Talking about culture in social work encounters: immigrant families and child welfare in Finland

This article aims at analysing the ways in which people talk about ‘culture’ in social work encounters involving child welfare in immigrant families. The empirical material includes conversations between immigrant clients, their social workers and co-operating professionals at six Finnish social service offices, as well as interviews with the persons participating in these meetings. The theoretical and methodological frames of reference are social constructionism and discourse analysis. The study suggests three ways in which the concept of ‘culture’ is used by social workers and their clients: firstly, as a means of explaining ‘the ordinary and normal ways’ of raising children; secondly, as ‘a difficulty’ in the interaction between social workers and clients; and thirdly, as ‘a methodical tool’ in creating dialogue with clients. As far as the practical implications for social work are concerned, it is emphasized that in order to avoid ethnocentric practice or ‘culturalization’ of problems, it is important for social workers to be conscious of the various meanings of ‘culture’ both in their own practice and in the ways their clients employ cultural symbolism.     

Who Writes the “Therapeutic Story” of Families in Extreme Distress: Overcoming the Coalition of Despair

ABSTRACT

When families in extreme distress come to social workers, the enormity of their needs often stresses the workers. The problems which these families face often require material and personal resources in excess of what the agency can provide. This places the worker in a position of being under pressure from both sides the clients and the organization. In these situations, the workers and families together can become subject to a coalition of despair. It is characterized by exhaustion and losing hope that therapeutic change is possible. A way to overcome or avoid the coalition is proposed.     

The “Other” Effects of Psychotropic Medication: Social Workers’ Perspectives on the Psychosocial Effects of Medication Treatment on Adolescent Clients

This study explores social workers’ perspectives on the psychosocial effects of psychotropic drug treatment of their adolescent clients. Using a mail survey, we asked a national sample of experienced clinical social workers to answer questions about their perceptions of the effects of such treatment on the sense of self and social well-being of an adolescent client. The survey questions also explored associations between perceived psychosocial medication effects and characteristics of the client and the treatment. The findings suggested that social workers viewed medication treatment as having greater beneficial than harmful psychosocial effects on their adolescent clients, but that both effects existed simultaneously. The most important factors associated with the perceived effects of medication that emerged from social workers’ reports included the etiology of the disorder, the type of drug treatment and its effectiveness in addressing symptoms, the client’s “competence,” and the quality of the relationship between the client and the treating social worker. This study provides direction for future research on a neglected but important question. It would be helpful to broaden the scope of professional discourse on the advantages and disadvantages of psychopharmacologic treatment for youth beyond the effectiveness or safety of the treatment to include questions concerning clinicians’ perceptions of the effects of drug treatment on youths’ sense of self and social well-being.     

Social Work Roles in Drug Treatment with Youth

ABSTRACT

Social workers working with youth, who are prescribed psychotropic medication, are routinely faced with tasks pertaining to psychopharmacologic treatment. Little is known, however, about how these workers contribute to the medication treatment process or the impact of their contributions. The purpose of this national survey of social workers practicing with youth was to explore three areas: (1) the frequency of medication-related functions with adolescent clients; (2) the worker, client, and contextual factors associated with greater involvement; and (3) social workers' perceptions of the effects of greater involvement on treatment processes and outcomes. Our findings suggested that in relation to medication treatment, social workers more frequently interfaced with clients than physicians, and that various treatment context and individual factors are associated with greater involvement. Social workers also perceived their involvement as associated with some desirable treatment processes/outcomes, especially the inclusion of adolescents in decision-making.     

Attention Deficit Hyperactivity Disorder (ADHD) and Diverse Populations

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood. Given the high prevalence of ADHD and its significant impact on children and families, it is important for social workers to understand and know how to respond. This paper looks at Attention Deficit Hyperactivity Disorder, explores its causes, and gives special attention to its effect on diverse populations. In addition, it discusses empirically supported treatment interventions used for children with ADHD, particularly the role of parent training in the management of ADHD. Finally, it discusses the applicability of using parent-training programs with diverse populations.     

ADHD in juvenile offenders: treatment issues nurses need to know

1. When working with juvenile offenders with ADHD, advanced practice nurses should consider prescribing stimulant medication in conjunction with other psychosocial interventions to achieve maximum treatment success. 2. Nurses working with young people with ADHD in the justice system must carefully coordinate care among all health care providers and juvenile justice personnel, including attorneys, probation/parole officers, and court assessment personnel. 3. Advocating for the individual needs of clients and their families is critical; often, this includes advocating for care that is not only evidence based, but also culturally competent.     

The impact of the economic crisis on the practice of social casework

ABSTRACT

What is the impact of the economic crisis on the practice of social casework? How is the economic crisis reflected in the professional practice, when social services have to cope with depletion as a result of an increasing attendance pressure? This study analyses the way in which social workers in community services face the understanding of the problem situation jointly with their clients. The aim is to uncover the items that professionals prioritize when they formulate and analyse the problem situation together with their clients. Data show that there is a discrepancy between the intervention criteria that have been considered important and their level of accomplishment. This difference points out that the understanding of the problem situation seems superficial, showing a low level of practice of the intervention criteria that assess the meanings which clients give to the incidents, strengths, solutions attempted, and larger systems involved. Data show that the implementation of fundamental analysis instruments is not sufficiently trusted and the use of the professional’s own knowledge is not regarded as important. This situation does not provide a context of intervention that is suitable and consistent with the problem situation and, consequently, the interventions for change will probably not match the clients’ needs.     

The Psychology of the Psychopharmacology Triangle

Abstract

The psychopharmacological triangle generated by recent changes in mental health practices requires social workers to deepen their understanding of the psychological meanings of such treatment. Many clients receive concurrent psychotherapeutic and psychopharmacological interventions from different providers, creating a triangular treatment relationship. To facilitate a successful outcome, social workers will need to understand how meaning, transference and countertransference are stimulated by this arrangement. The literature on these issues as well as clinical experience will highlight specific issues requiring attention. By attending to these dynamics, the social worker can maximize the chances for a successful treatment outcome.     

Parents of Children with Attention Deficit/Hyperactivity Disorder: A Meta-Synthesis,Part II

In 2011 6.4 million children in the United States ages four to 17 years had a diagnosis of ADHD. Quantitative studies have indicated that parenting stress for parents of children diagnosed with ADHD is high. The purpose of the current meta-synthesis was to conduct a comprehensive review of both the published and unpublished qualitative studies involving the experience of parents raising children diagnosed with ADHD. Searches in online scholarly databases yielded an initial 1217 hits, which were narrowed down to eighty studies that met the criteria. A “meta-ethnography” framework was used for the synthesis. Results of the first part of the analysis were reported in Corcoran et al. (2016) and had to do with the personal impact on parents. The themes in Part II have to do with the processes parents go through in accepting the diagnosis of ADHD and in deciding whether their children should take medication. Parents struggled to make sense of their child’s problems and came to terms with the diagnosis in a series of stages. Regarding medication use, parental attitudes varied greatly, with both costs and benefits noted. Though there was considerable ambivalence towards medication use, some parents reported relief after their child began using medication. Implications from this study are that providers should recognize the processes involved in making decisions about an ADHD diagnosis and the use of medication. Social workers should allow sensitive exploration of parents’ attributions and understanding of their children’s behavior and level of acceptance of the diagnosis. Keeping an ethical and critical stance toward the use of medication, social workers should also have full exploration with parents around the potential benefits and risks associated with the treatment of their children’s ADHD, taking into account parents’ preferences.     

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.     

Video conferencing applications in social work: Work locally,think globally

Abstract

Video conferencing is a technology that facilitates the provision of high quality education, health-care and consultation to clients and families served by rural area health professionals via visual and audio transmissions. It also plays an important role in the education, and training of rural health professionals and the development of a multidisciplinary team dialogue between rural and metropolitan partners. This paper describes our experience of a video conferencing program conducted at the Goulburn Valley Mental Health Service and St George's Older Persons Mental Health Service. We have found a number of benefits of this technology for clients, their families and for health professionals themselves. The development of expertise in the use of video conferencing technology has empowered social workers in their work places. Video conferencing has been extended to other aspects of social work practice. A pertinent example of this is the use of video conferencing in Guardianship and Administration hearings for patients who would otherwise be unable to attend because of health problems (physical, mental and mobility).     

Responsibilisation,social work and inclusive social security in Finland

ABSTRACT

In this article responsibilisation in social work is studied by analysing two Finnish state-level policy documents (called final report and research report) which concern a current activation initiative called inclusive social security (ISS). It is asked how social workers and clients are constructed as responsible subjects in these documents. Responsibilisation refers to the advanced liberal mode of governmentality, which aims to strengthen citizens’ abilities to self-governance through various techniques that include the intertwined elements of surveillance and empowerment. It is demonstrated that the policy documents construct the social workers’ and the clients’ responsibilities partly in different ways. The final report leads activation to be based on shared responsibility and social work to be more community-based, whereas the research report strengthens more individual-based responsibility of clients and social workers. For the clients, the interpretation of ISS based on shared responsibility would probably be less stigmatising and paternalistic than the one based on individual responsibilities, i.e. approaching long-term unemployed citizens as being personally ‘at risk’ and thus a justified target group of individualised techniques for activation. For social workers and clients, future activation appears to be a wide mix of different techniques, moral expectations and possible ways of being a responsible subject.     

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.     

Facilitating Transition Among Transgender Clients: Components of Effective Clinical Practice

Although transgender clients seek services in a number of settings in which social workers practice, there is a dearth of scholarly literature available to guide effective clinical practice with this population. When transgender issues are included in the practice literature, the trend has been to consolidate the needs of transgender clients with those of the larger lesbian, gay, and bisexual community or to simply focus on increasing the comfort level of clinicians working with this population. This is concerning because transgender individuals represent a vulnerable subgroup of clients with unique and specific treatment needs related to the transition experience. Social workers play a critical role; they may serve transgender clients and their families in many ways: as advocate, educator, diagnostician, and individual, couples or family therapist. The purpose of this article is to identify several key components of trans-specific clinical practice and the role of social workers in supporting and facilitating client transition. Specifically, the authors will discuss: (a) relevant definitions and terminology, (b) emerging issues related to depathologizing the needs and experiences of transgender individuals, (c) the critical elements of trans-specific clinical assessment, and (d) clinical advocacy associated with the medical legal and social aspects of the transition process. Specific recommendations for trans-affirmative social work practice will be offered.     

How Effective are Interventions to Enhance Adherence to Psychiatric Medications? Practice Implications for Social Workers Working With Adults Diagnosed With Severe Mental Illness

This study integrates eight systematic reviews of adherence enhancement interventions to develop practice guidelines for social workers who work with adults who do not adhere to prescribed psychiatric medications. Findings indicate that existing investigations are disparate in their adherence definitions, methodologies employed, and sampling strategies, rendering it difficult to construct overall guidelines for social work practice. However, themes associated consistently with increased adherence are collaboration between clients and providers regarding medication decisions, consistent follow-up care, and a comprehensive network of professionals and caregivers who support clients in their use of medication to facilitate stabilization of mental health symptoms.     

Stigmatizing Clients with Mental Health Conditions: An Assessment of Social Work Student Attitudes

Research suggests that stigma plays a major role in discouraging clients from participating in mental health treatment. Because social workers provide a significant amount of such services, this study investigates social work student stigma as a function of their willingness to treat clients with alcohol dependence, nicotine dependence, depression, and Alzheimer's disease. Students' held higher levels of stigma toward nicotine dependent clients and less toward those with depression. Personal histories of depression and student age - but not smoking or alcohol use - were predictive of higher stigma levels towards nicotine dependent clients. Implications for social work are discussed.     

Working with Homeless Populations to Increase Access to Services: A Social Service Providers’ Perspective Through the Lens of Stereotyping and Stigma

Through the lens of stereotyping and stigma, this article examines discrimination and prejudice toward homeless families from the perspective of social service providers. Semi-structured qualitative interviews were conducted with practitioners. A critical social work practice perspective is used to provide a framework for understanding how social worker knowledge about discrimination and prejudice informs the ways in which the workers engage with clients, build capacities, and advocate for clients in an anti-oppressive manner. The themes found in this study include: a) providers’ awareness of bias, stereotyping, prejudice, and discrimination; b) providers’ use of a range of strategies to work with people experiencing homelessness; c) providers’ ideas about strategies that organizations can implement for service provision; and) providers’ belief that additional advocacy and policy are needed in relationship to people experiencing homelessness.     

Worker skill and client outcome in child protection

The research in child protection and in work with other involuntary clients suggests that the use of certain skills by child protection workers is likely to be related to positive client outcomes. In particular, effective practice involves: helping clients and client families to understand the role of the child protection worker; working through a problem‐solving process which focuses on the client's rather than the worker's definitions of problems; reinforcing the client's pro‐social expression and actions; making appropriate use of confrontation; and using these skills within a collaborative client/worker relationship. This study attempts to identify the extent to which child protection workers make use of these skills and how these skills relate to client outcomes. Data were sought through 50 interviews with child protection workers and 282 interviews with family members. The child protection workers provided information about 247 client families. It was clear that when workers used the skills, their clients had better outcomes—the workers believed their clients showed better progress, the clients were more satisfied with the outcomes and the cases were more likely to have been closed 16 months later. Copyright © 2002 John Wiley & Sons, Ltd.     

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.     

Social profile,maternal depression and welfare concerns in clients of health visitors and social workers: a comparative study

Research into the practice of health visitors and child care social workers with depressed mothers is limited. This is surprising in view of the known relationship between motherhood and depression, and the association also between child care problems and maternal depression. The study described below is the first which seeks to compare health visitor and child care social work clients/service users in relation to the issue of maternal depression. In particular, it seeks to compare the extent to which maternal depression is a feature of the work of social workers and health visitors, the relationship between maternal depression and the social composition of different client groups, the relationship between maternal depression and welfare concerns—particularly child abuse—and the extent to which such concerns lead to referral from health visitors to social workers. The research shows: (1) interesting similarities between the depressed health visitor clients and social work clients as a whole; (2) the importance of low income and absence of support in the ‘progression’ from health visitor to social work clients status; and (3) an alarming emerging gap in services provided for severely disadvantaged families with child and family care problems.