AdvAnced SociAl Work PrActice - Council On Social Work .

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Advanced SocialWork Practicein Clinical Social WorkCouncil on Social Work Education

ConvenersIra ColbyUniversity of HoustonCarolyn JacobsSmith CollegeBarbara ShankUniversity of St. Thomas/St. Catherine UniversitySteering Committee MembersJill BakerNew Mexico Highlands UniversityElizabeth Dungee-AndersonVirginia Commonwealth UniversitySusan GrayBarry UniversityJoAnn McFallMichigan State UniversityDennis MiehlsSmith CollegeDavid RoseboroughUniversity of St. Thomas/St. Catherine UniversityJonathan SingerTemple UniversityLuis TorresUniversity of HoustonClinical Social Work Meeting ParticipantsMargaret Arnd-CaddiganEast Carolina UniversityDonna DeAngelisAssociation of SocialWork BoardsAlfredo GarciaNew Mexico HighlandsUniversityBarbara GissettEast Tennessee StateUniversityShinaz JindaniSavannah State UniversityCarol KuechlerSt. Catherine University/University of St. ThomasVirginia MajewskiIndiana UniversitySusan MasonYeshiva UniversityAmanda Duffy RandallAssociation of SocialWork BoardsJohn RonnauUniversity of CentralFloridaMartha SawyerNorfolk State UniversityCouncil on Social Work Education StaffJudith BremnerActing Director of AccreditationJessica HolmesAssociate Director for ResearchAndrea BediakoResearch AssistantNora SmithMonmouth UniversityHoward SnooksAmerican Board ofExaminers Center forClinical Social WorkSandra TurnerFordham UniversityThomas WalshBoston CollegeJames WilliamsSavannah State UniversityJames Herbert WilliamsUniversity of Denver

Advanced Social Work Practicein Clinical Social WorkBackgroundIn June 2008 the Council on Social Work Education (CSWE) approvedthe 2008 Educational Policy and Accreditation Standards (EPAS), whichmoved social work to a competency-based outcomes approach to education. The goal of this outcomes performance approach is to ensure that socialwork graduates are prepared to work competently with individuals, families,groups, organizations, and communities. The 2008 EPAS defines 10 competencies (EP 2.1.1—EP 2.1.10), which are common to all social work practice.Each competency is composed of knowledge, values, and skills that definewhat social workers must know and be able to do to practice effectively.For social workers at the advanced practice level the 2008 EPAS further defines thatadvanced practice incorporates all of the core competencies augmentedby knowledge and practice behaviors specific to a concentration. (EPM2.2; CSWE 2008a)On passing the 2008 EPAS, CSWE agreed to work with the education community to provide resources for crafting knowledge and practice behaviorsspecific to a concentration. The first of these resources, Advanced Social WorkPractice in the Prevention of Substance Use Disorders, was published in fall 2008(CSWE, 2008b). The publication included prevention knowledge and practice behaviors for each of the 10 competencies to define effective advancedpractice in prevention of substance use disorders. This document was thefirst of its kind; therefore, it also outlined a process by which other documents could be developed for concentrations and receive an endorsementfrom CSWE.Development of a Clinical Social Work StatementIn 2009 many social work programs had begun to think about curriculumunder the 2008 EPAS and to work on self-study documents. As they were doing so, Ira Colby, Carolyn Jacobs, and Barbara Shank thought that it wouldbe helpful for programs with a clinical social work concentration to collaborate in developing a clinical social work statement. The three approachedCSWE, which agreed to host a meeting at the CSWE offices in Alexandria,VA. An e-mail invitation was sent to programs that reported having a clinicalsocial work concentration. The list of invitees was generated from programswhose Web sites indicated the existence of a clinical concentration. In all, 47programs were invited to attend.The 2-day meeting was held August 3–4, 2009; 31 people attended from 21institutions. Participants included program administrators, faculty members,and representatives from associations. Ira Colby, Carolyn Jacobs, and BarbaraShank facilitated the meeting. Dean Pierce, emeritus director of accreditation, provided an overview about the 2008 EPAS and advanced practice toensure that meeting attendees understood the standards. Accreditation staffmembers, including Judith Bremner, acting director of accreditation, were1

also on-hand to respond to questions and make certain that the work wasformatted consistently with 2008 EPAS. During the 2-day meeting, participants drafted a definition of clinical social work, knowledge, and practicebehaviors related to each of the 10 competencies. At the end of the meeting,an eight-person steering committee was formed to move forward with editingthe document.The steering committee conducted the remaining work by e-mail and conferencecall. After revising the work completed during the meeting, the steering committee solicited feedback from three groups: (1) participants from the Augustmeeting; (2) Wynne Korr, chair of the Commission on Accreditation; and (3)the broader clinical social work education community. The steering committeeconsidered the feedback from all three groups before finalizing the publication.Clinical Social WorkConsistent with EP M2.2, the following document augments and appliesknowledge and practice behaviors for advanced practice in clinical socialwork for each of the 10 competencies. Taken together these competencies areintended to frame a concentration in clinical social work. Following each ofthe 10 competencies, clinical social work knowledge is outlined in paragraphformat, and the practice behaviors follow in the bullet points. The clinical social work material can be seen at a glance in the matrix beginning on p.11.As a specialty within the practice of social work, clinical social work builds onprofessional values, ethics, principles, practice methods, and the person-inenvironment perspective of the profession. It reflects the profession’s missionto promote social and economic justice by empowering clients who experience oppression or vulnerability. Clinical social work requires the professionaluse of self to restore, maintain, and enhance the biological, psychological,social, and spiritual functioning of individuals, families, and groups. Thepractice of clinical social work requires the application of advanced clinical knowledge and clinical skills in multidimensional assessment, diagnosis,and treatment of psychosocial dysfunction, disability, or impairment including emotional, mental, and behavioral disorders, conditions, and addictions.Clinical practice interventions include case formulation based on differentialdiagnosis and assessment of risks and vulnerabilities and those factors thatproduce and constrain the strengths and resilience found in the transactionsamong people, their communities, and the larger social environment. Treatment methods include the provision of individual, family, and group work.Clinical social workers are engaged in crisis intervention, brief and long-termpsychotherapy and counseling, client-centered advocacy, consultation, andevaluation. Interventions responsive to all dimensions of diversity are appliedwithin the context of the therapeutic relationship guided by best practicesand evidence-based guidelines. Clinical supervision is an important feature ofclinical social work in agencies, organizations, and private practice settings.Clinical social work practice augments the 10 core competencies with knowledge and practice behaviors, which can be used to operationalize curriculumand assessment measures. Clinical social work is grounded in the values ofthe profession:Service, social justice, the dignity and worth of the person, the importance of human relationships, integrity, competence,1 human rights, andThese six value elements reflect the National Association of Social Workers Code of Ethics(NASW, 1999).12Advanced Social Work Practice in Clinical Social Work

scientific inquiry are among the core values of social work. These valuesunderpin the explicit and implicit curriculum and frame the profession’scommitment to respect for all people and the quest for social and economic justice. (EP 1.1; CSWE, 2008a)Educational Policy 2.1.1—Identify as a professional social worker andconduct oneself accordingly.Social workers serve as representatives of the profession, its mission, and itscore values. They know the profession’s history. Social workers commit themselves to the profession’s enhancement and to their own professional conductand growth. Social workersa dvocate for client access to the services of social work;p ractice personal reflection and self-correction to assure continual professional development;a ttend to professional roles and boundaries;d emonstrate professional demeanor in behavior, appearance, and communication;e ngage in career-long learning; andu se supervision and consultation.Advanced practitioners in clinical social work recognize the importance of thetherapeutic relationship, the person-in-environment and strengths perspectives, the professional use of self with clients, and adherence to ethical guidelines of professional behavior. Advanced practitioners in clinical social workr eadily identify as social work professionals;d emonstrate professional use of self with client(s);u nderstand and identify professional strengths, limitations and challenges;andd evelop, manage, and maintain therapeutic relationships with clients withinthe person-in-environment and strengths perspectives.3

Educational Policy 2.1.2—Apply social work ethical principles to guideprofessional practice.Social workers have an obligation to conduct themselves ethically andto engage in ethical decision-making. Social workers are knowledgeableabout the value base of the profession, its ethical standards, and relevantlaw. Social workersr ecognize and manage personal values in a way that allows professional values to guide practice;m ake ethical decisions by applying standards of the National Associationof Social Workers Code of Ethics (NASW, 1999) and, as applicable, ofthe International Federation of Social Workers/International Associationof Schools of Social Work Ethics in Social Work, Statement of Principles(IFSW, 2004);t olerate ambiguity in resolving ethical conflicts; anda pply strategies of ethical reasoning to arrive at principled decisions.Advanced practitioners in clinical social work are knowledgeable about ethical issues, legal parameters, and shifting societal mores that affect the therapeutic relationship. Advanced practitioners in clinical social worka pply ethical decision-making skills to issues specific to clinical socialwork;e mploy strategies of ethical reasoning to address the use of technology inclinical practice and its effect on client rights;i dentify and use knowledge of relationship dynamics, including power differentials; andr ecognize and manage personal biases as they affect the therapeutic relationship in the service of the clients’ well-being.4Advanced Social Work Practice in Clinical Social Work

Educational Policy 2.1.3—Apply critical thinking to inform andcommunicate professional judgments.Social workers are knowledgeable about the principles of logic, scientific inquiry, and reasoned discernment. They use critical thinking augmented bycreativity and curiosity. Critical thinking also requires the synthesis and communication of relevant information. Social workersd istinguish, appraise, and integrate multiple sources of knowledge, including research-based knowledge and practice wisdom;a nalyze models of assessment, prevention, intervention, and evaluation;andd emonstrate effective oral and written communication in working with individuals, families, groups, organizations, communities, and colleagues.Advanced practitioners understand and differentiate the strengths and limitations of multiple practice theories and methods, clinical processes, and technical tools, including differential diagnosis. They deconstruct theories andmethods to evaluate how they relate to clients and client systems within theirenvironmental context. They regularly question and reflect on their own assumptions and consider how these might affect practice. Advanced practitioners in clinical social worke ngage in reflective practice;i dentify and articulate clients’ strengths and vulnerabilities;e valuate, select, and implement appropriate multidimensional assessment,diagnostic, intervention, and practice evaluation tools;e valuate the strengths and weaknesses of multiple theoretical perspectivesand differentially apply them to client situations; andc ommunicate professional judgments to other social workers and to professionals from other disciplines, in both verbal and written format.Educational Policy 2.1.4—Engage diversity and difference in practice.Social workers understand how diversity characterizes and shapes the humanexperience and is critical to the formation of identity. The dimensions ofdiversity are understood as the intersectionality of multiple factors includingage, class, color, culture, disability, ethnicity, gender, gender identity and expression, immigration status, political ideology, race, religion, sex, and sexualorientation. Social workers appreciate that, as a consequence of difference, aperson’s life experiences may include oppression, poverty, marginalization,and alienation as well as privilege, power, and acclaim. Social workersr ecognize the extent to which a culture’s structures and values may oppress,marginalize, alienate, or create or enhance privilege and power;g ain sufficient self-awareness to eliminate the influence of personal biasesand values in working with diverse groups;r ecognize and communicate their understanding of the importance of difference in shaping life experiences; andv iew themselves as learners and engage those with whom they work asinformants.Advanced practitioners are knowledgeable about many forms of diversity anddifference and how these influence the therapeutic relationship and clients’presenting issues. Advanced practitioners are knowledgeable about the waysin which various dimensions of diversity affect (a) explanations of illness, (b)help-seeking behaviors, and (c) healing practices (Cal-SWEC, 2006). Advanced practitioners are cultural beings and understand how clinical practicechoices can be culture-bound. Advanced practitioners in clinical social work5

r esearch and apply knowledge of diverse populations to enhance client wellbeing;w ork effectively with diverse populations; and identify and use practitioner/client differences from a strengths perspective.Educational Policy 2.1.5—Advance human rights and socialand economic justice.Each person, regardless of position in society, has basic human rights, suchas freedom, safety, privacy, an adequate standard of living, health care, andeducation. Social workers recognize the global interconnections of oppressionand are knowledgeable about theories of justice and strategies to promotehuman and civil rights. Social work incorporates social justice practices in organizations, institutions, and society to ensure that these basic human rightsare distributed equitably and without prejudice. Social workersu nderstand the forms and mechanisms of oppression and discrimination;a dvocate for human rights and social and economic justice; ande ngage in practices that advance social and economic justice.Advanced practitioners in clinical social work understand the potentiallychallenging effects of economic, social, and cultural factors in the lives ofclients and client systems. Advanced practitioners understand the stigma andshame associated with disorders, diagnoses, and help-seeking behaviors acrossdiverse populations. They also understand strategies for advancing humanrights and social and economic justice in domestic and global contexts. Advanced practitioners in clinical social work6Advanced Social Work Practice in Clinical Social Work

u se knowledge of the effects of oppression, discrimination, and historicaltrauma on client and client systems to guide treatment planning and intervention; anda dvocate at multiple levels for mental health parity and reduction of healthdisparities for diverse populations.Educational Policy 2.1.6—Engage in research-informed practice andpractice-informed research.Social workers use practice experience to inform research; employ evidencebased interventions; evaluate their own practice; and use research findingsto improve practice, policy, and social service delivery. Social workers comprehend quantitative and qualitative research and understand scientific andethical approaches to building knowledge. Social workersu se practice experience to inform scientific inquiry andu se research evidence to inform practice.Advanced clinical practitioners are knowledgeable about evidence-based interventions, best practices, and the evidence-based research process. Advancedpractitioners in clinical social worku se the evidence-based practice process in clinical assessment and intervention with clients;p articipate in the generation of new clinical knowledge, through researchand practice; andu se research methodology to evaluate clinical practice effectiveness and/oroutcomes.Educational Policy 2.1.7—Apply knowledge of human behavior and thesocial environment.Social workers are knowledgeable about human behavior across the lifecourse, the range of social systems in which people live, and the ways socialsystems promote or deter people in maintaining or achieving health and wellbeing. Social workers apply theories and knowledge from the liberal arts tounderstand biological, social, cultural, psychological, and spiritual development. Social workersu se conceptual frameworks to guide the processes of assessment, intervention, and evaluation; andc ritique and apply knowledge to understand person and environment.Advanced practitioners understand how to synthesize and differentially applythe theories of human behavior and the social environment (biological, developmental, psychological, social, cultural, and spiritual). They are familiar withdiagnostic classification systems used in the formulation of a comprehensiveassessment. Advanced practitioners understand how sociocultural contextsinfluence definitions of psychopathology. They have a working knowledge ofpsychotropic medications that are typically used in the treatment of mentalhealth disorders, including expected results and side effects. Advanced practitioners in clinical social works ynthesize and differentially apply theories of human behavior and the socialenvironment to guide clinical practice;u se bio-psycho-social-spiritual theories and multiaxial diagnostic classification systems in formulation of comprehensive assessments; andc onsult with medical professionals, as needed, to confirm diagnosis and/orto monitor medication in the treatment process.7

Educational Policy 2.1.8—Engage in policy practice to advance socialand economic well-being and to deliver effective social work services.Social work practitioners understand that policy affects service delivery, andthey actively engage in policy practice. Social workers know the history andcurrent structures of social policies and services, the role of policy in servicedelivery, and the role of practice in policy development. Social workersa nalyze, formulate, and advocate for policies that advance social well-being;andc ollaborate with colleagues and clients for effective policy action.Advanced practitioners in clinical social work recognize the connection between clients, practice, and both public and organizational policy. Advancedpractitioners have knowledge about factors that influence the development oflegislation, policies, program services, and funding at all system levels. Theyhave knowledge of advocacy methods that contribute to effective policies thatpromote social and econom

4 Advanced Social Work Practice in Clinical Social Work educational Policy 2.1.2—Apply social work ethical principles to guide professional practice. Social workers have an obligation to conduct themselves ethically and to engage in ethical decision-making. Social workers are knowledgeable

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