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.     

‘Care is not a dirty word!’ Enacting an ethic of care in social work practice

While ‘care’ has been positioned as a core value of the social work profession since its inception, the increasing influence of neoliberal rationalities have placed care on the periphery of social work theory and practice. Social work scholars have promoted the incorporation of ethic of care theory into direct social work practice as a means of countering the effects of a context that is antithetical to caring practice. I present findings from my Australian study, providing an original contribution by presenting concrete understandings of how social workers enact care in everyday direct social work practice. The study was guided by a grounded theory approach. Fifteen social workers were interviewed using a semi-structured interview schedule. The interviews were analysed using constructivist grounded theory techniques. ‘Meeting needs’, ‘just being there for clients’, ‘building relationships with clients’, and ‘going the extra mile’ were some of the ways that participants demonstrated care in their practice. Constraints on care were challenged and resisted by ‘taking a stand’, ‘bending the rules’, ‘picking battles’, ‘justifying care’, and ‘taking risks’.     

Predicting the Use of Spiritually-Derived Interventions in Social Work Practice

Abstract

Although research has grown considerably on spirituality and social work practice in recent years, there has been little investigation of what practitioners actually do with their clients and what influences their practice behaviors. Current findings from a random sample of 204 licensed clinical social workers indicate considerable focus on religion and spirituality in both assessment and intervention, with over two-thirds of the sample reporting that they had utilized 14 different spiritually-derived techniques with clients. In addition, analyses reveal four factors most predictive of the use of such techniques including: practitioner attitudes, the percentage of clients presenting religious/spiritual issues, the percentage of clients for whom religion plays a detrimental role, and the level of practitioner participation in religious or spiritual services.     

Social work students’ perspective on environmental justice: Gaps and challenges for preparing students

ABSTRACT

The integration of environmental justice into social work education, research, and practice has grown substantially in the past decade. However, social workers still report feeling unprepared to address these challenges with their clients and communities. To understand the disconnect between education about and application of environmental justice principles, semi-structured qualitative interviews were conducted with graduate social work students (n = 14). Findings suggest this disconnect is catalyzed, in part, by the environment’s meta nature and a lack of facilitated education on the dynamic feedbacks between the physical environment and social justice issues. Implications for social work educators are discussed.     

Young people and social networking sites: exploring the views and training opportunities of CAMHS social workers in Ireland

ABSTRACT

Social Networking Sites (SNS) (e.g. Facebook, Instagram) have become a fundamental part of the daily lives of many young people. SNS engagement has been associated with a number of risks and benefits, some of which are particularly relevant to young people who access child and adolescent mental health services (CAMHS). Consequently, understanding how and why young people engage with SNS, and the associated risks and benefits, may become an increasingly important part of CAMHS social work.

This small-scale study (n = 15) utilised an online survey to explore the importance that a sample of Irish CAMHS social workers attribute to maintaining an awareness of how young people use SNS, whether they, in their professional lives, have been offered the opportunity to learn about SNS engagement among young people, and whether they have taken it upon themselves to learn about this topic.

Findings suggest that participants consider an understanding of SNS to be an important part of CAMHS practice. However, participants report that they do not feel sufficiently aware of SNS trends among young people, suggesting that there is scope for SNS-focused training/learning opportunities among this sample of CAMHS social workers. Implications for practice and suggestions for future research are outlined.     

Pedagogy of international social work: a comparative study in the USA,UK, and Georgia

The social work profession worldwide has been increasingly influenced by globalization and its effects on social issues that require social workers to be responsive and knowledgeable in addressing them. In recent years there has been an increased emphasis on the internationalization of the social work profession and education. With limited examples of international social-work-teaching methods discussed in the literature, there is also a lack of information obtained directly from students on methods of instruction that they most prefer and find beneficial. This collaborative, comparative project examined students' perceptions of methods that make teaching international social work successful at three universities in the United States, United Kingdom, and Georgia. While there were different preferences for content- and process-driven approaches in teaching, students' common interest was in gaining practice examples and exposure to real-life practice of international social work in their own and other countries. The findings suggest that international social work education needs to be more experiential and practice-based.     

Solving Current Social Challenges: Engaging Undergraduates in Policy Practice

This article explores an innovation in teaching policy practice at the undergraduate level. It analyzes an experiential learning model that uses current social challenges as a compelling way to generate student learning about policy practice. Over the course of the semester, students examine antecedents, current issues, and potential solutions to a contemporary social issue through a series of assignments that build knowledge and skills and link the topic to larger social policy concerns. Using quantitative and qualitative evidence from seven semesters, the article explores benefits and challenges of this approach to teaching, and derives lessons for social work education.     

Social Workers and Social Justice During a Period of Intensive Neoliberalization: A Preliminary Investigation From the Republic of Ireland

Despite the championing of social justice within the discourse of social work, some express concern that there has been a dilution in the profession’s practical commitment to seeking a more just society. The article begins by defining social justice and then refers to a number of studies that have endeavored to identify whether or not social justice is being pursued by practitioners. It is argued that renewing efforts to achieve social justice is particularly relevant in times of intensive neoliberalization. In this context, we discuss the comments of a small number of Irish practitioners. This preliminary study indicates that social workers are struggling to achieve limited social justice gains in organizationally difficult and fraught situations. The findings suggest that some practitioners, located in stultifying working environments, are blunted in their capacities to pursue social justice demands for their clients and for themselves. However, a more wide-ranging research project, composed of a more substantial and diverse sample of respondents, would need to be formulated to further explore this theme.     

Reflective practice in a process for the re-approval of ASWs: An exploration of some inevitable resistance

In this article a mental health trainer and a group facilitator explore the background to developing a new protocol to manage the re-approval of mental health social workers in an inner London borough. The new procedure involved social workers attending a series of small group sessions in which they were invited to present and reflect on their work with clients. The dynamics of these sessions and particularly some of the transferential material between group members and facilitator are explored here. The significance for mental health social work, post-qualifying learning and the possibilities of reflective practice is considered.     

Social Work and Criminal Justice

SUMMARY

We shall begin with the principal, and complicated, conclusion: Regrettably, the social work profession has largely abandoned the criminal justice field. That is not to say that social workers are not employed in criminal justice settings. Certainly they are. Significant numbers of social workers earn their living as probation and parole officers, caseworkers in public defender offices, counselors in correctional institutions and halfway houses, and so on. As a profession, however, social work no longer has a major presence in the criminal justice field (Gibelman and Schervish, 1993). Relatively few social workers embark on their professional education with the aim of employment in the criminal justice field. Virtually no courses in social work education programs focus explicitly or comprehensively on criminal justice (Knox and Roberts, 2002; McNeece and Roberts, 1997). Workshops offered at professional conferences or continuing education seminars rarely focus on criminal justice issues per se. And, relatively little serious scholarship on criminal justice issues is authored by social workers.

Interestingly, this has not always been the state of affairs. Earlier in the profession's history, social workers were much more visible and vocal participants in dialogue, debate, research, and practice related to criminal justice. Ideally-in light of social work's unique perspectives on practice and social problems, and the profession's noble value base-the profession will reclaim its preoccupation with criminal justice. As Sarri (2001) concludes with respect to social workers' involvement in the juvenile justice system in particular:

Thirty years ago, social workers were in leadership positions in juvenile justice in the majority of states. In the 1980s, a gradual decline began in agencies and in social work education for practice in juvenile justice. Some have suggested that the decline was at least partially due to professional resistance to working in coercive settings with involuntary clients. However, given the millions of people now caught up in the criminal justice system who are not receiving the social services they desperately need, it is a priority that social work return to a more central role in criminal justice. (p. 453)     

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.     

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.     

Social Media and Social Work: The Challenges of a New Ethical Space

ABSTRACT

Social media and other online technologies have transformed communication between social workers and service users, with many practitioners engaging and working with clients through social networking sites. While there are numerous ethical issues associated with online practice related to con?dentiality, dual relationships, and boundary crossing, there is lack of clarity about how to deal with such issues. This article uses a case example to develop a nuanced understanding of ethical issues and ethical behaviour in online spaces. We argue that social workers need to link their knowledge of the complex interplay between discourses that underpin daily practice like those related to power, permanency, authorship, audience, embodiment, and professionalism to social media created spaces. In doing this, social workers must retain their commitment to ethical values and critical reflective practice. We conclude with recommendations for education, research, and practice.     

Culturally responsive social work practice with D/deaf clients

ABSTRACT

D/deaf individuals are often marginalized in our society. A lack of cultural understanding among social workers serving this population, coupled with communication barriers, inconsistent access to interpreters, or misperceptions of culture, adds to the potential for further marginalization. D/deaf individuals seeking mental health and social services live in a unique cultural context with which social workers may not be familiar and experience persistent issues surrounding access to mental health and social services. This article reviews some useful best practices, cultural points to be aware of, and suggests some strategies for providing culturally responsive social work when working D/deaf clients.     

Key misconceptions when assessing digital technology for municipal youth social work

ABSTRACT

Municipal youth protection work has become infused with digital technology, and yet there is still limited research on how to assess the impact of digital technology on municipal youth social work. This article reviews a range of misconceptions regarding the assessment of digital technology for youth social work in municipal contexts. This review was generated in connection with the development of an app system for communication between young clients and their municipal social workers in Denmark. The misconceptions relate to: variations in technologies and contexts; the impact of digital technologies on the relationship; social justice; differentiating between the user and the digital technology; digitalization and standardization; stakeholder and functional models of municipal social work. The paper concludes that the relationship between municipal social work and digital technology is complex and that thus complex comprehensions of municipal social work practice are needed if the relationship between technologies and practice is to be grasped adequately. The paper argues that given the complexity of the field and the speed of technological and legal changes, external support with regard to assessing how to use, develop and incorporate digital technology needs to be made available to municipalities and social workers.     

Reflective Practice Online—Exploring the Ways Social Workers Used an Online Blog for Reflection

Social workers are increasingly using social media for networking, peer support, reflection, and fun. Social media presents exciting opportunities for social work practice; however, social workers and employers of social workers need to understand the challenges and conflicts that can occur. This study explored the experiences of social workers who used an online blog for reflection, describing different levels of engagement with reflection and the development of an online community of practice to support isolated social workers. This study is significant because although there are many studies that describe the experiences of students using a blog for reflection, the author has been unable to identify another study that focuses on the ways social workers engaged with a blog for reflection.     

Hearing the stories of Australian Aboriginal and Torres Strait Islander social workers: challenging and educating the system

Hearing the stories of Australian Aboriginal and Torres Strait Islander social workers highlights the powerful influence that cultural identity has on their practice. Their identity is continuously negotiated alongside a professional social work identity that is dominated by Western discourse. The tensions that these social workers experience in their practice is revealed in the findings of a qualitative research project conducted by an Indigenous and a non-Indigenous practitioner and researcher. The researchers spoke to Aboriginal and Torres Strait Islander social workers engaged in diverse areas of practice across Australia. Their stories reveal a complex range of cultural and professional challenges. These include the difficulties encountered when working with their own kinship networks and the need to constantly negotiate personal and professional boundaries. The paper concludes with some thoughts about how the practice of Indigenous social workers can provide valuable lessons for Australian social work.     

'I know I signed something': older people,families and social workers' understanding of the legal aspects of entry to residential care

This purpose of this paper is to report findings that older people are legally vulnerable when entering an aged care facility, that social workers lack knowledge of the legal aspects of this move and do not necessarily view this information as core to their practice. The structure of social work services mirror the disjuncture older people and their families experience at this time and this may, in part, explain social work's lack of attention to these issues. Although many social workers are in contact with older people, the profession in Australia has been slow to develop a knowledge base to support effective practice with this group.     

The Psychoanalytic Social Worker/The Social Work Psychoanalyst: What Shall Be Our Message?

Many social workers experience a powerful bond with their profession and with the contributions of psychoanalysis. This paper explores these bonds and demonstrates the substantial overlap, and occasional divergence, which exists between these two important fields. It is especially gratifying to see the renewed emphasis on the treatment relationship in contemporary psychoanalytic writings because the relationship has always been central to social work practice. Finally, all psychoanalytic social workers are encouraged to invest themselves in transferring the legacy of their work to beginning social workers, social work students, and the generations of social workers that will follow them.     

What is clinical social work? looking back to move ahead

This paper traces the evolution of the concept of clinical social work and looks at where we are and where we are headed as clinical social workers. It reaffirms the view that clinical social workers intervene with clients presenting the full range of problems in a variety of facilities and in private practice and must draw on a broad knowledge base within a person-situation perspective and address the special needs of culturally diverse and oppressed populations. The paper also considers the move toward legal regulation, the role of private practice, the need for clinical doctoral education, the importance of new models for clinical research, and the significance of advocacy for a broad range of services to clients.