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PART III. ANNOTATION OF NEWSPAPER ARTICLES

4. Develop career-building relationships

Working within your niche will enable you to develop career-building relationships. Relationships are vital to building a satisfying career. You need a committed mentor and a network of like-minded colleagues. Mentors are individuals who have attained a certain prominence in your area of practice. Choose a mentor wisely, based on your career goals. (Always keep your vision in mind.) A mentor will enable you to reach those goals sooner by providing insightful counsel, making key introductions, and guiding you in the most beneficial direction.

5. Develop creative and innovative solutions

Build a satisfying career by developing creative and innovative solutions. New social workers are in a prime position to use innovation and creativity to address our community concerns. The key is creativity and innovation. First, define the real problem. There is a difference between a problem and a symptom. Second, consider the impact the problem has on the community. This will help you to develop ideas that comprehensively address the concern. Third, develop buy-in by building community coalitions. Remember the network we discussed? Change does not take place at the top. It occurs with innovative thinking, shameless creativity, and electrifying energy.

6. Take action

The final step is to take action. Take action and take chances. Listen to good counsel, and learn from your mistakes. Be fearless in your efforts to provide the best possible service. Be fearless as you work toward your organization’s mission and your own personal/professional mission. Be fearless in enjoying every moment of this exciting, challenging journey. Following these steps will lead you to the satisfying, successful career you desire.

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Respect: Ethical Imperative or Skills for Success?

by Adrienne McGhee, Ph.D.

We all know what it feels like to be disrespected. We may not remember exactly what happened that made us feel offended, but we often profoundly feel the smallness of being treated as if we don’t matter.

Respect is not an optional extra in social work. It is one of the foundational principles of practice, and it is promoted in professional codes of ethics in countries around the world. Human service organizations often build the principle of respect into their values statements, customer service charters, and continuous improvement systems. And many social workers work hard at being respectful. They listen carefully to clients’ stories of disadvantage, show sensitivity to their individual vulnerabilities, and do their best to bring

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about positive changes in their lives. In short, social work is based upon a strong ethical regard for the dignity of our fellow human beings.

Many of us think about respect in terms of how we engage with clients, oftenwrestlingwithhowtorespondappropriatelytopeoplelivingwithunique and/or complex disadvantage.

Honoring clients’ dignity is not the whole story, however, with social work codes of ethics also highlighting the importance of showing respect to colleagues, including those from diverse backgrounds and other disciplines.

I was reminded about this “other side” of respect during my Ph.D. research into the knowledge of disability support workers who provide in-home services to older people with an intellectual disability (McGhee, 2014). The disability support workers in this study were not professionals in the strictest sense of the word. They were not degree-qualified, and most were not members of professional associations. And despite having many years’ experience working with people with an intellectual disability, many had little experience working with older members of this group (people with an intellectual disability have only recently begun living into old age in large numbers), and lacked vital knowledge about how to support clients through the sometimes complex and frightening transitions into later life, such as coping with the deaths of friends and family, and developing life-limiting illness (such as cancer, dementia, and Parkinson’s disease). Workers’ lack of knowledge, along with a shortage of government and community-based services and resources, meant they were heavily reliant on other professionals to help them strengthen their evidence-based knowledge and assist them with supporting clients through some of the most challenging experiences of their lives. Social workers, in particular, played a critical role in linking disability support workers to new information and resources, as well as providing guidance on complex aspects of practice.

Whereas my research was mainly about practitioner knowledge, I also learned about a variety of environmental factors that shaped the nature and content of that knowledge. One of the themes that came through strongly was the role of respect in disability support workers’ relationships with other practitioners and professionals. I found that, when workers felt respected and valued by social workers and other specialists, they frequently sought out their advice and incorporated it into their practice. However, professionals who were disrespectful toward workers were usually perceived as arrogant and judgmental, and their advice was often criticized (and sometimes rejected). Mutual respect between professionals and practitioners was, I concluded, an important strategy for growing both strong collegial relationships and robust evidence-based practice.

My reflections in this area led me to the question: If respect is so important to the development of strong collegial relationships and practice knowl-

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edge, how can social workers become more skillful in this area of practice? The following are five simple lessons I learned from disability support workers, social workers, and other credentialed specialists who participated in the research about how to strengthen respect in professional relation-

ships.

1.Be polite.

2.Be conscious about your non-verbal communication.

3.Treat others’ knowledge and experience as valued contributions.

4.Adapt communication to meet stakeholder needs.

5.Contribute instead of criticizing.

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Risks of Risk Management

by Allan Barsky, Ph.D.

Social workers use a variety of methods to analyze and manage ethical issues: consulting with a supervisor, applying the NASW Code of Ethics, using a decision-making model for critical thinking, and applying ethical theories such as deontology (duty based ethics) or teleology (choosing actions that maximize positive consequences) (Barsky, 2010). Many agencies and some social work ethicists are strong proponents of a risk management approach to handling ethical issues (Lopez, 2014). According to this approach, workers should identify the risks of various courses of action so they can determine which course of action to take.

Risks may include possible harm to clients, workers, the agency, or others. Further, workers need to be attentive to various forms of harm, including the possibility of negative physical, psychological, social, spiritual, legal, ethical, and financial consequences. Once the worker has chosen a particular course of action, the worker should then use problem-solving strategies to pre-empt or reduce the risks of the particular course of action.

Risk management is an ongoing process (Reamer, 2013). Once a worker has embarked on a particular course of action, the worker should continue to monitor, identify, and respond to risks, as they may change, even within the course of a single intervention. Additional risk management strategies include: maintaining clear documentation of client contacts, goals, objectives, and treatment decisions; consulting with supervisors and attorneys; maintaining appropriate boundaries with clients; adhering to relevant laws; and keeping current on practice standards, research, and theory in your areas of practice (Zur, 2011).

Rationale for Risk Management

The purpose of risk management is to identify potential problems before they occur, allowing the worker and agency to make choices to avoid, mini-

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mize, or mitigate potential harm. Although avoiding harm to clients, workers, and others may be a valid ethical goal, at least part of the rationale for risk management is to avoid the legal consequences of causing harm — for instance, being suedformalpractice, having to pay compensation, losing one’s license to practice, or putting the agency’s legal status at risk. By pre-empt- ing and managing risks, workers and agencies can make strategic choices about which types of risks to accept and which to avoid. Some agencies have designated officials whose role is to help the agency manage risk. Other agencies leave it up to practitioners and their supervisors to manage risks.

Limitations of Risk Management

Risk management is essentially a teleological approach to ethics, focusing on the consequences of different courses of action. One drawback of this approach is that workers and agencies may place too much emphasis on risks, not giving enough weight or attention to potential benefits. Serena, for instance, opts for DBT not because it has the greatest potential benefits, but because it avoids particular risks.

Although a risk-averse approach to decision-making may protect social workers and agencies from lawsuits and other negative consequences, clients may be deprived of services that can provide the greatest benefits (e.g., interventions that treat underlying causes rather than dealing with surface issues and symptoms). Another limitation of risk management is that it may cause workers and agencies to avoid serving the most vulnerable and needy populations, because doing so entails additional risk.

Consider, for instance, an agency that decides not to serve divorcing couples, suicidal patients, clients with borderline or antisocial personality disorder, or clients with a history of litigation, simply because there is a higher level of risk than working with other clients (Zur, 2011). In such cases, workers and agencies may be focusing on protecting the worker and agency, rather than making the best interests of the client the primary concern.

A final risk of risk management is that it encourages workers and agencies to do the “least risky thing” rather than the “right thing.” According to a deontological approach, there are certain universal duties that we should follow, regardless of the risks and consequences. For instance, we should behave honestly and respectfully. We should also promote social justice.

Consider a plan to use civil disobedience to challenge racism or other forms of discrimination. People using a risk aversion approach might reject civil disobedience because it is inherently risky. Consider how many social work and social justice interventions involve significant risk. Consider also how avoiding risky interventions may also mean precluding the potential benefits of such interventions.

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Teaching Cultural Competence

by Ebony Hall, Ph.D., and Shelia Lindsey

The new social worker of tomorrow is emerging with a new way of critical thinking and a new way of application. The new social worker is different, not settling or conforming for reasons of financial stability and job security. The new social worker is on a path of self-discovery and has embraced acceptance, where he or she is from, and all that it entails. The new social worker speaks with confidence about race and ethnicity and knows about his or her culture. Are we ready?

For several decades, the social work profession has effectively saturated academia with various models of practice for students to be knowledgeable about other cultures in order to be culturally competent and sensitive (Sue, 1991; Locke, 1992; Poston, 1990; Rodgers & Potocky, 1998). As a younger generation of social workers emerges, the emphasis on identity not only creates a “more comprehensive view of cultural competence” (Garran & Rozas, 2013, p. 99), but attributes to a larger notion of being a healthy professional. The competency of social workers is limited when they do not possess tools of acknowledgment that can affect them when working with diverse populations. Teaching students to be mindful of and sensitive to issues, from potential language barriers to recognizing various religious sects, plays a role in effective practice. However, if the massive “elephant in the room” continues to be overlooked, ethnicity and race will continue to have an influence on professional and personal relationships, leading to insufficient cultural competence resulting in poor services (Seipel & Way, 2006).

The social work profession is built upon culturally sensitive practices that advocate for social and economic justice for those who are disadvantaged, oppressed, and/or discriminated against. Standard 1.05(c) in the National Association of Social Workers’ (NASW) Code of Ethics (NASW, 2000), reminds social workers of their duty to be culturally competent and to purposefully “obtain education about and seek to understand the nature of social diversity and oppression.” NASW’s National Committee on Racial and Ethnic Diversity (NASW, 2001) highlights this necessity by identifying standards that make up culturally competent practices, including self-awareness, cross-cultural knowledge, skills, and leadership. Although “diversity is taking on a broader meaning to include the sociocultural experiences of people of different genders, social classes, religious and spiritual beliefs, sexual orientations, ages, and physical and mental abilities” (p. 8), the historical impact of race on American society continues to play an integral part in the development and effectiveness of culturally competent practice.

Race is a social construct (American Anthropological Association, 1998) with the sole intention of separation and power based on the color of one’s

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skin. More accurate terms of ethnicity and ethnic origin have begun to emerge, not to displace the term of “race,” but rather to highlight a significant component of ethnic and national origin. Because of the impact “race” has had on society, it continues to be a necessary concept to acknowledge as the profession takes the journey toward fully embracing racial and ethnic identity.

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The Development of an Emotional Sense of Direction: A Clinical Approach to Alleviating and Preventing Burnout

by SaraKay Smullens

During the past two years, I have developed a new way of working with my clients who suffer from burnout. It is a short-term, highly focused interactive process based on the development of what can best be described as a trusted “emotional sense of direction.” I would like to share the developmental progression of this approach, one based on principles learned years ago.

Burnout, Self-Care, and a Yardstick To Measure What Went Wrong Upon reflection, I realized that in the past, most clients consulted me

about anxieties and feelings of hopelessness brought on by depression. Their depression was caused by loss of a loved one, or a job; by personal illness or illness of one dear to them; by the connivance of a dishonest friend or colleague; by betrayal or injustice. Sometimes there was the feeling of darkness and helplessness whose source was not understood.

Today, of course, the above losses and grave disappointments exist, and I continue to respond to clients who face them. A case example that follows involves depression heightened by the stress and exhaustion that accompany both burnout and depression. This said, however, presently I am consulted primarily because of the ramifications of burnout—that is, overload in our relentlessly fast paced society. The constant change and many pressures with little or no time for leisure, relaxation, connection with others, and nonexistent or exceedingly limited support or cushioning of our countless responsibilities is causing havoc in our society. Debilitating overload caused by personal, professional, and societal overload (or their combination) intensifies unresolved issues from personal, intra-psychic, and relational sources. Increasingly, I am told, “I am immobilized, falling apart.” “If I am not available 24/7, I will be fired.” “I do not know what to do first. As a result, I do nothing.” “I want direction, a how-to list. I have no time for lots of appointments.” “Manners are a thing of the past. Kindness is seen as weakness. I cannot cope.”

However, here is an optimistic note. Studies show that incorporating selfcare opportunities in one’s day-to-day life eliminates and prevents burnout.

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Effectiveness is based on the ability to select—among the many self-care opportunities that exist — one, or a combination, that suit each individual.

Putting this research together with the changing times, needs, and requests of clients, I asked myself: In the midst of today’s overwhelming pressures, how can client and social worker pinpoint where and why emotional direction did not develop or somehow was lost? This question led to a realization that the term “emotional sense of direction” can become a yardstick to determine where and why one lost or never developed a fulfilling path in love, friendship, and work. For example, perhaps direction failed because one was never allowed to say “no” to a parent. Or perhaps one equated relaxation with “underachievement,” fearing this direction would cause parental rejection. On the other hand, direction loss can be rooted in the present, where numerous responsibilities and life realities cause exhaustion, confusion, and an inability to move forward. With specific understanding of where things went wrong and why, individualized self-care options can be selected to get back on track, or to find direction for the first time.

Clinical Approach

Myclinicalapproachtoaddressburnoutisashort-termpartnershipofno more than three months (and frequently less) to identify where an emotional sense of direction has been impeded, to bring relief in presenting problems and their underlying causes. After taking a full history, each client and I “contract” for the number of sessions that we are comfortable with to address presented challenges. My goal is to offer the fastest possible relief and direction in a way that will not frighten or overwhelm, but will instead lead to insight and motivation. An agreed-upon number of sessions both calms and motivates, and anxieties lessen through awareness and development of a plan of action. Clients often successfully conclude our work in less time than they thought. Others require the full three months of concentration.

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What Every New Social Worker Needs To Know...

by Elisa Kawam, Ph.D., and Marcos J. Martinez, Ph.D.

As social workers, we work with populations with long and complex histories of abuse and violence combined with pressing physical, mental, emotional, social, and spiritual needs. Even when we are not serving the most vulnerable, we still may be working with people who have endured a traumatic event, which has affected their lives and their well-being.

Due in part to the recognition that traumatic events are increasingly common and that the effects of such can be negative (Briere & Scott, 2014), trauma informed care is becoming popularized among the helping profes-

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sions. Although trauma and trauma informed care are complicated, understanding them better enables social workers to care for the needs of their clients from a deeply holistic perspective.

Thus, the intent of this article is to describe the basics of trauma, trauma informed care, and applying trauma informed care in practice and policy settings. Certainly not an exhaustive guide to trauma informed care, this is an overview intended to introduce this subject and stimulate interest in it.

The Nature of Trauma

A traumatic event is an experience in which individuals fear for their lives or the lives of those close to them (American Psychiatric Association, 2013). Traumatic events include child maltreatment, domestic violence, poverty, gang/community violence, natural disasters, and war. Traumatic experiences can be experienced directly, or indirectly by witnessing the trauma of another. In this manner, seeing an act of violence against someone else may be traumatic. The frequency, chronicity, and intensity of the event must be considered (Ogden, Minton, & Pain, 2006) in determining the impact on a person. For example, an event that occurs frequently and involves a close family member, such as sexual abuse, will have a different outcome than an event that someone saw once and did not involve anyone known to that person, such as a car accident.

Trauma does not affect everyone equally, and this is partially dependent on the age/development of the person, gender, existing risks and strengths, and available social supports (Ogden, Minton, & Pain, 2006). Because of differences in hormones and societal norms, women tend to experience trauma more intensely with longer lasting symptoms than men (Ogden, Minton, & Pain, 2006). Additionally, traumatic events that occur at younger ages are thought to have more upsetting effects, as they co-occur with brain and social skill development (Schore, 2001). Finally, existing risks (addiction and mental illness, most importantly), along with the presence of a social support system, must be taken into account when understanding why traumatic events affect people differently.

Traumatic symptoms can range from mild to debilitating. When symptoms interrupt daily functioning, they may constitute a formal clinical diagnosis of Post-Traumatic Stress Disorder (PTSD), according to the DSM-V (American Psychiatric Association, 2013). Traumatic symptoms are highly individualized and, as a result, can manifest in a multitude of ways. The outcomes of trauma often affect mental functioning, social interactions, and coping mechanisms. Depression and anxiety are common, as well as difficulty eating, sleeping, parenting, and working. In addition, it is not uncommon for someone to experience flashbacks or dreams of the event(s) (intrusion) or to report that they feel easily startled (hypervigilance) by stimuli in their

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surroundings. Some people may notice that they are dulled to what is going on around them during routine daily activities (dissociation).

Finally, people with trauma symptoms are prone to social isolation. These individuals attempt to control their surroundings preemptively by evading any person, place, or thing that might serve as a reminder of the trauma (avoidance). Together, these four categories of symptoms not only take away from quality of life, but also make daily interaction and communication difficult.

Further, those with trauma histories are at an increased risk for addiction, substance use, and other risky behaviors, such as promiscuous sex and illegal activity. It is thought that these symptoms are side effects of traumatic exposure. These behaviors are thought to be ways of learned coping to compensate for a traumatic past. As social workers, we need to address and treat the underlying cause (the trauma) first and then treat the other issues that present (substance use, risky behavior, unemployment, or anxiety). This approach reframes the idea of the presenting problem in that the issues we deem as target behaviors may not really be what the client wants to change. These problems instead may represent the client’s way of living with a trauma history. By treating the presenting problem without screening for trauma, we are, in essence, removing the client’s solution to the larger issue. This approach does not get to the root cause of the problem and may do more harm than good, as a result.

The key component to understanding trauma is that it is both preventable and treatable (Herman, 1992). This is where the role of social workers comes in — acting as change agents to directly influence the lives of those who have endured traumatic events. This treatment approach is called Trauma Informed Care (TIC).

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What Every New Social Worker Needs To Know...

Trauma Informed Care in Social Work

by Elisa Kawam, Ph.D., and Marcos J. Martinez, Ph.D.

Trauma Informed Care (TIC) is more than a treatment modality or theory. TIC causes a shift in thinking about how we view people and social problems and can be added to any existing therapy. TIC, at its core, seeks to understand human behavior, coping mechanisms (both positive and negative), and any problems that result by examining traumatic events throughout life. TIC aims to understand one’s current functioning in light of past events and does not see presenting problems as needing to be fixed, but rather attempts to understand why these problems exist in the first place.

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Trauma exposure alone is a risk factor for future traumatic events. By default, then, TIC is a preventive approach. Through the systematic screening and treatment of trauma, it is thought that future traumatic events may be avoided. Trauma screening can occur at the primary (population), secondary (at risk), and tertiary (already exposed) levels without extra resources or personnel.

Apart from being preventive, TIC is inherently strengths-based, as the first principle is that of doing no harm to the client. Those operating from a trauma informed perspective view a client as a unique individual with all the tools necessary to regain healthy functioning. TIC often requires a degree of practice and training that extends past the social worker-client relationship. TIC requires that all persons, regardless of job duty, must be educated on trauma. They must understand what trauma symptoms look like and how they may be triggered, even if they do not work directly with clients, to minimize any chance of re-traumatization during service provision.

Specifically, TIC has several key components that help solidify thinking on the subject. The first is understanding trauma itself in terms of prevalence, risks, triggers, symptoms, and effects on physical, mental, and social health. Traumatic exposure, we are learning, is common, with many adults having experienced one to two adverse childhood events as well as two to three adverse events during adulthood (Felitti, 2002). Trauma symptoms may manifest as physical symptoms such as fatigue, pain, headaches, and digestive problems. Understanding that trauma is widespread, and not assuming that physical ailments are psychosomatic, helps to stress the benefits in becoming a trauma informed social worker.

The second key component uses the social work method of “person in environment” to see the whole person, not just the problems that are presented. Known to social workers as being strengths-based and client centered, TIC aligns perfectly with our Code of Ethics. Given its individualized nature, TIC places the client’s culture, beliefs, and desires first. In this manner, our transition to a TIC perspective is perhaps easier when compared to other helping professions.

The third core element of TIC is that it requires that services provided should return a sense of empowered control to the client. Many people who have enduredtraumahave losttheir senseofselfand may have a reducedor weakened self concept as a result. It is thought that this weakened self-con- cept may be associated with risk taking and health damaging behaviors that we often address in our agency settings. Returning this sense of power to the client is critical.

The last main, and arguably most important, element of TIC is safety. Working to provide someone with physical, mental, and social safety — away

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