Mental health practice in primary care: Some perspectives concerning the future of social work in organized delivery systems

Abstract

The rise of managed care as the dominant form of healthcare delivery in the U.S. clearly has dramatic implications for the profession of social work. Thus far and for good reasons, the professional dialog about managed care has largely focused on . the threats posed to the professional agenda of social work by managed care in its various forms. This article considers some of the more positive aspects of the transformation from fee‐based to population‐based healthcare systems, in particular the vigorous trend toward multidisciplinary primary care and collaborative mental health practice in primary care settings. It is argued that the market forces behind this trend also promote the emergence of models of social work practice that better integrate historically dichotomized aspects of health and mental health practice. Also considered are implications for social work education and the division of labor among the healthcare professions.     

过渡治理情境下的中国社会服务困境:基于Z市社会工作服务的研究

社会工作近十年来在创新社会治理的推动下发展迅速。本文将重点关注于社会服务组织的服务供给过程及其导致的社会服务困境。通过对治理情境的拓展分析,引入过渡治理情境概念,分析我国社会服务供给。在此情境下,本文以Z市家庭综合服务中心为例,围绕自由裁量权这一概念讨论社会服务组织的服务供给策略及其所导致的服务困境。在过渡治理情境中,消极的自由裁量权与社会工作的半专业化发展结合在一起,社会服务组织选择了“活动化”和“指标化”的服务供给,令社会服务处于创新和碎片化之间,而导致社会服务陷入困境。社会服务困境根源的解决在于建立合作的治理情境、强化本土化社工专业力量以及充分发挥第三方的社会服务供给效力。     

The Social Division of Care

In Australia, as in most developed economies, care has now ‘gone public’. It is no longer solely a private, familial concern that can be automatically assigned to women to be undertaken without pay. Nor is it contained in residential institutions or bureaucratic hierarchies. In this paper I consider what is emerging in its place ‐ the ‘care deficit’ and the new social divisions of care, in which paid care is assuming an ever more important place as a result of significant developments in both social policy and in market‐based provisions, especially the expansion of corporate care. Linking recent care theory with the need for a program of empirical research, the paper first considers the lack of consensus on the character and meaning of care, as seen from a number of different theoretical standpoints. Despite important differences in the perspectives on care, common features suggest that there are sound reasons to develop research concepts and tools that would help create the dialogue and sharing of ideas that a more mature field of research and practice requires. A starting point for this is the attempt to demark a clear definition of care. Building on this, I propose the development and use of a broad perspective, which I have termed the social division of care, to provide a joint framework for data collection and for monitoring the changing balances of responsibility for providing care.     

Social work and end-of-life care: reviewing the past and moving forward

This paper reviews the professional literature with respect to the social work profession's involvement in end-of-life care. The search process was conducted by entering key words in various combinations to electronic databases. Eligible articles were required to address one of the following: roles and activities of social workers in providing end-of-life care; core principles valued by social workers in the provision of end-of-life care; and barriers to provision of effective end-of-life care. The literature from 1990 through July 2004 was searched most rigorously. Based on this review, suggestions for where the profession of social work should focus its energies are offered. These key areas include focusing on generating empirically-based knowledge for practice and policy analysis and developing a system of social work education that addresses the unique knowledge and skills needed to participate in end-of-life practice as competent and informed professional practitioners. Current initiatives with regard to critical areas are summarized.     

Social work education: state of the art

In assessing the appropriateness of contemporary social work education to its context, the article assumes that social work practice and education must relate to its social reality. The article argues that, since the 1970s, that reality has changed in relation to the role of the welfare state, perceptions of economic growth and the independence of the state. As a result, the roles of civil society, the community and welfare personnel have changed, with implications for social work. At the same time, the earlier tendency of social work to avoid the major social issues of the day is no longer appropriate, and the article outlines five major issues needing to be addressed by social work. In conclusion, the article presents four options that social work education should, as a total profession, address, if the profession is to play the roles demanded of it by its contemporary social reality.     

The new privatized market: A question of ideology or pragmatism within the Swedish addiction treatment system?

Given its traditions of universal welfarism and social democracy, Sweden had already scored unexpectedly high on New Public Management by the 1980s. Health and welfare services remain primarily tax‐funded, but the production of care is increasingly transferred to a competitive quasi‐market. To what extent can this development be understood in terms of right‐wing governments, and to what extent in terms of other, socioeconomic and pragmatic factors? We examined this question through official statistics on providers of institutional addiction care since 1976, and through the total expenditure and purchases by local‐level municipal social services of interventions for substance users in Sweden in 1999, 2004, 2009, and 2014. We have analyzed the distribution across public and private providers within the addiction treatment system, and whether national developments and local differences across the 290 municipalities—which bear the major treatment responsibility—can be understood in terms of local‐level political majority, population size, and local wealth. The share of purchased services has remained stable, but the treatment system shows increasing financial turnover and an increasing share of for‐profit providers among producers of purchased care, especially in outpatient treatment. While venture capital enterprises emerged as a new actor, non‐governmental organizations lost out in importance. Bourgeois government correlated with larger shares of purchasing and purchases from for‐profit providers. However, purchasing on a market dominated by for‐profit providers has also become the “new normal”, regardless of ideology, and recent years have shown a reversed effect of left‐wing municipalities purchasing more services than right‐wing governments. Pragmatic reasons also influence local‐level purchasing.     

Social Workers who Move into Private Practice: The Impact of the Socio-economic Context

Summary This paper is based on a doctoral research project, conductedin New Zealand between 1993 and 1999, that considered factorsin the movement of social workers into private practice (vanHeugten, 1999). The study employed a qualitative methodologyin which 33 private practitioners were interviewed using semi-structuredquestionnaires. All respondents had at least a first professionalqualification in social work. The research grew from a realizationthat there had been an upsurge in private practice since themid-1980s, during a time of increasingly right wing governmentpolicies, and free market philosophies. These policies and philosophiesled to a radical restructuring of government and not-for-profitorganizations that employed social workers. Some workers respondedto the changes by seeking alternatives to organizational employment.Concurrently opportunities for private practice were createdby the availability of third party payments for counsellingof survivors of sexual abuse and parties to marital disputes.A similar pattern of confluence of expanding social work privatepractice and free market ideology has been noted in countriessuch as Great Britain and Australia. The implications of thismovement into private practice are considered in relation toprofessional social work associations.     

Managed care: Challenges to survival and opportunities for change

Many agree that the health care delivery system is in serious trouble. Managed care emerged in response to growing concern over spiraling health care costs without commensurate increases in population health outcomes. However, managed care needs to be evaluated within the historical context of using rationing strategies to distribute health care resources. This paper will explore the impact of managed care on social work practice, including the many challenges faced by practitioners. It will conclude with a discussion of potential opportunities for change in this volatile, health care environment.     

Professional Ideologies and Preferences in Social Work: A British Study in Global Perspective

This paper comes at a time when the social work profession inthe UK is redefining its professional ideology and working practicesin the face of key government initiatives for social work educationand the regulation of practice. It seeks to contextualize and,thereby, inform these deliberations by providing a cross-nationalperspective. Indeed, the search for international perspectivesthat might advise or validate national perspectives on socialwork has become increasingly important (Midgley, 2001). Thepaper uses data from a global study (Weiss et al., forthcoming)that identifies and compares the attitudes of graduating socialworkers at the point of qualification in ten countries representinga diverse range of social, economic and cultural contexts (n= 781). Through a comparison of commonalities and differencesof professional ideologies and practice preferences across samples,the paper distinguishes particular characteristics of the socialwork profession in the UK. Whilst a claim cannot be made tobe representative, the findings present a set of empiricallybased contentions that provide information about what socialworkers are being trained for and what they prefer to do. Findingsreveal a mix of psycho-social orientation, whereby a welfareagenda was preferred—one that co-existed with the espousalof elements of a statutory social work role in terms of ideology,level of practice, choice of technologies, age and populationgroupings and practice strategies. Whilst such a mix appearedcontradictory in conceptual terms, the students appeared toreconcile the dilemma through the espousal of a particular valueposition. A key finding for policy makers and educators, however,concerns the fact that while the UK students felt willing towork through social problems in individual situations, theywere unhappy about the extent to which they were able to utilizetheir therapeutic skills in statutory social work settings.Their preference would be to work in the independent sector.     

Social Work and End-of-Life Care

Abstract

This paper reviews the professional literature with respect to the social work profession's involvement in end-of-life care. The search process was conducted by entering key words in various combinations to electronic databases. Eligible articles were required to address one of the following: roles and activities of social workers in providing end-of-life care; core principles valued by social workers in the provision of end-of-life care; and barriers to provision of effective end-of-life care. The literature from 1990 through July 2004 was searched most rigorously. Based on this review, suggestions for where the profession of social work should focus its energies are offered. These key areas include focusing on generating empirically-based knowledge for practice and policy analysis and developing a system of social work education that addresses the unique knowledge and skills needed to participate in end-of-life practice as competent and informed professional practitioners. Current initiatives with regard to critical areas are summarized.     

社会工作伦理困境及其解决方式

社会工作专业的本质是一种道德实践,其对意识形态的介入及专业实践中所涉的道德价值判断和伦理抉择使之不同于一般的专业。社会工作在专业化的进程中包涵着诸多的伦理议题,概括之为：社会工作的道德特质、伦理困境、伦理抉择等。这些构成了社会工作复杂的价值与伦理议胚中的核心议题。对这些问题的探讨有助于进一步澄清社会工作的专业本质,并提升社会工作的专业化水平。     

Gender and Social Work: Will Dip. S.W. make a difference?

Correspondence to Moira Kirwan, Gateside House, Hill Road, Gullane, East Lothian EH31 2BE. Summary With the publication of Paper 30 (CCETSW 1991) and the developmentof Dip.S.W. programmes which incorporate a strong emphasis onequal opportunities, it might be reasonable to expect that socialwork training is now going to take on board the issue of gender.Dip.S.W. programmes are immersed in concerns about anti-discriminatorypractice and aim to provide up-to-date training for an up-to-dateprofession. This paper is based on a study of the Dip. S.W.programmes running in Scotland in 1991/92. This was when thefirst Dip.S.W. qualified social workers emerged from the newtraining. Do these social workers have a new way of lookingat issues such as gender? This paper argues that the Dip.S.W.programmes are focusing on practice issues while ignoring theissues within the profession. Practice issues cannot be separatedout in this way. Social work cannot be anti-oppressive as longas the social work profession itself continues to oppress itsfemale workforce. Dip.S.W., as it is currently provided, doesnot offer the prospect of a change in the gender imbalance ofthe profession and thus it will not make a difference to howemerging Dip.S.W. social workers can tackle the issue with colleaguesor clients.     

The post-1994 transformation of social work in South Africa

This article examines the transformation of social work in South Africa in response to the transition to a developmental welfare approach. Always moulding and shaping itself in response to its social context, social work in South Africa, as elsewhere, is a reflection of the broader political landscape. In South Africa the social work profession has struggled to assert its independence and become self-regulating. It is unique in the Western world in that since 1978 it has been regulated by a legislatively constituted statutory council. While the profession has tried to transform itself in the new democracy, outside pressures have found it wanting and deeply divided. Thus, despite progress in other areas social workers have not yet been successful in forming a strong, united professional association and this severely limits its ability to lobby politicians and advocate on behalf of clients. It seems, however, that the tide is turning and social workers are gaining recognition but, once again, the challenge remains deciding on the extent to which the profession cooperates with the government's agenda for change. Social work educators took the lead in setting education standards in response to higher education policy and are also playing a part in devising practice standards through their involvement in the social work board which falls under the umbrella of the Council for Social Service Professions. However, education and practice are somewhat out of step and professional unity remains a pressing issue on social work's transformation agenda.     

The Essential Power of Group Work

SUMMARY

For almost two decades, leaders in the field of social group work have been warning that the foundational principles and practice of group work as a modality are in danger of being absorbed into generalist social work practice. This paper expands upon the appeal of leaders in the social group work field to generate an environment in which group work is recognized as an integral method in social work practice and education. This paper examines group work as a powerful methodology in social work practice with a specific theoretical framework and skill base that is fundamental to the social work profession. The characteristics of group work's strengths are explored with a comprehensive overview that inspires renewed commitment to preserving, practicing and promoting social group work as a viable and integral part of social work practice.     

Asset poverty and happiness in urban China

Individual and social are the two foci of the mission of change that drives the social work profession. This dual-focus provides not only a cultural mechanism by which the profession can negotiate its professional boundaries but the flexibility for the profession to adjust its focus when its social assignment changes. However, the uncritical pursuit of a full-fledged professional status within a neoliberal ideology is upsetting the balance of these two foci and may weaken the long term adaptability of the profession.     

社会工作专业“实践教学系统”构想

社会工作是一门应用性的学科,是实务性、操作性取向的专业。社会工作专业人才除了具备一般社会科学和社会工作专业的理论和知识之外,还应树立社会工作的价值理念和掌握社会工作的方法、技能。这就要求必须强化社会工作实务教学,使之贯穿整个社会工作专业教学过程。本文分析和反思了目前影响社会工作专业实践教学实效的问题,从社会工作专业实务性特征入手探讨了＂角色—方式—目标＂相结合的社会工作实践教学系统的设计。该系统通过将＂实验型＂实习模式、＂项目化＂实习模式及＂分类分层化＂实习模式合理、有机地整合起来,为学生提供了适宜的实习条件。     

Formalizing the Unformalized: Practitioners' Communication of Knowledge in Practice

Correspondence to Dr Jennifer Osmond, School of Human Services, Logan Campus, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia. E-mail: j.osmond{at}griffith.edu.au Summary Despite considerable debate in the literature, social work continuesto invest considerable analytical and empirical energy on understanding,recognizing and critiquing the nature and form of its knowledgebase. Although such contributions have advanced the discussion,what is largely absent but essential to this debate is an understandingof how practitioners actually express what they know. This paperfocuses specifically on this issue and in so doing, advancesone template for working with practice language. From a qualitative,multi-method research methodology, it was found that participants'communication of their knowledge was not always formal and labelled.Knowing could be expressed via examples, stories, metaphor,as well as understandings that resembled existing theoreticalknowledge or that which had been reformulated and synthesizedin practice. The paper emphasizes the necessity to recognizethis diversity in knowledge communication, so as to accuratelyand responsibly map actual practice knowledge, but in doingso, also raises the issue of addressing limitations that suchrecognition brings. The issue of competent and clear practicearticulation is a topic to which the profession should giveserious attention. The inability of practitioners to explicitlyarticulate the basis of practice behaviour places them at aconsiderable disadvantage in a competitive labour market.     

Revisiting Eight Decades of Social Work Education in India

Social work education commenced in India in 1936 with the establishment of the Tata Institute of Social Sciences. This paper examines the historical evolution of professional social work education in India. It also critically examines the growth of social work education, fieldwork practice, and social work as a profession in India to discern its limitations. Various alarming situations have hampered the growth of social work in India and as such the profession suffers a credibility problem. We offer recommendations for the growth and success of social work education in India.     

社会工作课程理论教学与实践教学的整合优化研究

21世纪我国社会工作教育已经进入新的发展时期。社会工作教育的发展,说明它在协调社会关系、防止社会冲突、解决社会问题方面显示出重要作用。但是,通过对社会工作专业学生、教师以及机构社工进行调查,本文认为,在社会工作教育发展中存在两大主要问题:教学中的"重实践、轻理论"和实践中的"重书本、轻操作",针对此情况,进一步提出从加强社会工作专业的理论意识和建立社会工作专业实践教学的操作平台两方面着手解决,为后社会工作专业的教育教学提供较为客观和现实的指导和建议。     

Instilling the Soul of Group Work in Social Work Education

This article addresses the process of developing an educational model for teaching social work with groups in an undergraduate social work degree program in Israel. The model was developed against a backdrop of decreasing status of social group work within the profession and the consequent loss of its unique identity and power in the social work field. The model's aims are to provide the students with the basic principles of social group work, to ensure its place in their professional identity, and to awaken curiosity regarding its use in their future practice as social workers.