Chapter 9 - SOCIAL
WORK *
Gayle
Gilchrist James and. Bryon M. Gero
I.
HISTORICAL DEVELOPMENTS AND WORK ENVIRONMENTS
1.
History
Social
work is rooted in antiquity and in humankind's efforts to help one another in
times of hardships like poverty, pestilence, and disease. These efforts began
around 2100 BC. Drawings on the walls of tombs depict Egyptian rulers giving
things to the poor; Egyptian farmers were given seed in the event of a crop
failure (Conger, 1975).
Social
inventions continued, through a process of progressive differentiation, to
comprise charity given by monastic orders (350 AD to the present); to laws
regulating the movement of "able-bodied beggars" and the "right
to relief of those who were unable to work for themselves" (First English
Poor Law, 1388 AD); to the establishment of "hospitals" (almshouses,
orphanages and training homes -- 1520 AD); to "welfare officers"
(civil officers who directed the expenditure of tax funds levied for the
purpose of relieving the poor -- England, 1572 AD); to the Elizabethan Poor Law
of 1601 AD which established categories of relief recipients, artifacts of
which still exist in Canadian and American legislation currently, implicitly
describing the poor as "deserving" or "undeserving"; to the
major public and private programs and policies of the Nineteenth and Twentieth
Centuries (Sickness Insurance in Bismark's Germany in 1884 and his Workmen's
Compensation in 1885 and Old Age and Incapacity Insurance in 1889; Family
Allowance in France in 1918; Old Age Pensions in 1908 and compulsory health
insurance in 1911 in Great Britain; the New York Children's Aid Society in 1853
and the Juvenile Court in Chicago in 1898) (Conger 1973).
As
"charity" moved from religious auspices to secular auspices, and as
our understanding of human and societal development deepened, the need for
personnel with skills above and beyond those intuited by "good will"
became apparent. This gradual realization led to the development of the
profession we now call "social work". Volunteers could no longer
fully meet the demands for service and thus, the first paid charity workers,
i.e., social workers, were employed in
"Brilliant young
graduates of
Conger, 1973
At
about the same time, the training of social workers moved from a model based on
in-service, in social agencies, to one based on university training.
Initially,
when the Canadian Association of Social Workers (CASW) was founded in 1926,
professional social workers across Canada belonged to that Association as
individual members; since 1975, CASW has been a federation of 11 provincial and
territorial associations, representing within its own borders roughly 8,000
social workers in the country.
(b)
Training Programs
The
first school of social work was established in
There
are now 26 schools, faculties, and departments in
In
addition, through a high degree of co-operation with the Council on Social Work
Education (CSWE),
Most
Canadian social work schools offer undergraduate and graduate degrees: the
Bachelor of Social Work (BSW) degree, known within the field as "the first
professional degree", and the Master of Social Work (MSW) degree. Only the
There
exist, as well, community college programs in social services, leading to a
diploma or certificate. Usually of two years' duration, these produce graduates
who work in direct social services, usually under the supervision of a
university-trained social worker. Although there is not currently a national or
international accreditation body for these training programs, most have an
active liaison with schools of social work in their region, to provide an
educational ladder for those wishing to continue formal studies in social work.
In
general, the BSW requires four years of study, with an additional year or two for
completion of the master’s degree. Some students may enter BSW or MSW
programs with a prior undergraduate degree (usually, a Bachelor of Arts with a
major in the social sciences) although they may be required to take a
qualifying year, particularly for graduate admission. Doctoral studies,
undertaken in
Professional
social workers work in a variety of settings including: child welfare
organizations; group homes; neonatal intensive care units of active treatment
hospitals; probation services; United Ways and social planning councils; policy
and planning secretariats of major provincial and federal social programs; law
reform and human rights organizations; boards of self-help groups and agencies;
institutions for the physically and mentally disabled; services for the aging
and elderly; youth drop-in centres and street agencies; academic institutions;
personnel departments in major industries and businesses; and treatment
organizations for those suffering alcoholism and drug addiction.
II.
BODY OF KNOWLEDGE
Social
work, like other professions, does not have an exclusive "corner on the
knowledge market"; what is unique to social work is its perspective on
people's problems in living, the solutions to those problems and, therefore,
the body of knowledge required to sustain work from that perspective. Social
workers take a broad view of problems that focuses on the inter-connectedness
and interdependence of individuals with their society, believing that
"private troubles" and "public issues" are intimately
related. The knowledge base, therefore, is derived from research about
individuals and society and, more importantly, about the dynamic relationship
between the two (where general systems theory is a key principle).
(a)
Core Subject Matter
Most
social work education assumes a "two plus two" arrangement in BSW
programs, i.e., a minimum of two years of (liberal) arts education in relevant
areas (psychology, sociology, anthropology, political science and economics)
followed by two years of more specialized subject matter, which reflects the
perspective of social workers that individuals and their society are
interdependent.
There
is international agreement on the knowledge base of social work and the core
subject areas are: human growth and social environment; social policy; social
welfare administration; research methodology and design; supervised practice or
field work experiences; and, methods courses in the application of and
integration of the learned knowledge base. In addition, most Canadian education
programs consider an interviewing and communications course an integral part of
the curriculum.
(b)
Specialized Subject Matter
Graduate
and post-graduate education provide opportunities to specialize in a particular
area (casework, group work, policy and administration, community organization,
and research are the traditional forms), or in a given field of practice (child
welfare, education and social work - social work services in schools,
gerontology, social work in health settings), or in a particular methodology
(family therapy, behaviour modification, social planning, locality development,
supervision).
The
emphasis on research in social work is demonstrated by the requirement that all
graduates must have successfully completed research courses in the arts portion
and/or in the core social work portion of studies. The goal, mainly, is to
train social workers to be good consumers of research and, secondarily, to
design and conduct studies in their own profession, thereby fulfilling the
profession's commitment to evaluation, which is considered a core skill in all
forms of social work practice. Because social work draws heavily on the
information provided by psychology and sociology, it is important that social workers
be able to judge the validity and worth of their studies.
III.
CLINICAL SKILLS
Social
work practice has a generalist and a specialist component. For all forms of
practice, the purposes, functions, foci, objectives, and values are the same,
wherever that practice occurs. Further, knowledge base, methods and skills are
a part of all practice, although they differ from one practice site to another.
Specializing
assumes that a social worker, accepting and building on a common base of
beliefs; purposes, foci, and objectives for the profession, has decided to
pursue one of the basic functions of social work more than others; to confine
practice to a particular methodology (for example, social planning or family
therapy) or to a particular field of practice (practice in a hospital or health
care setting). Thus, specializing (including "clinical practice")
implies a declaration of emphasis within the broad range of practice but never
a denial of the complete range of social work functions.
The
term "clinical skills" in social work is something of a misnomer,
inasmuch as what one is really referring to is social work skills used in a
"clinical" setting where the social worker works mainly with
individuals, families and small groups, as opposed to working with large
groups, institutions, organizations and communities. The social work research
and literature of the seventies has underlined the commonalities of skills in
all practice areas, and the integrated functions of social work.
(a)
Functions of Social Work
Seven
separate functions of social work have been identified. (Pincus and Minahan
1973) These functions, while they appear to be separate and distinct entities,
in fact, are not. There is a high degree of interaction and inter-dependency
among the functions and, taken together, the whole represents a greater entity
than the sum of its parts. Each function, while separate and identifiable, does
not tell one a great deal about the package-as-a-whole; it is the entire
package that comprises the substance of social work practice.
When
social workers talk about the functions of social work practice, they often use
a term called "resource systems". These systems fall into three
categories. The first is the "informal resource system" which refers
to that set of linkages that most people in our culture possess, i.e.,
connectedness and a support network involving family and friends. These are the
people to whom we turn for the nurturance of our daily emotional and physical
lives. A second is termed the "formal", which refers to the more
structured attempts people make to support one another (e.g. self-help groups,
memberships groups, professional associations, unions). The third is the
societal one, which comprises the largest attempts on the part of western industrialized
democracies to cope with common human needs. Examples of societal resource
systems include health, education, social welfare, and justice/legal services.
It follows that when social workers link people with systems that provide them
with resources, services and opportunities, they are linking human beings with
other human beings in each of the resource systems identified.
Thus,
the functions of social work include the following:
1.
Helping people enhance and more effectively use their own problem-solving and
coping capacities.
This
is done via counselling which closely approximates the tasks and activities of
psychologists and psychiatrists. Further, social work draws on the techniques
of psychoanalytic theory and its derivatives: social learning theory;
existential theory (more properly, a philosophy rather than a treatment
technique); social systems theory; and (unlike psychology and psychiatry)
certain economic and political theories.
2.
Establishing linkages between people and resource systems.
3.
Facilitating, modifying, and building new relationships between people and
societal resource systems.
4.
Facilitating, modifying, and building relationships within resource systems.
These
linkages, relationship, and interaction activities cover an inexhaustible list
of items.
Linkages
may mean connecting a runaway adolescent with her family; organizing a national
conference of deputy ministers of social welfare; referring an indigent client
to a legal aid society in order to obtain counsel in a divorce application;
arranging a workshop with the criminal law association to enable social workers
to perform better in the role of expert witness; or recognizing a new client
population (like "battered wives", parents of "foetal alcohol
syndrome" children, or parents of "sudden infant death
syndrome") and linking members of that client population for their mutual
benefit and support.
Relationship
and interaction activities may include family therapy with dysfunctional
families; retreats and think-tanks; Nominal Group Process with a dysfunctional
staff group in a social agency; getting a frightened senior citizen living
alone to accept and welcome a dally telephone call on a "buddy" basis
from a senior citizen self-help society; coordinating efforts of local, provincial
and federal officials concerned with services to seniors to fund agencies (so
that a "buddy" service can be offered in the first place); accepting
referrals from pediatricians to organize special education services for a
learning disabled child, and later, consulting with the pediatrician on
strategies to persuade local school authorities to expend more funds on the
diagnosis and remediation of learning-disabled children.
5.
Contribution to the development and modification of social policy.
Social
workers manifest professional responsibility for contributing to social policy
by working, often with others, for policy objectives. They call attention to
unmet needs, gaps, dysfunctional social policies and legislation; design and
promote the establishment of new services; coordinate and integrate existing
societal resource systems; and influence and change social policy and
legislation designed to alter the social conditions and restraints under which
people live. (Pincus and Minahan 1973) Social Workers have involved themselves
in "middle-range levels of policy change" rather than involving
themselves in basic changes in the entire structure of societal institutions.
It is their belief that fundamental social change is brought about in the
political arena through political processes; while professions can offer
technical expertise in these processes, no one profession should have sole
responsibility for an area which ultimately affects the lives of all people in
a particular province, state or country. Social workers feel that falling to
work on the development and modification of social policies and provisions for
humans is to function from a stance alien to social work (that is, that the
client is "the problem", or "the client is the author of his own
misfortune").
6.
Dispensing material resources.
This
function has traditionally been associated with social work: the involvement by
social workers in the planning and implementation of a variety of social
allowance and other income security plans. More subtle forms of this allocation
of resources function include decision-making in which school social workers
participate (e.g. to select students for limited space in special classes).
Similarly, the selection, maintenance, and co-ordination of foster homes is an
example of dispensing resources available to children.
7.
Serving as an agent of social control.
Tasks and activities include the
supervision of people labelled deviant by society; investigation of complaints
of abuse and neglect in child welfare matters; and licensing resource
facilities to ensure^-hat adequate care is provided to those in need. Social
work is a profession that is mandated by the society in which it exists; some
social workers believe that the profession cannot exist outside of democratic
countries and governments. Professions mandated by a society in turn reflect
and validate societal beliefs, thereby becoming agents of social control. While
this function is traditional, more subtle forms may not be obvious. Social
workers note particular "therapeutic" techniques which may carry
biases unfair to certain segments of society, and thereby conflicting with the
code of ethics to which social workers adhere.
(b)
Skills Unique to the Profession
The
skill areas in clinical social work practice, follow the series of skills
established for all areas of social work. That the skills are manifested with
varying degrees of finesse and intuition adds an element of art to this
process.
Skills in "generalist" social
work practice include assessing problems; collecting data (by direct verbal
questioning, written questioning, projective verbal techniques, and use of
existing documents); making initial contacts (including reasons for initiating
contact and assessments of motivations and resistances to change); negotiating
contracts (including a knowledge of consent versus informed consent; developing
strategies and techniques for contract negotiations, and dealing with
resistances thereto); forming and maintaining systems of action so that social workers
may work in concert with others to engage in a planned changed process;
exercising influence in change; intervening in the lives of individuals,
groups, and communities through use of specific methods of intervention; and,
finally, terminating and evaluating the change effort and disengaging from the
particular set of relationships initially established to achieve that effort.
The final skill is in stabilizing the change effort that has occurred, to
prevent regression to a previous level of functioning. Irrespective of whether
the client system involved is an individual, a group, or a community. (Pincus
and Minahan 1973). In clinical practice, distinguished from general 1st
practice by its location or the size of the client system (individuals, families,
and small groups), the clinical skills represent much the same typology
although the language differs somewhat: study, diagnosis, and treatment; or
assessment, planning. intervention, evaluation and termination. Further, in
clinical practice there is a greater tendency to focus on counselling, but
never to the exclusion of the other functions.
(c)
General Clinical Procedures and Treatment Program
Most
clinical social work is founded on a knowledge base borrowed more from
psychology than from the sociocultural and socioeconomic sciences. Social
workers, in this form of practice, refer to the users of their services as
"clients" or "patients" (the latter if they are in health
care set-tings) rather than as "consumers" or "citizens"
(more commonly used in community practice).
Social
workers take a client's comprehensive social history, and made judgments on the
amassed data classified into social, psychological, cultural, economic,
physical, and biological components. This classification results in an assessment
of the entire person-in-situation constellation and indicates possible
directions for change (i.e., intervention/treatment).
Social
treatment requires a contract (informed consent) on the part of the client to
such intervention. The goals of the treatment include the restoration,
maintenance and enhancement of adaptive capacity, and facilitating adjustment
to social reality. (Klenk and Ryan 1974)
A
treatment strategy is selected which best fits that client's needs (and if the
social work specialist does not have that technique in his interventive
repertoire, referral to a professional who does is indicated). Intervention
techniques are selected based on a (prior) analysis of their elements
including: importance attached to present versus past versus future experiences
as behavioural determinants; plasticity of behaviour (nature versus nurture);
extent to which behaviour can be changed; kinds of behaviour which can and
cannot be changed; consequences of behavioural change; importance of
intrapsychic versus social influences on behaviour; amenability of a technique
to scientific testing; presence of empirical evidence to support a technique;
and absence of value conflicts in applying the technique. (Briar and Miller
1971, Whittaker 1974)
The
treatment plan contracted with the client is then initiated. Most treatment is
focussed (as opposed to non-directive), and seeks behavioural (rather than
personality) change in a brief time-limited period in a climate where an
accepting and empathic relationship is a foundation for action rather than a
goal in itself.
Historically
speaking, earlier treatment models based on psychodynamic formulations have
given way to models based more heavily on social learning (problem-solving
strategies: including task-centered practice, behaviour modification, reality
therapy); systems or ecological models (systems approaches to family therapy);
and neo-dynamic models (transactional analysis, for example).
Evaluation
of any intervention is. in some ways, on-going; it is a formal part of
terminating treatment undertaken toward goals agreed to by the client and
social worker, at the outset of their contacts.
Specializations
described above are based on variable therapeutic methodologies. Another way to
specialize is by gaining specialized knowledge and skills required for work in
certain micro-level settings. While a methodology may remain constant, the
knowledge base specific to certain client populations varies considerably. For
example, behaviour modification techniques and communication skills may be used
with a group of parents learning parent-effectiveness training; convicted
sexual offenders on a forensic ward of a mental hospital; a child in a special
education classroom for the behaviourally-disordered; or parents who are child
abusers. However the knowledge base required to work with these populations is
highly specific.
IV.
RIGHTS AND RESPONSIBILITIES OF THE PROFESSION
(a)
Autonomy Needed by the Profession
Social
work possesses commonalities with other helping professions; and some distinct
differences. Like other professions, social work has (in virtually all of the
provinces in
A
key distinction between social work and the mainline organized professions like
law and medicine is that, while virtually all social work associations in
Canada have control of specific titles for their members and registrants, (such
as "Registered Social Worker") there is no professional social work
association in Canada with complete control of practice as well as of the
(assorted) titles. In many provinces people can refer to themselves as a
"social worker" or may practice "social work" without fear
of infringing on any law. This uneven distribution of powers, rights and
obligations of the profession has led to confusion in the minds of the public,
and to difficulties in relating to the mainline professions, particularly
around issues, which may, at times, remain unregulated by law (for example,
issues such as sharing confidential information).
In
most provincial social work jurisdictions the initials RSW, following a
particular practitioner's name, indicates that practitioner has subjected
himself to the full range of professional and civil legal responsibilities and
is, therefore, subject to charges of malpractice and incompetence, as well as
breaches of the Code of Ethics.
Social
work most resembles law in the organization of its professional members; while
no particular specialties are recognized by statute, members are allowed to
confine their practice to specific areas but must, upon investigation, be able
to justify why they, by virtue of experience and training, are practicing in a
particular area. Thus, the pattern in medicine (i.e., of specialties involving
specific titles and entitlement) is not the model used by most social work
associations in
Because
of social work's connectedness with governmental and organizational forces, it
is the profession's belief that it is important to demand a degree of
accountability from policy makers and organizational experts who apply what
policy makers and others have developed regarding institutional arrangements
for helping people. It is for this reason that the social work profession has
continued to demand accountability not only from direct service practitioners
but also from those individuals who (while their job description may call them
executive directors, managers, consultants) obtained their position by virtue
of their social work training and are, therefore, still accountable to the
social work profession for their professional performance of duties.
(b)
Referral Systems
In
social work practice in clinical settings, since social workers often work in
teams with other professionals, in-house referrals are readily accepted between
and among team members. For example, in a child guidance clinic, referrals to
psychologists, psychiatrists, and psychiatric nurses are usually pro forma; in
an education clinic, referrals to reading/education specialists speech
pathologists. audiologists, and psychologists are routine practice.
Referrals
to disciplines outside of a multi-disciplinary setting, and acceptance of
social worker s referrals by those other disciplines are, however, fraught with
unpredictability, and varying laws regulations and prerequisites for service.
Many medical specialists will not and (depending on the exigencies of health
care funding bodies) cannot accept referrals from social workers. Social
workers, for their part, are sometimes seen as making unreasonable demands on
physicians who have referred clients to them ("I am a family therapist and
I will see only the entire family not just the mother and child").
Referrals to public agencies (e.g., child welfare, income security
organizations.) are accepted from all professions... and form the general
public. Some services are available only in the public sector. Accessing a
reading specialist, for example. may mean having to deal with a variety of
levels of the education bureaucracy.
In
general, it is safe to say that social workers who are
registered/licensed/certified, thereby ensuring accountability in terms of
ethnics and conduct) have relatively little difficulty referring their clients
to a variety of professions (language-speech pathologists. medical specialists
psychologists, etc.) as long as they have also developed a skill called
"exercising influence": Their “exercising influence" translates
as possessing real knowledge and expertness; having legitimate authority;
possessing material resources and services; status, reputation, charisma, and
know-how" to establish and maintain relationships with their
"professional family". (Pincus and Minahan 1973) This, however, can
be said of any professional making a referral to another.
V.
SUBJECTIVE EXPERIENCE AND EXPECTATIONS OF THE PROFESSION
(a)
Cooperative Services from Other Professions
Co-operation
among professionals is a dream when it occurs, a nightmare when it does not...
the terrors of which are borne by the client and to a lesser extent by the
professionals concerned who are, presumably, less vulnerable.
In
the intricacies and complexities of rehabilitation, the team approach is the
preferred strategy. Referrals to other colleagues who possess the skills a
patient needs are facilitated quickly, avoiding costly delays associated with a
series of sequential professional referrals. Working in close physical
proximity with colleagues who share a common goal permit trusting
relationships, which promote security for patients. Team charting and record
keeping produce current, readily available data useful to all professions
involved. Thus a patient's varying needs may be met in one location, with a
minimum of duplication of effort (particularly so in the data collection and
assessment phases). The management of particular client populations may be
distributed, depending upon the particular personal attributes and experiences
of the individuals in a team. This differential use of manpower is simply not
possible in non-team situations.
Rehabilitation
teams are rewarding experiences for professionals, themselves, in addition to
the increased quality of care for patients. The common commitment to high
quality of care, a value system that prefers co-operation to competition, a
history of working together as a group in good times and in bad, the cumulative
gains and losses, are all experiences which strengthen bonds - highlights in
one's career. The pooled energies of a well-functioning team are truly more
than the sum of the contributions. Few who have sung with such a chorus wish to
sing solo again.
(b)
Areas of Conflict with Other Team Members
The
real prohibitor to good teamwork is the tendency to view problems in team
functioning as functions of the "personality" of one or more of the
team members. The only solutions available then, of course, are to eliminate a
team member, or to try to change the "personality" of the team
member; neither step, predictably, engenders much support from the involved
member. What is wrong is the failure to recognize that so many difficulties in
team functioning are based on systemic variables (regulated lines of authority;
tradition; varying case load sizes; differing societal sanctions; budget
constraints) and not on the personalities of the individual practitioners
concerned.
Another
potential problem lies with practitioners, in any discipline, who do not have a
deep and abiding acceptance and understanding of their own profession before
entering into inter-disciplinary practice. Unsure in their own
profession-of-origin, they quickly become a hybrid professional, operating
without societal sanction in fields for which they were never trained and doing
a disservice to the field for which they were (allegedly) trained.
The
problem for the latter decades of this twentieth century will not be which
profession has rights, priorities, and responsibilities that supersede another
profession but, rather, whether the professions, as collectivities which offend
the pseudo-egalitarian instincts of a population currently unimpressed with the
rigours of scientific investigation and self-discipline, will be allowed to
survive through the forthcoming years.
(c)
Issues Within the Profession
The
major issues facing the social work profession, apart from the ones facing all
professions (above), include:
1)
the differential use of social work/social welfare manpower, i.e., what
training level is required to perform which tasks?;
2)
the need to make all trained social workers accountable in law for their
practice. i.e., mandatory registration or licensing;
3)
the maintenance and improvement of the health, education and welfare systems
through negotiated and fair federal-provincial fiscal arrangements; and
4)
careful attention, in social planning, so that certain principles of service
delivery are maintained: universality within
(d)
Rewards, Challenges, and Satisfactions
The
challenges are many. The first is to understand, in the words of Agnes Denes,
that "the universe contains systems, systems contain patterns (and)... the
purpose of the mind is to locate these patterns and to seek the inherent
potential for new systems of thought and behaviour." This "location
of patterns", as it were, is the challenge to social workers in all forms
of practice.
The
second challenge to social workers is to maintain this creativity and
innovation, research and development in a climate currently beyond the
expansionist programs of the sixties, when the current theme is "making do
with (comparatively) less".
A
third challenge is to find in one's own profession and in the other professions
those persons of like mind and competence who envision a better world and are
willing to undertake the work to make it so. The energy manifested by such a
"community" sustains and enriches its members and makes possible the
most difficult of undertakings.
The
rewards of social work lie in meeting the above-named challenges.
REFERENCE
MATERIAL FOR THE PROFESSION
a)
The Code of Ethics of the Canadian Association of Social Workers (CASW) is
available from the CASW national office:
b)
A list of the Canadian faculties and schools of social work is available from
the Canadian
Association
of Schools of Social Work national office:
KIP
5H5
* Published in: Rehabilitation
Teams: Action and Interaction. Health Services Directorate, Health Services and
Promotion Branch. Edited by Finer Boberg and Eve Kassirer. Published by the
Authority of The Minister of National Health and Welfare. Opinions expressed in
this discussion report are the responsibility of the authors and do not reflect
the official policy of the OTTAWA Department of National Health and Welfare.
December 1983, pp. 85-95.
*
Reviewer of this chapter: Richard F. Ramsay, Associate Dean, Faculty of Social Welfare,
University of Calgary; and Executive Member, Canadian Association of Social
Workers.