Social Work: Value-Guided Practice for a Global Society

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Value-Guided Practice for a Global Society

An Introduction

Never believe that a few caring people can’t change the world. For, indeed, that’s all who ever have.

—Margaret Mead, feminist, humanist, cultural anthropologist

How could you get back what has disappeared?

—Kiki Dimoula, national poet of Greece

The world we have created is a process of our thinking. It cannot be changed without changing our thinking

—Albert Einstein

What happens here in the United States affects my family in Mexico and the worth of the euro, and what happens in Africa affects my friends in the United States; we don’t realize how we are all connected. I chose social work to make the world a better place.

—A social worker

I was adopted as a Vietnamese orphan before I was 1 year old. Raised in New York City and licensed to practice social work there, I have never been to Asia. Now I am seeking to adopt a 2-year-old girl whose mother’s custody has been terminated. Adoption social workers only want to focus on how my Asian heritage will affect my ability to parent. this child, whose birth family came to the United States from Guatemala. I found this frustrating. There were many areas of concern for me, such as the child’s abuse and trauma; ethnic background was not one of them. Shouldn’t we focus practice on where the client is?

—A social worker

This book has been written to extend generalist practice in ways essential to 21st-century demands. It provides readers a comprehensive text that covers the values, knowledge, and skills necessary for all social work practitioners. New definitions and explanations for the established tenets of social work concepts and principles including assessments, relationships, communication, differential use of self, best practices, and interventions are illustrated and integrated with case material for practice guided by the profession’s values and ethics. Recognizing that practice with individuals is the shared foundational skill of every social worker, this comprehensive text is unique among the many on the market in covering what all students need to know for ethical practice with individuals in a world changed by globalization.

Global Consciousness

This book explores the topic of global consciousness, introduced as a new construct for the social work profession. The global interconnectedness that increasingly defines the early 21st century has shifted populations and economic structures, requiring innovative ways to think about and implement the welfare state; this demands novel approaches from the social work profession. Toward this end, global consciousness provides an original framework for practice across systems and across ethnic backgrounds and national borders.

Global consciousness prepares social workers for contemporary practice. Extending the important and necessary framework of international social work from its underpinning in nation-states, global consciousness provides a construction to understand a world in which circumscribed national boundaries no longer suggest reasonable assumptions about culture, ethnicity, language, and norms of behavior. Global consciousness allows for practice through a continuous global perspective, regardless of the initial geographic origin or current location of clients and practitioners.

Important contributions of international social work over its long history include recognition of and advocacy for action around international issues concerning domestic practices and policies, troubles shared by nations, dilemmas emerging from large-scale displacements and migrations, and international exchanges. These activities remain relevant and necessary. Global consciousness specifically targets a changed world with boundaries obscured by globalization and technological developments. It considers social work within a context of rapidly changing populations and communities that are now simultaneously local, global, and virtual. Social work practice with a global consciousness incorporates the lens of both geographic and cultural context, drawing from the profession’s values and skills as well as from multidisciplinary knowledge and skills to respect the uniqueness of each person and situation and also to recognize the universality of shared experiences.

In these chapters, global consciousness provides a new paradigm for social work by viewing the global in the local. The National Association of Social Workers (NASW) ethical Standard 6.01 states: Social workers should promote the general welfare of society, from local to global levels, and the development of people, their communities, and their environments (National Association of Social Workers [NASW], 2008 [1996], p. 21). Accreditation guidelines set by the Council on Social Work Education (CSWE) now require international content in the curriculum of U.S. social work programs (Council on Social Work Education, 2008). The term global consciousness has a number of meanings and practices in a range of fields. At Princeton University, global consciousness is a multidisciplinary virtual project that explores linkages between people and the earth while attending to issues of presence and activity of consciousness. The Center for Consciousness Studies in Tucson, Arizona, attends to parapsychology phenomena. Jeremy Rifkin, an economist and international affairs expert, has written numerous books on climate and the environment, offering a reinterpretation of history from an empathic lens of expanded human consciousness. He believes that as technological developments open people up to a wider world, they may also help to create a more caring world: New developments in global Internet connections suggest that it might be possible to imagine a paradigmatic shift in human thought and a tipping point into global consciousness (Rifkin, 2009, p. 472). Suárez-Orozco and colleagues’ (2007) approach to this term is closest to the one developed and illustrated in this book with its emphasis on learning and understanding in the global era.

This book develops and uses the following definition of global consciousness for social work:

Global consciousness is a recognition of the world as a unity consisting of complex interactions among people across the globe. In viewing the world as one ecological system, global consciousness requires critical thinking and communication that is open and sensitive to multiple meanings for the same phenomena.

For practice with a global consciousness, social workers must be able to

1.  Attend to a global society with its complex mixture of people and environments. Social work’s person-in-environment perspective must be broadened across ethnic, racial, cultural, and geographic variables, incorporating the profession’s mission of human well-being, which includes both individual and social well-being.

2.  Respect the uniqueness and dignity of all people and advocate for their empowerment. Through human relationships, social workers advocate for and with clients to foster self-determination and empowerment and to create change in a range of individual and social conditions.

3.  Remain aware of self as simultaneously distinct from and in community with others. This requires reflexivity—looking outside of oneself from the perspective of another person while at the same time recognizing one’s worldview and membership in particular groups.

4.  Convey curiosity and caring through differential use of self. This demands articulation of one’s biases and personal reactions to client situations, accompanied by flexibility and openness in reaching out to a diverse world.

5.  Embrace critical thinking and critical practice. These are skills of reflection and action in using reasoning, geographic and cultural context, peer-reviewed scholarship, and the profession’s values and skills while also recognizing the client system as the best ethno-specific cultural expert.

6.  Promote communication within and across borders with sensitivity and tolerance for multiple meanings attributed to the same phenomena. Recognition of and respect for differences in languages and cultures and the infinite ways of interpreting events are necessary for one’s own communications as well as for facilitating interactions among and within cultural groups and nation-states.

Global consciousness is an important new construct for social work practice. It provides an extension to international social work made necessary by globalization. Expanding the profession’s reach beyond culture, individuals, and their immediate communities, it encompasses the wider world as community. This recognizes the social world as one ecological system with multiple subsystems that are in continuous interaction, resulting in changes of culture, places, and people that may make them unrecognizable, as the Greek poet Dimoula so compellingly states in the epigraph given on the chapter-opening page. In its respect for the uniqueness and dignity of each person, global consciousness addresses issues of diversity and difference with sensitivity to a range of border crossings, such as class, race, ethnicity, and nationality. Whether in Philadelphia, London, or Nairobi, the movement of people requires a change in social workers’ ideas and perceptions, not a change in the physical locale of the social worker. The world comes to each location. Contexts of geography as well as of culture are therefore necessary components of practice in a global world; this new construct of global consciousness for social work practice promotes ethical practice on a global scale both within and across national borders.

Values, Ethics, and a Social Morality Perspective

Inherent in global consciousness is a moral perspective. Social work’s values and ethics are the profession’s distinguishing features; they provide the language for promoting the profession’s mission of social justice and human well-being locally and globally. This book translates these abstract concepts into practice to change the behavior of individuals and society—the nexus of the profession’s domain. Human rights, cultural relativism, and philosophical frameworks drawn from Appiah (2005), Kant (1785), Mill (1863 [1957]), Sen (2009), and feminist ethics of care (Koggel, 2007; Kabeer, 2012; Tronto, 2012) are examined for ethical practice in a global society. Work by various social work scholars to clarify the profession’s mission and translate the values into practice behaviors includes Dolgoff, Loewenberg, and Harrington (2005), Reamer (2002), and Reisch (2002).

The focus in chapter 3 is on the profession’s mission to advance social morality—to embrace the dual areas of individual and social well-being that together constitute human well-being; this directly reflects the person-in-environment paradigm. These perspectives inform and guide social work’s knowledge and skills, leading to the promotion of social justice. A term difficult to define, social justice means fairness and access to opportunities for social mobility and improved potential for individuals and society—a better life for all people. It requires tolerance for diversity and a broad and inclusive focus on the morality of social structures and policies as they influence both the social life and the private lives of individuals. A range of ethical codes allows examination of social work’s historical basis in morality within the context of its status as a profession. I focus on the direct linkages between its mission and the values of service, human dignity, relationships, integrity, and competence, as well as on the inherent contradictions between the ethical principles that both emerge from the values and extend them. My discussion of ethical reasoning incorporates empowerment and advocacy, and my examination of challenges and future directions discusses multidisciplinary social welfare perspectives for practice toward global social justice and human well-being.

Chapter 3 also considers the conundrum faced by the profession and especially those in practice. The profession’s social justice mission reflects a universalist or deontological view—based as it is on principles of what is right or wrong and what Reamer (2012) calls duty-based ethics, associated with Kantian ethics and the moral philosophy adapted by Rawls (1971) for social work. Yet social work’s strong ethical commitment to cultural sensitivity and respect for difference can lean toward a consequentialist or teleological view based on what is most beneficial for the greatest number of people, a view associated with Mill (1863 [1957]). Virtue-based ethics focuses on character and relationship—what kind of person I want to be and what I owe to others—associated with Aristotle, Confucius, Buddhism, and some religions and has received much contemporary attention for its complementing both the universalist and consequentialist views while adding the common good to what is good for the individual. Moreover, its concern with fairness can resonate with a broad range of norms in various parts of the world. Narrative- and case-based ethics also fits comfortably in this body of thinking with its emphasis on rich descriptions by clients of their stories followed by similarly rich explanations by social workers in the case studies. This book explores these challenges through case studies and analyses of practice behaviors and decision making. Banks (2006), Clifford and Burke (2009, Hugman (2005), and Butcher, Banks, Henderson, Robertson (2007) contribute perspectives critical for ethical practice.

Additional Unique Features

In addition to covering global consciousness and a values/ethics perspective, this book uses a historical context to frame the profession’s evolving knowledge base, mission, values, and practice components. History grounds those entering the profession so that they can draw from the past to shape new directions responsibly and evaluate emerging concepts. Contemporary relevance and effectiveness of the profession requires familiarity with the ideas and intentions of those who have come before.

Chapter 2 explains and illustrates the two core paradigms of social work. Person in environment encompasses the multiple levels of practice—people, policies, communities, and organizations—delivered through interactions with individuals, groups, and families. Biopsychosocial practice includes physiologic factors (chemistry, neurology, genetics, physiology), the psychological (cognitive, affective, and emotional functioning), and a special focus on the social (community resources, social supports, income, education, and housing). A historical perspective introduces social work as a profession within the broad context of professional occupations and connects the founding of social work with its contemporary paradigms. This connection to history can facilitate incorporating the new construct of global consciousness with its broadening of social work’s domain to include the biosphere, organisms, and cells along with the earlier concepts of society and culture (Engel, 2003), A framework that covers history in the context of emerging ideas allows for focus on practice that addresses specific variables such as individual predispositions, familial effects on personality, social norms, and access to resources, as well as their interactive effects on each other.

Chapter 4 covers case theories for assessment that incorporate evidence from multiple sources, including clients and the professional literature gathered by social workers to make sense of each client’s situation from a biopsychosocial perspective. These assessment methods organize the practice, shaping relationships, communication, differential use of self, and intervention. This chapter also addresses the complex ethical challenges for assessments within a globalized society, including technological developments and multidisciplinary perspectives.

Building human dignity and respect in relationships with renewed emphasis on their core significance to the profession in fostering inclusion, belonging, and caring among people within and across national borders is the focus in chapter 5. Informed by the values of human dignity and respect and their continuing historical significance, explanations and illustrations of relationship building emphasize belief bonding along with ethical and cross-cultural challenges, purposefulness, boundaries, issues of helping and power, supervision, beginnings, and endings.

Chapter 6 addresses shared constructions of meaning in communication with constituencies that extend the local toward a more global focus for practitioners and clients as seekers of mutual meaning in complex phenomena. My focus is on the exchange of thoughts, feelings, and information, presenting communication as a concept bound by culture and context. Ethical global practice requires intercultural communication that considers changes in the mode, quality, and quantity of interactions brought about by technological developments. I also consider the importance of social workers’ communicating with a wider public and their use of tools to record and analyze their interactions with others, including clients, supervisors, and team members.

Critical consciousness, reflection (considering what happened and what should follow), and reflexivity (increasing awareness of personal assumptions) for differential use of self are examined in chapter 7. These concepts allow practitioners to develop self-awareness along with deep knowledge of the profession and its ethical guidelines so that they can base practice on social work’s values and the client’s needs; continual observation and thought allows workers to identify and remain aware of their personal values in order to keep them separate from their professional behaviors.

Chapter 8 explains and illustrates strategic interventions as directed by evidence, best practices, and case theory and supported by emerging normative theories and concepts such as ecological approaches and ethics of care. These interventions include the statement of the problem, short- and long-term goals and goal-setting, and evaluation, all of which relate what is done to why it is done. I also discuss challenges of cross-cultural practices across and within national borders as social workers act to protect from harm and provide for necessary concrete services within a framework of promoting social justice and enhancing human well-being. Best practice is therefore highly complex and requires a wide range of data sources to support intervention decisions that result in good outcomes for clients. From this perspective, data are not limited to information gathered from clients and other related people and professionals; they must also come from research, concepts, theories, and approaches discussed in the professional literature. Peer-reviewed journals, books, and a range of statistical material (census figures, United Nations reports, etc.) on populations and problems pertinent to situations faced by clients add critical information, and most are easily accessible in our networked world.

Most chapters conclude with exercises, examples, and discussion questions.

Practice Theory

Readers of this book will acquire a conceptually grounded framework through which to organize each practice component into a dynamic whole. Bertha Reynolds, one of social work’s most important teachers, long ago recognized the need for practice theory: The security of having at least a core of theory common to all of social work, and of seeing it in a dynamic way, so that change can be welcomed instead of feared as new data come, is one of the greatest needs of social work in our time (Reynolds, 1942 [1965], p. 8). In this book, we see how assessment directs relationship and communication yet is dependent on client trust and on the shared meanings. It also becomes evident that without assessment, intervention takes place in a vacuum, and without differential use of self, interventions may cause harm.

Siporin (1975) discusses the value of practice theory in providing a structure of ideas that we use in helping people (p. 118). This practice theory was informed by the social work practice literature, the CSWE accreditation guidelines, the NASW standards (NASW, 2008 [1996]), and multiple codes of ethics (British Association of Social Workers, 2002; Canadian Association of Social Workers [CASW], 2005; IFSW & IASSW, 2004), as well as by analyses of case material provided by social workers through intensive interviews and audio and video material. Treatment theories such as narrative or cognitive-behavioral therapy or theories of diagnosis such as attachment or social isolation address specific client problems or populations or help guide assessments. Distinct from these theories, social work practice theory, along with the profession’s values and ethics, sets a foundation for ethical decision making about which of these other theories to use for assessments and interventions. Theory building is continuous; new problems require new knowledge about human development and about the social world. These social work domains are constantly in flux. The relationship of biology to psychology was viewed as somewhat fixed in the 1950s; family therapy as a field and modality of practice did not become widely accepted until the 1970s; AIDS was not a problem until the 1980s; and in 2010, debates began about eliminating Asperger’s syndrome as a separate category from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and to fold it in as an autism spectrum disorder (ASD) Tensions continued into 2014 about this change: some families welcome the shift to a continuum, and others worry about decreased support—financial and biopsychosocial (Baron-Cohen, 2009; Carey, 2012; Grinker, 2010). New practice environments and technologies and previously unknown problems will create needs for new theories just as the components of practice theory must evolve to address changes in people and environments. Practitioners need both kinds of theory to understand and explain the situations in their work and help address thorny questions such as whether categorizing Asperger’s syndrome as an ASD in the DSM V was positive. Practice theory rationalizes the art of social work in ways that specific assessment or intervention models cannot. While the primary focus in this book is on change with individuals, practice theory that rationalizes the art of social work provides a way of thinking about direct and clinical social work practice to build linkages between what is done and why it is done across these multiple levels and from a biopsychosocial perspective that recognizes problems in social functioning as a function of biological factors, psychological issues, and the social context (Bisman, 1994).

Users of This Book

This foundational practice text fully meets accreditation expectations for practice in the United States and covers issues pertinent to practice in other nations. Adhering to current CSWE (2008) Educational Policy and Accreditation Standards (EPAS) and to those emerging for 2015, these chapters embrace a human rights viewpoint and teach for competence in evidence-based practice with a person-in-environment and strengths perspective; biopsychosocial assessments; attention to a global world; critical thinking accompanied by reflection and reflexivity; policy practice and advocacy; integration of multiple sources of knowledge; effective oral and written communication in working with diverse individuals, families, groups, organizations, communities, and colleagues; engagement, assessment, intervention, and evaluation with individuals, families, groups, organizations, and communities. To meet these accreditation guidelines, all chapters draw from the ethical codes of the professional organization that sets standards for practice in the United States (i.e., NASW) and from those of the international organizations—the International Federation of Social Workers (IFSW) and the International Association of Schools of Social Work (IASSW)—for ethical decision making in practice. Coverage emphasizes respect for human diversity, the value base of the profession, and its ethical standards in recognizing and managing personal values to ensure that professional values guide practice.

Cases, Narratives, Practitioners

Comments by social workers accompany all the case studies and narratives and are central to understanding the concepts presented throughout the text. Information about the social workers includes facts about their upbringing and their cultural backgrounds and provides a fuller picture of what it means to be a social worker in practice with clients; this helps us identify with them as real people who are working in challenging situations. Furthermore, knowledge about their own values and qualities helps us to understand their decision making and appreciate the impressive diversity within our profession. Personal and background information reveals them as a diverse population on the variables of race, disabilities, class, sexual and gender orientation, and ethnicity, among others. Social workers present their cases, which cover a range of practice areas and populations, including child welfare, illness, gerontology, substance abuse, reproduction, school social work, family problems, violence, sexuality, death and dying, discrimination, and poverty.

Acquired from various countries, cities, and regions, these cases (many followed through different chapters) illustrate practice to alleviate oppression and promote civil society that is relevant domestically as well as globally. Note that to adhere to confidentiality guidelines, the case studies and narratives for each chapter section include a range of locales rather than the specific city or nation for each case. Moreover, for confidentiality of clients and social workers, names have been changed in all cases, and no one has been presented in his or her actual employing agency or geographic locale. Identifying data have been shifted so that individuals cannot be connected to the facts about them. Some cases are composites, and some have been discussed in other books (Bisman, 1994; Bisman & Hardcastle, 1999). Yet the thrust of analysis in all cases is on global and critical consciousness and a values/ethics perspective.

Finding neutral terms was a struggle, and so was deciding to specify the many differences among social workers and clients despite arguing against relying on dated notions of ethnicity and race, among other variables. The context of cultural backgrounds and socioeconomic location became necessary in exploring when these variables are relevant to practice and when they are harmful. It is hoped that learning about cases directly from the social workers themselves helps readers to practice both the art and science of social work. Clients is used inclusively to refer to individuals, families, groups, organizations, and communities (NASW, 2008 [1996], p. 2).

To become a social worker is to enter a profession that challenges with ambiguity and fulfills with change toward the common good. Through work on the social welfare, social workers deal with public matters and personal troubles. A cookbook approach cannot adequately cover the intellectual and emotional journey necessary for effective social work practice. Instead of recipes, social workers need to draw from a wide range of knowledge in order to develop understanding and use skills that fit the unique needs of each client. This requires recognition that professional practice is both science and art. In her admonishment that the real world is not an exam, Zuger advocates for less emphasis on test scores of medical students which don’t prepare them for complicated, contradictory cases for which there were no clear ‘best’ strategies, but many reasonably acceptable ones (2014, p. D4). This book examines how social workers draw from theories and the empirical world, despite difficulties in applying scientific rules or verifying data, to inform the aesthetics of practice—their creative integration of material to fit the unique lives and idiosyncrasies of human beings and their communities within social work’s values and ethics framework—toward the moral ends of human well-being and social justice that imbue the profession with its purpose and define the role of social work in society.

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Organizing the Ideas of Social Work

When … social workers have a conception of development and advance which includes both the welfare of the individual and of the mass … social work will at last come into full possession of itself and of its rightful field of service.

—Mary Richmond, social work pioneer

Social work is about making positive differences for people and for the communities in which they live. In my 20 years of practice, the hardest thing for me has been managing my role in the organization and the sometimes problematic service delivery. The biopsychosocial perspective guides everything I do as a practitioner; it is not possible to provide effective services to kids in schools without paying attention to conditions such as whether they need medications, their social world, and how well the school is educating and serving their needs.

—A social worker

Real-world problems—deciding whether to medicate a 4-year-old child with serious behavior problems or considering options with a 14-year-old girl raped by her uncle and now pregnant—confront professionals with serious epistemological and methodological challenges. There are no standard models or general laws for these problems, and the concrete solutions (the means of intervention) may differ radically depending on the unique circumstances of the clients. All professional occupations are similar in their need to analyze a problem situation in order to apply knowledge to obtain outcomes that alleviate the problem. Judgment on the part of a profession’s members is critical in deciding which knowledge to use and what outcomes to seek for effective practice. Interactions with clients shape the content discussed, often making understanding of an objective reality mostly illusory. Meanings that clients and professionals attach to particular experiences and styles of communication vary, making shared constructions difficult, yet these are necessary for effective practice. Moreover, successful outcomes require from clients accurate information and adherence to a treatment regimen, along with follow-up actions by professionals relevant to the unique needs of each client.

This chapter presents a description of professional occupations, which is followed by a focus on social work as a profession and its major organizing ideas. Inherent in the historical roots, mission, and values of social work are two core paradigms: the first is the person in environment perspective with its attention to the troubles of individuals, conditions in the community, agency service provision, and the social policies that affect the lives of individuals. The second paradigm, biopsychosocial practice, requires incorporation of physiologic factors (chemistry, neurology, genetics, physiology) with the psychological (cognitive, affective, and emotional functioning) and gives special attention to the social (community resources, social supports, income, education, and housing). Interactions among the broad domains covered in both of these core paradigms shape human functioning, and case studies illustrate how social work practice reflects these organizing ideas.

Professional Occupations

The concept of profession is itself an ideal—a construction to make sense of work that is driven by a moral commitment to serve the community toward a greater good by creating change in some public phenomena such as injustice, illness, social disorder, or education. This feature most distinguishes professions. Service to the society, shaped by a profession’s values and ethics, is unique to professional occupations, and an ethical code emerging from a profession’s service mission distinguishes professional occupations. Gustafson (1982) emphasizes the primacy of service and the importance of a moral foundation for professional occupations: "A calling without professionalization is bumbling, ineffective, and even dangerous. A profession without a calling, however, has no taps of moral rootage and cannot envision the larger ends and purposes of human good that our individual efforts can serve" (p. 514). It is this service mission and its implicit values that drive a profession’s specialized knowledge, ethical code, and practice skills. Social work’s status and authority is lower than that held for the legal or medical professions. This is partly a consequence of its broad base of knowledge, primarily located in the public sphere, and its high commitment to service.

Historically, users of professional services have relied on the professional’s judgment: The exchange on the part of the client is trust in specialized expertise that will provide competent help to alleviate a problematic situation. Nonprofessional occupations serve customers, who choose their purchases and can obtain a refund if not satisfied. Although Jane Addams considered those who lived in her settlement as citizens-in-the-making rather than clients, many professions today retain use of the terms clients/patients. Nonetheless, there have been efforts by some social workers to change the language to consumers, such as in mental health, and to service user in the United Kingdom (Clifford & Burke, 2009).

In recent times, the power of the professional’s monopoly of judgment has begun to weaken: It is now not unusual for clients to shop around for the best professional and to make their own decisions on which services are needed. Insurance companies often require second opinions on medical recommendations for surgery, and legal suits against professionals are common. The service function is also at risk from increasingly high fees and shrinking public service, especially evident among some lawyers and medical specialists in the United States. The norm of public service of professions emphasizes that clients’ problems must supersede practitioners’ self-interests and that clients are not to be exploited; decisions to offer services should be based on clients’ need for help, not practitioners’ need for remuneration. Unlike some professions, social work practice is primarily carried out in the public sector in the United States (although there has been an increase in for-profit social services) and especially so in the United Kingdom. Even those social workers employed in for-profit settings and in private practice address issues that pertain to the public sphere. Those entering the social work profession are considered to be strongly committed to a calling to serve and to altruism in seeking to enhance human well-being and promote social justice.

Extraordinary developments in technology have increased the rapidity of change during these early years of the 21st century. Medical practice relies heavily on electrocardiogram (EKG) measurements of heart rates and on magnetic resonance imaging for finding cancerous tumors. Social work practice now looks quite different from, yet shares some similarities with, practice in the early 1900s. More lifestyle options for men, women, and lesbian, gay, bisexual, and transgender (LGBT) individuals have altered traditional notions of family life, while massive border crossings by people in many parts of the world have marked the beginning of both the 20th and 21st centuries. Indeed, movements of people across continents now takes a much shorter time, information transmission is fast and easy, and access to information is relatively inexpensive. These transformations affect the conduct of work, including that of professional occupations. Record-keeping is increasingly digitized, creating challenges for confidentiality and privacy but allowing for direct communication among a range of providers. Location is not as important: Satellite clinics in far-flung places can still be connected to the main hospital or child welfare office. Drucker (2002) believes we have entered the knowledge society in which high-knowledge professionals will be joined by a range of technical experts who consider themselves professionals rather than workers, further expanding the upward mobility offered by professional occupations. Just as their knowledge base is continually in development, professional occupations are continually in formation, being shaped by their history and by contemporary social norms.

Members of professional occupations must change and adapt to these challenges yet retain some of the core traditions and adhere to the values and missions of their professions. Justice Oliver Wendell Holmes (1881) states in The Common Law, The life of the law has not been logic; it has been experience. … In order to know what [the law] is, we must know what it has been, and what it tends to become (p. 1). Education for a profession involves personal change as its students adopt a way of thinking about phenomena. Socialization is an ongoing process starting at birth and continuing throughout life. The focus in childhood is on learning about and integrating the norms and culture of one’s family and of the larger society; during the adult years, further socialization builds on these early attitudes and skills. Those joining a professional occupation go through a similar socialization (Miller, 2013) in acquiring the profession’s skills and knowledge and assimilating its norms into their identity as individuals and professionals.

Social Work Becoming a Profession

Similar to other professional occupations, the practice of social work takes place in the current and very real world to address contemporary problems and maintain social order, yet it also draws from historical traditions about its practice and domain, connecting to earlier social welfare approaches with differing values and norms. Such socialization is located in the art, not the science, of the social professions. This is a term used in some European nations for a range of occupations that address social services for people in need (Clifford, 2013). Social work is inherently political in its concern with social policy and with influencing social policy’s regulation of social behavior, connection to public and civic affairs, and the community’s distribution of social statuses, privileges, and other resources (Banks & Nohr, 2003). Theories and technologies have emerged, and more are needed to address new challenges faced by individuals and their social worlds. To illustrate this we consider, albeit in a very cursory way, the early traditions that inform the social work profession and the professionalizing process for social work.

Early Welfare Traditions

The tradition of religious charity offers a prehistory of social welfare services. Medieval canon law in the Middle Ages reflected the Catholic Church’s emphasis on charity, offering care and protection of the poor. Tierney (1959) explains that ecclesiastical law included several provisions to protect the poor, including maintenance of legal rights, exemption from court fees, and provision of free legal counsel. Canonists agreed that the church had a special duty to protect wretched persons; poverty was viewed as an affliction, not a defect. As Sahlins (1972) points out, in traditional societies poverty is not a certain small amount of goods, nor is it just a relation between means and ends; above all it is a relation between people … a tributary relation (p. 18). Slack (1988) compares this attitude to those in early modern England where the wealthy were in danger of eternal torment if prideful of their riches, which were not considered their own but held in trust for the poor as stewards of the Lord. Charity encompassed … love of all one’s neighbours; hospitality should be extended widely, to neighbours and strangers alike (Slack, 1988, p. 19).

As England became a more secular society, attitudes toward the poor and services for them shifted. During the reign of King Henry VIII in the early 1500s, the civil parish evolved from its medieval counterpart and considered poor relief one of its responsibilities. Along with local assessments for upkeep of churches, street cleaning, and bridge maintenance, rates for the poor were one further expression of the responsible local community fulfilling its obligations (Slack, 1988, p. 131). Guided by some of the precedents from these years, the Elizabethan Poor Law of 1601, established basic strategies of poverty relief that were followed until another set of major changes was introduced two centuries later in the Poor Law of 1834. Two principal assumptions from these poor laws, however, continued through most of the 20th century—state acceptance of responsibility for the social welfare of its citizens, and implementation of a complex apparatus to deliver services. Slack (1988) emphasizes their extraordinary achievement and believes that in 1700, the scale of the English welfare system had no parallel in Europe: in looking out for the poor, Englishmen were also exhibiting a refusal to tolerate misery and deprivation (p. 206). Though contemporary standards might view the benefits as meager, within the context of those years the laws were radical and humane.

By the end of the 18th century, there were clear distinctions between poverty (those whose only property was their labor) and indigence (those in misery and distress who needed alms to survive). Growth of towns and concern for cleanliness and appropriate behavior complicated perspectives of the poor. Though for some the poor were pitied, blamed for their weakness, and viewed as a threat to public morality and public health, for others they were a potential productive resource needing training and services (Slack, 1988). All of these competing views persist today.

Professionalization of Social Work Education

The Early Years   Along with inefficiency and religious prejudice, early social workers were criticized for practicing in: the only field of human action in which … good intentions take the place of training (Masterton, 1888). A model of education including a combination of apprenticeship, supervision, and lectures focusing on actual work in agencies was developed in England by collaboration between the Charity Organization Societies (COS), the Women’s University Settlement in Southwark, and the National Union of Women Workers (Smith, 1965, p. 22). By 1896, today’s model of mixing didactic information in formal classes with on-site supervision was established. The first School of Sociology, founded by the COS in 1903, joined with the London School of Economics in 1912 and became the Department of Social Science and Administration. Reverend Henry Solly declared this is the science of doing good and preventing evil in our social system (cited in Woodroofe, 1964, p. 48). Such changes were also occurring in the United States, with Mary Richmond advocating for inclusion of both the practical and the theoretical in educating for the profession of applied philanthropy (1898, p. 186). In 1898, the New York COS offered a six week Training School in Practical Charity (Woodroofe, 1964), which ultimately became the Columbia University School of Social Work, followed by social work programs at Chicago and Simmons. Richmond’s work to advance the profession was further spurred by a report on educating doctors by Abraham Flexner (1915), who asserted that in comparison to the established professions of medicine, law and engineering, social work lacked a distinctive method and scientific body of knowledge. In addressing Flexner’s criticisms, Richmond ultimately met her goals for a more highly organized body of knowledge (Richmond, 1930, p. 100) and the development of higher ideals of charitable service (p. 104). In developing the Social Diagnosis as the profession’s method, the primary purpose of the writer, in attempting an examination of the initial process of social casework, is to make some advance toward a professional standard, she provided a method and knowledge base that continues to guide the profession (Richmond, 1917, p. 26). Systematizing gathering data about the client’s history and the critical linkage of diagnosis to intervention: Social evidence, like that sought by the scientist or historian, includes all items which … throw light upon the question at issue; namely as regards social work, the question what course of procedure will place this client in his right relation to society? This is discussed more fully in the later chapter on assessment (Richmond, 1917, p, 39).

Individual Change and Social Reform   Jane Addams through her development of the settlement movement and Mary Richmond through her work with the COS are the most significant figures in the history of social work in the United States. The COS emphasized charity relief (direct services) and individual change and called its volunteers who provided treatment the friendly visitors, whereas the settlement house movement workers sought community changes to assist the settlement of immigrants and improve social conditions. Settlement workers engaged in political action for social change with focus on issues large and small—sanitation, recreation, daycare, and literacy classes—and helped to found the National Association for the Advancement of Colored People (NAACP) in 1909.

These dual roots define and distinguish the social work profession. Nevertheless, to this day what should be viewed with pride is more often a source of tension and divisive: simultaneous attention to both individual change and social reform remains a challenge in the theory and practice of social work. In one of her first works, Richmond (1899) eloquently states, We must know how to work with others, and we must know how to work with the forces that make for progress … to forward the advance of the … people into a better and larger life (p. 151). Later, in one of her lectures to students at the New York School of Social Work, she passionately pleads for reconciliation between social reform and work with individuals:

When social movements, social agencies, social workers, have a conception of development and advance which includes both the welfare of the individual and of the mass, which reconciles these two points of view and assures the permeation of each by each, then the upward climbing spiral … will no longer lose its balance and momentum by swinging violently from one side to the other. It will take a far wider, firmer sweep in both directions, it will cover more ground more symmetrically. In some such way as this, as I see it, social work will at last come into full possession of itself and of its rightful field of service. (Richmond, 1930, p. 584)

From charity work to child welfare, social work practice expanded to schools and medical and psychiatric hospitals, widening its areas of employment and its services for clients. In addition to their broad social reforms, the settlement workers used a range of approaches still highly significant today including client advocacy, policy practice, group work, self-help, and community organization. In addition to civil rights, they are recognized for reforms such as the labor movement and public welfare: Addams embraced social feminism and engaged international issues. For further elaboration of social work’s history, see Gilchrist, Jeffs, and Spence (2001), Leiby (1985), and Pumphrey and Pumphrey (1961, 1964); see Bisman (1994, 2004) for the professionalization of social work. See Elshtain (2002) for an excellent historical account of this period and of the life of Jane Addams.

Social work has been criticized for a lack of coherent theory and a heavy reliance on knowledge from other disciplines, including sociology, psychology, medicine, and psychiatry. Its advocates argue, however, that the wide scope of social work’s person in environment—simultaneously encompassing social reform and individual change—necessitates creative borrowing and integration of knowledge and theory from many sources. They further point out that many professions increasingly draw broadly from a range of sources (Held, 2006; Clifford & Burke, 2009).

Contemporary Perspectives   While there are variations across nations, it is common for most professional occupations to guide their practices through ethical codes, to develop curriculum, and to function as gatekeepers by controlling the process of admission to and graduation from the educational programs that are themselves accredited by members of the profession. Certification, licensure, and education all restrict admission to professional practice. In the United States, the National Association of Social Workers (NASW) is social work’s primary professional organization. It handles certification via a review committee structure created in 1987 to provide expert professional and technical judgment necessary to ensure the validity of its professional certification, the Academy of Certified Social Workers (ACSW). The president of NASW, elected by the NASW membership at large, appoints committee members. NASW also handles credentialing as the profession expands into new areas to respond to societal changes and individual needs. One of its core functions is development and revision of the profession’s code of ethics, and NASW has the responsibility to form ethics panels to hear complaints about the ethical behaviors of social workers and to censure such workers if necessary.

Initiated to protect the public, licensure is a function of state boards composed of representatives from the public at large and members of the profession. Regulations vary from strong social work licensure in Kansas to a weaker model in Pennsylvania (in some U.S. states, individuals can practice social work with no license). Both certification and licensure require a candidate to pass examinations. Certification has become less common with the increase of licensure. Heavily used by direct service and clinical social workers, licensure allows for insurance payments to cover services, and some agencies will only hire licensed social workers for their own protection from malpractice suits and to ensure a minimum of expertise.

In the United States, accreditation of social work programs is the responsibility of the Council on Social Work Education (CSWE). Formed in 1952 to establish educational standards for master’s degree programs in social work, its role has expanded to faculty development and to creation of a rigorous accreditation process that now includes a majority of bachelor’s degree (bachelor of social work; BSW) programs—as of February 2014, 492 programs, with the master’s degree (master of social work; MSW) offered by 231 programs. Unclear distinctions in the United States between these two levels of entry into practice have at times generated confusion for the profession and the public. Although autonomous practice has been associated with the MSW degree, the title of social worker is used by graduates of undergraduate or graduate programs. Whereas NASW’s code of ethics focuses on the behaviors of individual social workers, CSWE’s concern is with the educational programs. Its Commission on Accreditation (COA) develops standards for competent preparation of social work students: These standards require institutional self-studies, site visits by a team of COA-trained educators from other accredited programs, and periodic program reviews for reaffirmation. CSWE regularly updates its Educational Policy and Accreditation Standards (EPAS), and recent additions to these standards require international content in the curriculum of U.S. social work programs (Council on Social Work Education, 2008).

In the United Kingdom, debates about social care versus social control have been more heated as the state has begun to exercise greater authority over the social work profession and control over unruly or anti-social behaviour [from child abusers to child criminals] (Banks, 2004, p. 36). On the whole, government in the United Kingdom is more heavily involved in curricular development for social work (Friedson, 2001; Hugman, 2005).

As in the professions of teaching and nursing, women in social work have vastly outnumbered men; in 2004, the ratio was more than 4 to 1 (National Association of Social Workers [NASW], 2008 [1996]). While the feminization of women’s roles in the latter half of the 20th century did help to facilitate the professionalization of social work, there is still a widely held perception that social workers are primarily do-gooder women who interfere in the lives of others. Issues of class and gender have had an impact on the view of social work as a profession with lesser status than that of medicine and the law. Yet, there have been shifts: a major shift is in the class background of those entering social work educational programs—from the wealthy of the early friendly visitors to low- and middle-income women and, to a lesser degree, men, all finding education for social work a means of upward mobility (Schultheiss, 2001).

Social Work’s Person in Environment

The contemporary person in environment perspective, initially developed by Gordon (1965) and Bartlett (1970), emerges from and further builds on the dual roots of individual change and social reform. Social workers are to target change with individuals and in environments. Though the emphasis will vary, both individuals and their environments are considered together to enhance human well-being and to promote social justice. This orientation views the client as part of an environmental system … encompasses the reciprocal relationships and other influences between an individual, relevant others, and the physical and social environment (Barker, 2003, p. 322; NASW, 2005, p. 9).

In this book, person in environment includes people individually or in families or small groups. Environments cover local neighborhoods and broader communities, organizations, and social policies.

Social workers engage with individuals to help them better negotiate their environments, and they intervene with environments to serve the needs of individuals better. Notwithstanding that other professionals may address similar issues and concerns and may use the same areas of knowledge, this focus on simultaneously creating change with people and with the social world remains unique to social work.

Therefore, for effective practice in the area of substance abuse, in addition to direct counseling social workers need information about state and federal policies as well as familiarity with rehabilitation programs and other approaches accessible in the community. Likewise, knowledge about city, state, and federal immigration policies and appropriate medical settings is critical in providing services to a young pregnant woman who is not a U.S. citizen; additional information would also include her social support networks, financial and employment status, and potential educational/vocational opportunities to enhance her future stability. Social workers must be sure to not cause harm and also to advocate for and empower clients through attention to these multiple levels of practice. Case studies throughout this book illustrate such practice. For example, in a placement that provides services to families and children, Linda advocates that her setting expand with a satellite office to provide services to people in need. To empower and protect a woman who wants to leave her husband because of abuse, Karen needs to know which shelters are safe and available and whether they take children (when needed). At the same time, Karen must have knowledge of policies for protection of abused spouses while she also uses her knowledge and direct practice experience to inform policy change.

Multiple Levels of Practice

The person-in-environment paradigm with its multiple levels of components—societal policies and regulations, the community and its resources, the service delivery of the agency, small groups and families, and individuals—is discussed in the preamble to the NASW Code of Ethics:

Clients is used inclusively to refer to individuals, families, groups, organizations, and communities … activities may be in the form of direct practice, community organizing, supervision, consultation administration, advocacy, social and political action, policy development and implementation, education, and research and evaluation. … Social workers also seek to promote the responsiveness of organizations, communities, and other social institutions to individuals’ needs and social problems. (NASW, 2008 [1996], p. 2)

Contributing to the profession’s ongoing struggle to reconcile its divergent roots may be the ambiguity and even elusiveness of its primary concepts. In the subsequent sections of this chapter, the definitions and explanations of the practice levels of social work are followed by illustrations and further discussion.

Policy Practice

Social policy determines to a large extent the functioning of the profession, including what its practitioners do, their clients and colleagues, and how they get paid (Hardcastle, Powers, & Wenocur, 2011). Policies mandate the provision of services and allocate the resources for funding and implementation of programs (Jansson, 2008). Improving the situations of clients through policy practice requires knowledge about existing policies and about potential client needs such as income, food, housing, community safety, child welfare, and school-related issues, among others. Determinations for apportionment of services and subsidization of costs are usually difficult and often require intensive planning to be equitable and reduce favoring of some groups over others. As social constructions, policy formulations involve negotiations between competing interest groups representing conflicting needs, unequal access to resources, and often different meanings attributed to the problem and to the policy (Alexasti, 2002).

Social policy is the social context that provides the goals for social development and the parameters for social control. Current values and mores, cultural traditions, religious beliefs, and scientific and technological knowledge all affect policies and practices. Social work practiced during the time of Richmond had somewhat different concerns than social work today, just as issues during the middle of the 20th century have shifted during the early years of the 21st century. Abortion remains contentious but legal in Europe and the United States (although that seems to be turning back again); the normative role for women is still changing with broader options and autonomy in some nations and violent oppression in others. Contemporary practitioners face a perpetually changing landscape in family structure and marital options for the LGBT population depending on their particular state of residence in the United States or on their nation of residence. Social, legal, economic, and medical developments and policies in a society profoundly affect the practice of social work.

Even though social workers addressing their attention to change in individuals may not be involved in direct policy decisions, ethical practice requires that they have knowledge and capacity to advocate for policies that promote social justice and alleviate oppression. As Moody (2004) points out, policy practice interventions in hospital settings are now necessary, as many social workers find themselves facing ethical challenges around manipulation of diagnoses in order to lengthen hospital stays, increasing revenue for the setting at possible risk to the clients.

Jansson (2008) defines policy practice as efforts to change policies in legislative, agency, and community settings, whether by establishing new policies, improving existing ones, or defeating the policy initiatives of other people (p. 14). Others, including Hardcastle et al. (2011), Gammonley, Rotabi, Forte, and Martin (2013), and Mosley (2013) agree that policy practice and advocacy is a primary function of social workers and a core competency in social work education. Effective policy advocates are committed and informed, make assessments and engage in strategic planning, and use assertiveness.

Those engaged in private practice are also involved in matters of policy in a variety of ways. As Clifford (2012) points out, What may appear to be a very personal problem … will be directly or indirectly influenced by the political or policy decisions of governments and organizations (p. 188). Moreover, strict licensure laws that strengthen social workers’ authority to make diagnoses and receive reimbursements from third-party vendors have been strongly advocated by the Clinical Social Work Societies. Knowledge of policies is integral to obtaining payments, and facts about the tax laws assist in accurate claims for deductions. Some social workers concentrate in policy practice and, similar to those in community practice, must keep in mind the needs of individuals and families, although the thrust of their work is on policy change.

Child abuse offers an example of the strong ties between policy and practice and the powerful impact of geography and culture. In the Western world, views about the worth and care of children have changed drastically: The increase of the middle class and decrease in the need for income from children’s work allowed for changing attitudes toward child labor (in mines, factories, farms, etc.) accompanied and followed by changes in mores and values. Society became responsible, sometimes instead of the family, to assure children a protected environment (protected even from the family if necessary). Child abuse has now become one of the predominant problems for social workers (in the United States and United Kingdom) who address abuse across economic and social classes and in all racial, ethnic, and religious groups. Just as in the early years, issues raised in practice will continue to influence funding decisions and policy planning for child abuse programs, while policy decisions affect the availability and quality of direct services. More