk-management tool that highlighted documentation as a key area of ethical risk. Through a process of evaluating existing recording practices, social workers were able to meet the challenge of improving social work recording in medical records, returning it to its proper place as a vital component of clinical and ethical practice rather than an administrative task submerged beneath competing priorities. It was anticipated that the social work documentation proforma that resulted from the ethics audit process would have applicability in other health care settings.     

Ethical assessment and moral reasoning in child therapy

Social workers find it hard to operationalize the profession's Code of Ethics, and few professionals even rely on the Code, as a point of reference in making judgments when faced with ethical dilemmas. Children and adolescents hold a special position in clinical practice. Issues requiring ethical judgments are more complex, because any intervention involves people other than the child. How the professional meets the interests of the parents and those of the child, is frequently a cause for conflict. This article presents philosophical models of moral reasoning, and ethical assessment, to assist clinicians in identifying and resolving frequently faced practice dilemmas, with the goal of improving the quality of patient care, in terms of both the process and the outcome. Emphasis is not only on the ethics of the actual decision but also on the ethics of the decision-making process itself.This article is based on the author's unpublished dissertation, seminars, and grand rounds presentations on applied ethics in clinical social work. Additionally, this author has had consultative and collaborative contact with the Hastings Center, Institute of Society, Ethics and Life Science.     

Personalisation,social justice and social work: a reply to Simon Duffy

This paper begins by defining what is meant by adolescence and reviewing the literature which indicates concern for the high rates of suicidal behaviour in adolescence. Possible explanations as to why adolescents harm themselves are considered, as is the contagious aspect of some suicidal behaviours. Extracts from three interviews conducted with young women in residential care who have engaged in self-harming behaviours are then considered. Links are made between what they say and relevant theory. The paper goes on to discuss the impact of suicidal behaviour in residential care settings. It concludes that it is essential to create time and space to think carefully about this complex and multi-faceted difficulty both for the adolescents themselves and those in the caring professions charged with the responsibility of trying to help them.     

FEMALE CAREGIVERS’ REFLECTIONS ON ETHICAL DECISION-MAKING: THE INTERSECTION OF DOMESTIC VIOLENCE AND ELDER CARE

As our population ages, increasing numbers of social workers and other therapists will provide counseling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.     

Working with the enemy? Social work education and men who use intimate partner violence

This article examines service user involvement in social work education. It discusses the challenges and ethical considerations of involving populations who may previously have been excluded from user involvement initiatives, raising questions about the benefits and challenges of their involvement. The article then provides discussion of an approach to service user involvement in social work education with one of these populations, men who use violence in their intimate relationships, and concludes by considering the implications of their involvement for the social work academy.     

Social Work with Clients Contemplating Suicide: Complexity and Ambiguity in the Clinical, Ethical, and Legal Considerations

Social workers in agency and private practice settings often work with clients grappling with suicide, either as an acute or chronic situation. Probably more than any other clinical condition, suicide forces the practitioner to confront complex ethical, legal, and psychological questions while managing an urgent circumstance. This article attempts to illuminate the ethical and legal considerations that may arise when a client contemplates suicide. Rather than advancing one answer, we stress that in training and the workplace social workers must fully consider the complexities and ambiguities of a client's experiences as well as their own clinical, ethical, and legal obligations.     

The bad and the ugly: ethical concerns in participatory photographic methods with children living and working on the streets of Lima,Peru

Visual methods are particularly well suited for getting at the ways in which children living and working on the street understand their socio-spatial environment, and can bridge gaps between researcher and researched. In this study, adolescents who live and work on the streets of Lima are asked to take photographs, documenting their lives and their socio-spatial environments. While participatory methods such as photovoice can bring children and adolescents into the research process and can provide significant benefits to research and its participants, the introduction of photographic methods with marginalised populations carries with it important ethical concerns. This article explores the various critiques of documentary photography, and ethical concerns that arise when using visual methods, including issues of exploitation and intrusion in research with adolescents living on the streets. It also examines the ways in which researchers must continuously reassess their methodological practices in order to protect the best interests of the participants involved.     

Clinical correlates and repetition of self-harming behaviors among female adolescent victims of sexual abuse

This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups according to level of self-mutilating behavior and then compared on symptom self-reports; 62.1% of the adolescents engaged in at least one self-mutilating behavior. A graded relation was observed between level of self-mutilating behavior and rate, and total number of clinical disorders. At nine month follow-up, one in four teenagers still reported a moderate or high level of self-harm. The need for systematic assessment and intervention of self-mutilating behaviors is discussed.     

Equine-assisted social work counteracts self-stigmatisation in self-harming adolescents and facilitates a moment of silence

The purpose of this study was to determine whether equine-assisted social work (EASW) could affect self-stigmatisation and thereby counteract false identities in self-harming adolescents. Data were collected via interviews with nine female self-harming clients aged 15–21 years and eight staff members. Interviews and video-recorded human–horse interactions with three staff members and four clients were analysed. The interviews were followed by further dialogue with participants while they viewed videos of their own EASW sessions. The analysis indicated that the horse had a calming effect on the clients; enabled them to free themselves of their preoccupations; provided real-time, non-verbal and non-judgmental feedback on their emotions; and increased feelings of trust, patience and empathy. The presence of a horse provided a ‘moment of silence’ for the clients, silencing their inner critic, and made them feel more authentic and better able to regulate their emotions. However, staff could counteract this ‘safe’ healing by being too focused on goals, making interpretations and lecturing and encouraging clients, thus making clients feel judged anyhow. EASW seemed to give clients the opportunity to break free from self-stigmatisation, which seemed to lower the barrier to change.     

People with experience of long-term drug use and homelessness teaching with us: experts by experience participation in university social work education

ABSTRACT

Participation of experts by experience in university social work education is an important shaping factor for future social workers. This article presents two-year long experience in lecturing together with people who have had experience with long-term drug use, homelessness and have a lot of experience with being in a role of social work clients as well. The aim of the presented approach is to recognize their experience, opinions, and attitudes as an important source of knowledge in social work. Based on the research outcomes, the authors discuss topics such as: the role of experts, empowerment, breaking the stereotypes and ethical issues related to experts’ participation. They conclude with practical recommendations.     

Ethical Tensions and Dilemmas Experienced in a Northern Ugandan Social Work Internship

This article explores the ethical tensions and dilemmas that arose for 2 U.S. social work students during an 8-month international clinical internship in northern Uganda. These students encountered cultural differences related to issues of confidentiality, autonomy, and self-determination. Student experiences were analyzed using the cultural orientation framework of collectivism. A strategy for reflecting on ethical dilemmas that arose is presented involving identification and exploration of the ethical dilemma, reflection on the dilemma in the context of culture and socioeconomic factors, development of culturally responsive and ethical interventions, and continued review and reflection. Such exploration of culturally based value differences is needed to increase social work students' cultural competence.     

Ethical Dilemmas of Practicing Social Workers Around Psychiatric Medication

Abstract

It is acknowledged that social workers in mental health and other settings routinely experience client-related ethical dilemmas. Further, there is wide recognition of the potential impact of ethical dilemmas on social work practice with clients who use psychotropic medication. Little is know empirically, however, about the experiences of practitioners with these dilemmas. This article describes the results of a national survey of practicing social workers regarding the nature of ethical dilemmas they face related to their work with clients on medication issues. The results make it clear that social workers regularly confront a variety of ethical dilemmas in this type of practice. Many of these dilemmas are related to ambiguities around the knowledge base of practice, appropriate roles of providers, and basic personal and professional values. The authors present implications of these findings for social work practice and further research.     

Elder Abuse: Clinical,Ethical, and Legal Considerations in Social Work Practice

As a consequence of the steadily growing older population, and increased demands on family for community based care of elderly, elder abuse is an issue to be considered in all domains of social work practice. Intervention in cases of elder abuse is often fraught with ambiguity and ethical dilemmas as the application of professional principles is less than straightforward, bringing to the fore personal, legal, and ethical concerns in the management of the client’s safety and well-being. This article addresses challenges which arise from the complexity of elder abuse cases and reviews clinical, ethical, and legal obligations to inform ethical decision-making.     

Assessment: A critical component of clinical social work practice with physically Ill adolescents

The establishment of an accurate psychosocial assessment is important in clinical social work with all adolescents. With those who are physically ill the complexities imposed by the illness make it essential to take into account the predictable physical and emotional effects of the illness or disability as well as the developmental tasks, the apparent adequacy and flexibility of the defenses and coping capacities and the availability of personal, cultural and institutional resources. A framework for assessment is proposed which examines these variables and their dynamic relationships.     

Re-Collections of Childhood Sexual Abuse: A Biopsychosocial Perspective

A number of theories—biological, psychological, and sociological—inform clinical practice with adults who report memories of childhood sexual abuse. However, each of these theories is inadequate in and of itself. This has several, potentially damaging clinical implications. Therapists might doubt the validity of their clients' reports of traumatic incidents, they may place too heavy an emphasis on the recollection of traumatic events, or they may shy away from discussing these events. Any of these responses can jeopardize the helping relationship, leaving clients without professional assistance in managing a most difficult emotional situation. This paper provides a review of the biological, psychological, and sociological perspectives that lie at the foundation of current practice. These perspectives are then integrated via social work's biopsychosocial perspective. This holistic view provides an empirical base for effective, ethical social work. Specific practice implications are discussed.     

Social work ethics and children: Protection versus empowerment

Evidence indicates that a growing proportion of children and adolescents experience traditional child protective services as intrusive, oppressive, and even exploitive. Professionals tend to deny the reality that youngsters experience, project their own perceptions and vulnerabilities onto youngsters, and refuse to recognize the ability and right of youngsters to control their own lives. Empowerment of minors is an ethical obligation of the social work profession and the only true protection from abuse and neglect.     

Using the NIAAA brief alcohol screener in social work practice for selected prevention targeting youth

ABSTRACT

This article discusses the use of brief screeners in social work practice to identity adolescents in need of selected interventions for alcohol and other drug use problems. Brief screeners can increase access to alcohol or other drug intervention services and promote the diffusion of evidence-based interventions to underserved communities when integrated in Screening, Brief Intervention, and Referral to Treatment (SBIRT) initiatives. The two-item NIAAA Brief Alcohol Use Screener is discussed as a developmentally tailored assessment tool that can be integrated into SBIRT in social work practice to improve detection of early-stage alcohol problems among adolescents who lack routine access to preventative health care. The use of brief, empirically supported alcohol screeners in trainings for social work students and new professionals can enhance their preparation and competence to offer child and adolescent clients appropriate selected intervention options to reduce harms associated with underage alcohol use.