[Editor’s Note: A version of this article was published in the October 2016 edition of the NASW-MA Chapter’s FOCUS newspaper. FOCUS is only available to NASW members and can be accessed through http://www.naswma.org/?page=195.]
Conversation about the range of foundation year field placements has created a “buzz” in social work education, and it has to do with the range of field placements available for social work students – particularly those in clinical programs. As a clinical social worker and field instructor of many years, and now field director, it has become a topic of much interest, and one around which I hope we can find common ground.
Perhaps it is my generation of social worker that has a picture of sorts in our collective thinking about what a placement looks like for a clinical student. If your picture is anything like mine was, it might include direct practice in an inpatient or outpatient setting with rich opportunities to develop relationships with clients; write psychosocial assessments; meet with, and advocate for, individuals, families, and groups; and have supervisors who are available to teach because they are afforded the luxury of “release” time from their hefty caseloads. Oh, and add to this picture the availability of third party reimbursement for the student’s work! That picture is a dated one, and not keeping pace with the myriad changes in this world of practice we now inhabit.
Many of us who occupied these internships a decade or more ago, are likely now in the position of teaching, supervising, and mentoring those currently in MSW programs. In the intervening years, new models of care have been introduced: the Affordable Care Act is changing the face of primary care practices and including behavioral health professionals as part of the team; the Children’s Behavioral Health Initiative in Massachusetts (and its counterparts in other states) answered the gap in services for children in 2009; and evidence-based practices (EBPs) provide exciting new approaches to the work we do. I may have my particular loyalties to the theoretical foundations of my training – and they are still alive and well – but their place has shifted in some segments of the practice world. I would like to suggest that what we see now is not better or worse, but different. Traditional outpatient clinics are few and far between, inpatient stays are brief and for those acutely suffering, and home-based work has become more the norm for children and adolescents with significant needs. As has been the case throughout the history of our profession, policy has a major impact on defining the work that social workers do. And so it is, in the current era of practice, that we send our students to more community-based settings. These are rich settings, with most offering plentiful opportunities for our students to develop the required competencies we ask of them in their foundation, and generalist, year.
As social work educators, I would like to suggest that we help our students to better understand the social work lens and skill set that defines our work, regardless of the role they ultimately choose. Licensure and legitimization of our field of practice have been validating and liberating, but may have muddied the waters of our professional identity that has its roots with Jane Addams and the first settlement house for European immigrants in the late 1800’s. Perhaps in the minds of some, clinical social worker equals psychotherapist. While some may choose that role in time, we must think about a much broader role as we educate and socialize students into the profession.
Without some of these distinctions in mind, do we find our students wanting the training to become psychotherapists, but without the ability to articulate just that? Are we, in turn, unable to define for them the role of social worker, and what it is we need to expose them to in order for them to fully identify in their newfound profession? In its handbook, the Simmons School of Social Work (2014) defines clinical social work as follows:
A disciplined process for collaboration in service of social, emotional, and behavioral change for individuals, groups, families, organizations, and communities, clinical social work draws on knowledge of human development, relational and group process, cultural learning, and social policies and practices. It employs evidence-informed methods that facilitate change through dialogue and collective action. It is grounded in a history of commitment to social justice and guided by a professional code of ethics. (p. 1)
This is not a definition that leads me to think immediately – if at all – of the 50-minute (or as I was recently reminded, 45 minute) hour. It does capture, however, the “person-in-environment” framework and social justice commitment that defines us; and it is a definition that necessitates clinical skills to “engage, assess, intervene, and evaluate” on behalf of individuals, families, groups, and communities.
So, back to the notion of social work field placements. Where do we send students to establish this foundation? The answer is that this learning can be gained in a whole host of settings. There will be some – though few and far between – that resemble settings of the past, but more often they will look quite different. They will be afterschool mentoring programs, in-home therapy programs, skilled nursing facilities, medication assisted drug treatment programs, and schools – just to name a few. Where there is a relationship with a client, whether at bedside, or walking to an afterschool program with a young mentee, there is opportunity for “dialogue and collective action,” advocacy, and prevention. Likewise, there is opportunity for field instructors to make the experience more clinical with encouragement to write biopsychosocial assessments where they may otherwise not be required; and to hone the skills of critical thinking, applying theoretical concepts from the classroom and self-reflection during supervision.
As a new field advisor years ago, I recall getting a call from one of my students on the first day of her placement. She was irate, and rightfully so—or so I thought at the time. She had been placed in a homeless shelter, and there was little time to spend with “guests” as they had to be out of the shelter during the day. I went in to meet with my student and her supervisor about this dilemma. In the course of the discussion with the program director, I could see my student’s expression changing. It was no longer one of anger, but intrigue. My student’s supervisor engaged us in conversation about some of the policy and resource issues that necessitate the departure of “guests” at shelters during the day. What evolved was quite powerful. The student began to shadow her supervisor, who also happened to be the program director, developed new programming, and became attached to the dream of running a non-profit one day. It was hard for her to say “goodbye” at year’s end. A knee-jerk reaction of removing her from the placement may have denied her that opportunity. Though some may suggest, as the student initially did, that this placement was “not clinical enough,” I’d say she made it into a foundation year experience that embodied the role in all its functions. Through some critical thinking, and using a social work lens, she molded it into a placement that had some rich clinical components, while also gaining a glimpse of mezzo and macro level practice that changed her career focus. In the process, her contributions left a legacy to the agency.
Clinical is, I would suggest, as clinical does, no matter what the setting. And perhaps the “burden” is on those of us engaged at any level of social work education—teachers, supervisors, and field advisors alike—to help our students see the work where it may not otherwise be apparent.
Simmons School of Social Work. (2014). Handbook of MSW policies & academic guidelines. Boston, MA: Simmons School of Social Work. Retrieved from https://internal.simmons.edu/~/media/Simmons/Strategic-Initiatives/For-New-Online-Faculty/SSW-Student-Handbook.ashx?la=en