Field Educator: A Scholarly Journal from the Simmons University School of Social Work

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Introduction

This article describes the Graduated Forensic Learning Model (GFLM), a systematized structured process for onboarding advanced Master of Social Work (MSW) students who serve as interns in a forensic inpatient psychiatric program located on a California state prison campus. The California Healthcare Facilities-Psychiatric Inpatient Program (CHCF-PIP) located in Stockton, formerly the Department of State Hospitals-Stockton, is an adult male correctional institution. CHCF-PIP and the MSW program at California State University-Stanislaus partnered to provide enriching educational experiences to MSW students desiring clinical training. The GFLM uses a gradual or progressive learning approach where students are expected to demonstrate an increase in knowledge, skills, and values during their field practicum. The GFLM relates specifically to CHCF-PIP, however, its utility and applicability is transferable to other social work contexts particularly since literature about onboarding students in field placement agencies is so scant.

Overview of the Forensic Setting

The California Healthcare Facilities-Psychiatric Inpatient Program is the newest intermediate-level healthcare facility, having opened in 2013 with 360 intermediate-level beds and 154 acute-level beds. CHCF-PIP is one of three forensic inpatient psychiatric programs housed within a California state prison that provides around-the-clock mental health services to adult correctional inmates. The facility has seventeen treatment units that span nine buildings. CHCF-PIP is accredited by the Joint Commission as a Behavioral Healthcare Service (The Joint Commission, 2018).

The CHCF-PIP primarily provides treatment for prisoners with major mental illnesses that have demonstrated diminished ability to function within a traditional prison environment. Inmate-patients are transferred from the California Department of Corrections and Rehabilitation (CDCR) with the goal of rehabilitation and restoring the patient to such a level as to function within the traditional correctional setting. In order to achieve this treatment goal, staff utilize a multi-disciplinary team approach to assist the patients. The treatment team consists of a psychiatrist, psychologists, psychiatric technicians, clinical social workers, rehabilitation therapists, and registered nurses. Additional treatment team members may include a dietician, medical doctor, or correctional officer. CHCF-PIP utilizes a patient-centered and strengths-based approach to assessment, treatment, and discharge preparation.

In order to be employed as a Clinical Social Worker at CHCF-PIP, one must have a master’s degree in social work and a license to practice clinical social work in the state of California, that is, a Licensed Clinical Social Work (LCSW) credential. Clinical social workers provide a wide range of treatment modalities for the patient population including, but not limited to, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Motivational Interviewing. The inmate-patients are offered treatment groups and one-to-one sessions facilitated by licensed social workers. These clinicians are housed in the Department of Social Work on the premises of CHCF-PIP.

A voluntary responsibility of some of the clinicians is to supervise MSW students who are placed in the Psychiatric Inpatient Program to complete field practicum hours. The primary emphasis of CHCF-PIP’s internship program is facilitating learning opportunities so that interns can effectively function as professionals in a forensic mental health setting. Within this milieu, social work students need a platform to discuss their emotions and to process their interactions with others (e.g., inmate-patients, staff members, collateral contacts, etc.). Thus, agency culture and the supervisory climate should encourage honest discussion in a way that normalizes, validates, and helps learners manage manifestations of feelings, such as, indirect trauma and countertransference (Knight, 2015). Interns are encouraged to think critically and apply appropriate assessment and treatment methods throughout their field placement.

MSW Internship Program at CHCF-PIP

Historically, CHCF-PIP has not offered internships to social work students. However, in an effort to promote interagency collaboration and increase workforce skills in the region, a partnership ensued between the Department of Social Work at California State University-Stanislaus and CHCF-PIP. Relationship building is critical between agencies that ultimately may employ MSW students. Field education can play a major role in developing and sustaining collaborative endeavors between service providers and the delivery of social work curriculum (Lewis, Kusmaul, Elze, & Butler, 2016). As noted by Staton-Tindall et al. (2007), when linking community partnerships with university-based researchers, one of the key elements is that both institutions come together for the conceptualization of a study. Such was the case for CHCF-PIP and CSU-Stanislaus when a faculty scholar, who served in the role of field liaison, saw the need for formalization and spearheaded subsequent student-centric research-based meetings. The CHFC-PIP internship program and structure was organized in such a way that it can serve as a template for other agencies that supervise MSW field students. The University ensured alignment with the Council on Social Work Education’s Educational Policy and Accreditation Standards (EPAS). According to CSWE (2015), social work field internship experiences should be focused on assessing competencies and learning outcomes.

The internship program at CHCF-PIP consists of three rotations. The first rotation is understanding the CHCF-PIP organizational system. An in-depth agency overview is paramount and lasts approximately two months. The internship program uses a traditional didactic model, where the subject matter expert concentrates on articulating her/his area of specialization. A subject matter expert is licensed by the California Board of Behavioral Sciences and possesses “technical and professional knowledge gained through advanced education and extensive work experience to form a definitive opinion regarding the standard of care for the profession” (California Board of Behavioral Sciences, 2015, p. 10). Some subject matter experts help to develop written examination workshops that “include item (question) writing and review, passing score setting, clinical vignette writing and review, and examination construction” (California Board of Behavioral Sciences, 2015, p. 10). Rotation One includes introduction to case management for social work interns, shadowing of employees, and supports team-based learning early in their internship experience.

The second rotation is roughly ten weeks long and students are placed in the Intermediate Treatment Program (ITP). They work directly with relatively stable inmate-patients and emphasize treatment delivery. The third and final rotation is in the Acute Treatment Program (ATP), lasting approximately four months. Inmate-patients present with active symptomology and the main foci are stabilization and assessment. The expectations of an intern in Rotation Three are advanced. A reasonable degree of case management independence gets exercised and the required EPAS competencies (CSWE, 2015) should be consistently demonstrated. The three rotations, combined, constitute the authors’ Graduated Forensic Learning Model (GFLM) (see Figure 1). The GFLM aligns with CSU-Stanislaus Department of Social Work’s approach to applied learning where students increasingly are challenged with more autonomy, more responsibility, and more hands-on learning.

Figure 1 Graduated Forensic Learning Model (GFLM)

Graduated Forensic Learning Model and Social Work Competencies

In developing the field learning plan, CHCF-PIP identified their learning objectives and the university classified its MSW Program indicators. Additionally, CSWE EPAS have been linked to the field agency’s objectives, as well as social work programmatic indicators. The goal of Rotation One is to orient students to the philosophy, principles and values, and understanding of the multi-layered and multi-faceted mental health system. Social work interns spend two months becoming acclimated to the vision, mission, values, organizational goals, workplace structure, and required documentation. Interns will interface with various important department leads including, but not limited to, the Patient Appeals Coordinator, Performance Improvement Team, Admission/Discharge Unit, Transitional Care Management Program, and the Health Information Management Department. Presented in a matrix (see Table 1 below), the left column contains items that CHCF-PIP expects of students, the middle column contains the corresponding CSWE EPAS, and the right column contains MSW Program indicators.

Table 1 Alignment of Agency, University, and CSWE (Rotation One)

Rotation Two

The second rotation is assignment to a unit in the Intermediate Treatment Program (ITP). The goals of Intermediate Treatment are to internalize CHCF’s mission, hone clinical and assessment skills, and develop reflexive/reflective self-evaluation. Activities in Rotation Two involve assisting patients in becoming psychologically stable, aiding patients with insight into their mental illness, helping patients assume a meaningful role in managing their mental illness, and supporting patients as they acquire and refine adaptive coping skills. These ambitions are monitored through:

• Intern observation of individual therapy and treatment groups facilitated by the field instructor and/or task supervisor
• Intern co-facilitation of individual therapy and treatment groups with the field instructor and/or task supervisor
• Interns being observed by the field instructor and/or task supervisor while they conduct individual therapy sessions and facilitation of treatment groups.

Table 2 details congruence between CHCF-PIP learning objectives, CSU Stanislaus MSW Program indicators, and CSWE EPAS competencies.

Table 2 Alignment of Agency, University and CSWE (Rotation Two)

Rotation Three

The third rotation is assignment to a unit in the Acute Treatment Program (ATP). The duration of this rotation is four months. The Acute Treatment units provide tailored and immediate psychological and psychiatric treatment for patients exhibiting mental health symptoms of danger to themselves, others, and/or a grave disability. These patients have been assessed as requiring current stabilization. Interns are expected to articulate and demonstrate the difference between ITP and ATP.

The goals of Rotation Three are to apply academic course content to field practicum, examine and evaluate patients’ rights and advocacy, describe patient impact of CHCF-PIP programming and policy change initiatives, and experience effective team cohesion. Table 3 details congruence between CHCF-PIP learning objectives, CSU Stanislaus MSW Program indicators, and CSWE EPAS competencies.

Table 3 Alignment of Agency, University and CSWE (Rotation Three)

Discussion

There are a plethora of factors which impact the relationship between students and agencies, such as, a weak cultural fit, failure to create or strengthen team relationships, lack of clarity or alignment around performance goals and metrics, poor political skills, and the absence of a formal assimilation process (Ross, Huang, & Jones, 2014). Coleman Selden and Sowa (2015) recommend careful attention to onboarding as a strategy to reduce voluntary turnover. Klein, Polin, and Sutton (2015) explored organizational onboarding practices and found that organizations believe employees are experiencing more onboarding activities than may be the case. Volunteers, or in this case MSW interns, fare better when psychological contracts (i.e., mutual obligations) are not breached when a person perceives a discrepancy between what the organization promised and what the organization is actually delivering (Vantilborgh & Van Puyvelde, 2018). These elements make it imperative to provide systemic and structured onboarding activities for MSW students, who will inevitably become part of a workforce expected to deliver favorable client outcomes. Ross et al. (2014) suggest an onboarding checklist as a strategy to redress disruptions.

CHCF-PIP leadership is committed to the Graduated Forensic Learning Model and MSW student learning in a professional environment. The GFLM prototype has applicability for countless MSW field placement settings. A similar structured approach allows interns to have a firm understanding of the agency policies, the role and expectations of a practicing social worker, and the tasks involved for competence and mastery. Within the GFLM, supportive supervision, mentorship, and coaching are embedded throughout the placement cycle. A hands-on approach demonstrates an obligation by the field placement agency to equip students with marketable professional competencies. The social work profession postulates that field is the signature pedagogy for academic programs (CSWE, 2015) and the GFLM supports placement agencies in shared responsibility for developing a work-ready labor force.

The Graduated Field Learning Model is being offered as a useful approach for field placement agencies, especially new internship sites. Onboarding MSW student interns is an operative recruitment and retention strategy for prospective job candidates who best match with agencies’ needs and student learning goals.

References

California Board of Behavioral Sciences. (2015). Subject matter experts wanted. BBS Newsletter, 1(1), 10–11. Retrieved from https://www.bbs.ca.gov/pdf/newsletters/winter_2015.pdf

Coleman Selden, S., & Sowa, J. E. (2015). Voluntary turnover in nonprofit human service organizations: The impact of high performance work practices. Human Service Organizations: Management, Leadership & Governance, 39(3), 182–207. doi:10.1080/23303131.2015.1031416

Council on Social Work Education. (2015). 2015 Educational policy and accreditation standards. Retrieved from https://www.cswe.org/getattachment/Accreditation/Accreditation-Process/2015-EPAS/2015EPAS_Web_FINAL.pdf.aspx

The Joint Commission. (2018). State recognition details. Retrieved from https://www.jointcommission.org/state_recognition/state_recognition_details.aspx?s=CA

Klein, H. J., Polin, B., & Sutton, K. L. (2015). Specific onboarding practices for the socialization of new employees. International Journal of Selection and Assessment, 23(3), 263–283. doi:10.1111/ijsa.12113

Knight, C. (2015). Trauma-informed social work practice: Practice considerations and challenges. Clinical Social Work Journal, 43(1), 25–37. doi:10.1007/s10615-014-0481-6

Lewis, L. A., Kusmaul, N., Elze, D., & Butler, L. (2016). The role of field education in a university–community partnership aimed at curriculum transformation. Journal of Social Work Education, 52(2), 186–197. doi:10.1080/10437797.2016.1151274

Ross, W. E., Huang, K. H., & Jones, G. H. (2014). Executive onboarding: Ensuring the success of the newly hired department chair. Journal of the Association of American Medical Colleges, 89(5), 728–733. doi:10.1097/ACM.0000000000000214

Staton-Tindall, M., Rees, J. D., Oser, C. B., McNees, E., Palmer, J., and Leukefeld, C. (2007). Establishing partnerships between correctional agencies and university researchers to enhance substance abuse treatment initiatives. Corrections Today, 69(6), 42–45.

Vantilborgh, T., & Van Puyvelde, S. (2018). Volunteer reliability in nonprofit organizations: A theoretical model. VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations, 29(1), 29–42. doi:10.1007/s11266-017-9909-2